Health care facilities: to clean or to disinfect?

Cleaning and disinfecting products and procedures vary within health care facilities and, when not monitored appropriately, can result in the overuse of toxic chemicals, increased exposure to patients and staff, and increased costs. Therefore, it is important for health care facilities to have systems in place for selecting and purchasing cleaning chemicals. To develop such systems, facilities should understand what level of cleanliness is needed for each area and surface.

Levels of Cleanliness and Disinfection
Health care facilities have a variety of surfaces and areas, which require differing levels of cleanliness. For example, waiting areas often need cleaning only; patient rooms need cleaning and low-level disinfecting, while surgical suites require high-level disinfection and sterilization of instruments. Due to the complexity of health care facilities and the variety of cleaning and disinfecting regimens, staff members may become confused, which can lead to them using multiple disinfectants or unnecessarily disinfecting surfaces. This can result in staff members overusing cleaning chemicals and disinfectants, which are pesticides. Additionally, this practice can increase the potential for antimicrobial resistance.

Hospital and cleaning guidelines, a new reference list developed by MnTAP, can help health care facilities determine what level of cleanliness is needed and help guide them in their purchasing practices. The list classifies a variety of commonly used items found throughout patient care areas of health care facilities according to Spaulding’s Classification (CDC, 2003) and by degree of cleanliness or disinfection needed. Spaulding’s levels, non-critical, semi-critical, and critical, are based on the potential for infectious disease spread via furniture, equipment, and instruments as well as the level of sterility normally required for the body part coming in contact with it. Levels of disinfection that correlate with Spaulding’s classification are low, intermediate, high, and sterilization. For example, a chair located in a patient room is a non-critical item requiring cleaning whereas in the surgical area, a scalpel is considered a critical item and requires sterilization.

Moving Forward
Developing a system for selecting and purchasing cleaning chemicals can reduce the amount of chemicals a facility has on-site. As an example, a hospital may have five different products on the shelf for each cleaning
or disinfecting application. Using multiple chemical products is not only costly, but can make it difficult to manage inventory in terms of safety, proper training, hazard communications, security, and waste management. After evaluating the level of cleaning required, health care facilities can improve their processes and procedures, lessen their environmental footprint, and provide a safer workplace for staff members and patients.

For More Information
To learn more about cleaning and disinfecting in health care facilities, view the MnTAP reference list, Hospital and cleaning guidelines.

Additional resources available on the MnTAP Web site include the Disinfection best management practices fact sheet, , and an intern summary about improving cleaning processes from a project at Olmsted Medical Center.