Know what would trigger a deep cleaning.
“From a cleaning perspective and when to give detail to proper cleaning, that is the challenge,” says Len Sears, director of sales at ProCare Medical.
Nursing homes generally never overlook major pathogens, but deep cleaning always should be performed after bathing any resident infected with Clostridium difficile (C. diff), any kind of infections like staph and urinary tract infections, and pseudomonas, he adds.
Other common resident conditions that call for an extensive cleaning after bathing include incontinence, especially diarrhea; open wounds with or without bandages; skin discoloration or appearance, and residents with any type of illness or cold, Sears says.
Lee Penner, president of Penner Bathing Spas, agrees about the need for additional cleaning and treatments after a highly infectious resident is bathed.
Aside from that, he maintains that sound and thorough cleaning between baths should obviate any extraordinary measures where virulent pathogens are not a concern.
“A deep cleaning at the end of each day used to be done 30 years ago,” he says. “But that is no longer standard practice, because if you have to deep clean at the end of the day, you didn’t clean well at the end of the bath in the first place. If staff clean [between baths] the way we suggest, I myself will jump in the bath. It doesn’t matter who came in front of me.”
Be mindful of invisible dangers as well as the physical signs.
The physical environment will provide visual clues that point to the need for a deep cleaning, or outright replacement. These include uncleanable mold and mildew and chipped or loose flooring.
Sears believes many caregivers forget to check under the surfaces on which they sit, noting that items like castors are notorious bug transfer agents from non-sanitized areas of the facility.
“Rust is a huge trigger for deep cleaning or replacement,” Penner says. “Patient transfers that aren’t made with a double-powdered coating or have water-submersible parts made of anything but stainless steel are major rust candidates,” he adds.
Cracks in any porous surfaces that come in contact with a resident’s skin are major culprits. These include cracks or splits and tears in transfer cushions.
“If you are using a product with porous foam padding and the cover material is cut or damaged, there is an excellent chance the foam has absorbed whatever might be present,” Sears says. “There are ways to seal the damage, but the foam has already absorbed the bacteria.”
Other culprits are deep scratches or cracks in fiberglass surfaces that are common in tubs, spas and transfers.
“Deep scratches in the fiberglass in the tubs could harbor bugs,” notes Penner.
Adds Sears: “A crack in a fiberglass or acrylic surface is a major skin/safety issue. Cracks, right angles and nooks and crannies in general are breeding grounds for bacteria.”
Understand the basic infection control standards.
The most tried and true measures are education and vigilance, Sears says, urging staff to be aware of the industry-approved infection prevention protocols and when there are elevated threats of infection occurrence.
Staff also should be mindful of carefully matching the disinfection and cleaning agent with the type of material — including metal, fiberglass, acrylic, padded foam or closed-cell polyurethane and mesh.
If the wrong agent is used, surfaces can become damaged, or compromised for future breakdowns, which could cause even bigger problems.
As trite as it might sound, it pays to read labels, particularly on cleaning and disinfecting products.
In addition, staff need additional vigilance when inspecting and cleaning porous surfaces.
Sears believes additional education and regular inservicing on proper cleaning measures are continually needed, given the high rate of employee turnover in nursing homes.
Adhere to industry best practice standards.
According to Sears, an accepted practice is cleaning and disinfecting the bathtub or spa according to instructions for use before the first bath of the day and after each bath.
“Bathing equipment and the chairs/stretchers used in conjunction with them, must be cleaned after every use,” he says. “This process is different for each method [type of equipment] used and manufacturers are clear about how to clean equipment.”
The tools needed are fairly simple. Approved disinfectants kill most pathogens, including C. diff, and bleach wipes are effective depending on dilution, Sears says. In addition, quaternary cleaners suffice in almost all situations.