Assisted Living, News

Housekeeping for senior living: Cleaning and disinfecting (Part 1)

The following is an excerpt from Disaster Planning, Infection Control, and OSHA Compliance: A Toolkit for Senior Living written by Karen T. Stratoti, RN, BSN, LNHA, CALA.

Disinfecting Senior Living

Many of the staff in a senior living facility are considered “universal workers” and are responsible for the cleaning and disinfection of residents’ apartment units in addition to caring for their residents. Most senior living staff have responsibilities that are scheduled on a daily, weekly, quarterly, and yearly basis. Much of the cleaning and dusting as well as the laundry is done on the night shift. Staff must be aware that some residents will want to use their own cleaning agents, and this is allowed as long as staff is informed about these products.

The facility should have a written schedule for housekeeping and maintenance tasks. Cleaning and maintenance chemicals used in the facility fall under the rules of the Occupational Safety and Health Administration (OSHA). OSHA is very specific in these regulations, which are highlighted in the following sections.

Hazardous chemical program

All administrators must be aware that where chemicals are used, it is necessary to institute a hazardous chemical program. A hazardous chemical program must follow, at a minimum, the following guidelines:

  1. All chemicals (e.g., cleaning compounds, drain openers, dishwashing chemicals) that are used by the facility staff must be appropriately labeled and must have a safety data sheet (SDS) located near where the chemical is stored. Manufacturers and suppliers of chemicals must provide an SDS for each chemical they make or supply.
  2. No chemicals may be used in the facility that are in unlabeled containers, or that do not have an SDS on file. Staff must not bring in their favorite cleaner to use in the facility. If the cleaner is to be used, it must meet the requirements above.
  3. All staff who use chemicals must be trained in their use and must be informed of hazards and how to protect themselves from injury.
  4. The employer must maintain records to show that he or she has provided the required training on the handling of hazardous chemicals.

Cleaning schedules

Senior living staff are tasked with numerous responsibilities, ranging from clinical care for residents to keeping areas and units clean. Without an effective cleaning schedule, it’s easy for staff to become preoccupied with their many other responsibilities.

Establishing cleaning schedules also honors senior living facilities’ philosophy of care, which includes the following concepts:

  • Choice: One resident may want her apartment cleaned three times a week while the resident next door only wants his linens changed once a week, nothing more. Cleaning schedules need to take what the resident wants into consideration.
  • Independence: If a resident doesn’t want housekeeping services but asks to borrow the vacuum because he or she wants to remain as independent as possible, this should be accommodated.
  • Privacy: Before entering an apartment to clean, staff should knock, inform the resident who they are, and ask permission to come in so they don’t startle the resident or invade his or her privacy.
  • Individuality and dignity: Adherence to these various cleaning schedules contributes to each resident’s sense of dignity by allowing them to maintain choice, independence, and privacy.
  • A homelike environment: Policies and procedures need to be established that address all areas of the community to create an overall homelike environment that reaches beyond the resident’s unit. Areas to address include the bistro, dining room tables and floors, parlors, arts and crafts rooms, public bathrooms, etc.

Keep in mind that schedules are guidelines and may change. This is especially true in a senior living facility. While it is important to keep on schedule, it is just as important to be flexible and willing to work with unplanned situations that may arise. The main goal is to serve the needs and preferences of the residents. When their situations and preferences change, understand the cleaning schedule may be affected.

There are no set rules for how to clean. Usually cleaning tasks are prioritized, with the most soiled area being attended to first and the cleaner areas being attended to last. The best approach to cleaning is one which is efficient and makes sense to you. Staff members need to plan to spend about 15–20 minutes in each apartment for daily cleaning. Once the resident’s apartment is finished, staff should wash their hands and continue on to the next apartment. Gloves should be worn while cleaning, and hands should be washed prior to putting on gloves and after taking off gloves. Staff should never wear gloves from one apartment to another, as this could spread germs and does not follow infection control standards.

OSHA expects senior living facilities to have written cleaning schedules. Facilities should have policies and procedures that discuss:

  • The process of cleaning bathrooms
  • How to handle laundry bins
  • How to handle buckets for mopping and washing floors
  • How to handle trash
  • Laundry processes and equipment maintenance

It’s important to emphasize to staff that they should not mix cleaning agents. Staff should participate in the daily monitoring of chemicals being properly stored and labeled. All staff members should attend an orientation on OSHA requirements regarding the hazard communication program (found at www.osha.gov/dsg/hazcom/index.html) before starting work at the facility.

Cleaning equipment

Cleaning equipment requires attention to avoid cross-transmission of microorganisms and proliferation of microorganisms in dirty environments. The following precautions should be taken when dealing with cleaning equipment:

  • Tools and equipment used for cleaning and disinfection must be cleaned and dried between uses (e.g., mops, buckets, rags)
  • Mopheads should be laundered daily; all washed mopheads must be dried thoroughly before storage
  • Cleaning equipment shall be well maintained, clean, and in good repair

Cleaning carts should:

  • Have a separation between clean and soiled items
  • Never contain personal clothing or grooming supplies, food, or beverages
  • Be thoroughly cleaned at the end of the day
  • Be equipped with a locked compartment for storage of hazardous substances, and each cart shall be locked at all times when not attended

Equipment used to clean toilets should:

  • Not be carried from room to room
  • Be discarded when the resident leaves and as required
  • Minimize splashing
  • Stored well—sufficient housekeeping rooms/closets should be provided throughout the facility to maintain a clean and sanitary environment

Mopheads should be:

  • Laundered daily
  • Dried thoroughly before storage
  • Stored up when cleaned
  • Stored down when dirty

Soiled utility rooms/workrooms

Each resident care area should be equipped with a room that may be used to clean soiled resident equipment that is not sent for central reprocessing (e.g., IV poles, commode chairs). A soiled utility room/workroom should:

  • Be readily available and designed to minimize the distance from point-of-care
  • Have a work counter and clinical sink (or equivalent flushing-rim fixture) with a hot and cold mixing faucet
  • Have a dedicated handwashing sink with both hot and cold running water
  • Have adequate space to permit the use of equipment required for the disposal of waste
  • Have PPE available to protect staff during cleaning and disinfecting procedures
  • Be adequately sized within the unit and for the tasks required
  • Be physically separate from other areas, including clean supply/storage areas

If a soiled utility room is used only for temporary holding of soiled materials, the work counter and clinical sink is not required; however, facilities for cleaning bedpans must be provided elsewhere.

Soiled utility rooms/workrooms should not be used to store unused equipment.

Cleaning supply rooms

Each resident care area should be equipped with a room/area that is used to store cleaning supplies and equipment. A cleaning supply room/area should be:

  • Separate from soiled workrooms or soiled holding areas
  • Able to keep supplies free from dust and moisture
  • Adjacent to usage areas and easily available to staff
  • Equipped with a work counter and a dedicated handwashing sink if used for preparing resident care items
  • Readily available in each resident care area

Housekeeping rooms/closets should:

  • Not be used for other purposes
  • Be maintained in accordance with good hygiene practices
  • Have eye protection available
  • Have an appropriate water supply and a sink/floor drain
  • Be well ventilated and suitably lit
  • Have locks fitted to all doors
  • Be easily accessible to the area
  • Be appropriately sized to the equipment used in the room
  • Not contain personal supplies, food, or beverages
  • Have safe chemical storage and access
  • Be free from clutter
  • Be ergonomically designed

Cleaning agents and disinfectants

The following are recommendations for dealing with cleaning agents and disinfectants:

  • Cleaning agents and disinfectants should be labeled with identifying information
  • Cleaning agents and disinfectants should be stored in a safe manner in storage rooms or closets
  • Automated dispensing systems are preferred over manual dilution and mixing, because they are monitored regularly for accurate calibration
  • Disinfectants should be dispensed into clean, dry, appropriately-sized bottles that are clearly labeled and dated—not topped up—and discarded after the expiry date

Cleaning and disinfection equipment should be:

  • Well maintained
  • In good repair
  • Cleaned and dried between uses

For sample policies and procedures, in-services, and downloadable tools for housekeeping and infection control, click here.