Control of the Care Environment

Objective

Care environments and shared equipment should be cleaned and disinfected thoroughly to help prevent the spread of infection. At the same time, it's important to remember that care homes are people's homes, so maintaining a warm and comfortable atmosphere is essential. A balance should therefore be struck between effective infection control and keeping the environment homely. Regular auditing of cleaning and disinfection practices should also take place to ensure standards are being met consistently.

Further information: Preventing Infection Workbook - Page 37

Why This Matters

• Dust, dirt, and clutter can harbour microorganisms and allow them to multiply.
• Effective cleaning and disinfection reduce the risk of infections spreading between residents and staff.

Key Principles

1. Responsibility

• Each care home should have a designated lead for environmental cleaning and decontamination.
• Cleaning schedules and procedures must be documented, followed, and reviewed.

2. Cleaning Schedules Must Include:

• What needs to be cleaned/disinfected.
• How often it should be done.
• How it should be done (technique, order, products used).
• Which products to use, including:
  • Correct dilution.
  • Contact time.
  • Safe storage instructions.

3. Colour Coding: Follow the National Colour Coding Scheme for cleaning equipment and PPE.

Red - Sanitary areas and items - Toilets, Bathrooms, Showers, Basins, Bathroom Floors

Blue - General areas and items - Residents' Rooms, Lounges, Corridors, Offices

Green - Food and drink areas and items - Kitchens, Pantries, Dining Areas, Food Service areas

Yellow - General Healthcare, clinical areas and items - Isolation Rooms, Bedrooms where residents are infectious or have specific care needs

4. PPE for Cleaning

• Always wear gloves and apron.
• Wear eye/face protection if there's a risk of splashing.
• Follow correct donning and doffing sequence (see Section 4).

5. Cleaning Technique

• Work from top to bottom and most contaminated to least contaminated.
• For large surfaces, use an "S" shaped pattern, overlapping slightly without going over the same area twice.

Two-Stage Decontamination

1. Cleaning - Use detergent and water to remove dirt/debris (does not kill microorganisms).
2. Disinfection - Use a disinfectant to kill/reduce microorganisms to a safe level (must be applied to a visibly clean surface).

Tip: Sanitisers can be used in a two-stage process:

• First application: clean the surface.
• Second application: leave for full contact time to disinfect.

Specification of Disinfectants

For environmental or shared equipment disinfection:

• Option 1: Combined detergent + chlorine-based disinfectant (1,000 ppm).
• Option 2: Neutral detergent in warm water → chlorine-based disinfectant (1,000 ppm).
• Alternatives must meet EN 14476 (virucidal activity).
• For electronics: use 70% alcohol or manufacturer-recommended product.
• For Clostridioides difficile: use a sporicidal disinfectant.

Safe Management of Blood & Body Fluid Spillages

General Rules:

• Only trained staff should handle spillages.
• Wear PPE (apron, gloves, mask, eye protection if splashing risk).
• Ventilate the area.

Blood or Blood-Stained Bodily Fluid:

• Use a blood spillage kit.
• If unavailable, use chlorine-based disinfectant (10,000 ppm) * .
• Cover spill with paper towels → apply disinfectant → leave 5-10 mins (or per manufacturer) → dispose as infectious waste → clean area with detergent & water.
• Wash and dry hands.

Bodily Fluids Without Blood:

• Use a body fluid spillage kit or chlorine-based disinfectant (1,000 ppm).
• Follow same steps as above.

Do not use chlorine-based disinfectant directly on urine, it releases toxic fumes.

Exposure to Blood/Body Fluids in Eyes, Nose, Mouth:

• Rinse immediately with copious warm water.
• Follow exposure incident procedure (see Safe Management of Sharps in Section 10).

*Check manufacturer's instructions to ensure disinfectant strength does not damage surfaces or equipment.

Resources
Health Protection IPC Environmental Daily Spot Check (PDF, 99 KB) 
Sips Assurance Tool:  https://www.infectionpreventioncontrol.co.uk/resources/sicps-assurance-annual-ipc-audit-tool-for-care-homes/  
Spillage Kit Location Poster: Spillage-kits-located-at.pdf

References and Further Guidance: 
PHW Environmental Cleanliness:phw.nhs.wales/services-and-teams/antibiotics-and-infections/infection-prevention-control/environmental-cleanliness/national-standards-for-cleaning-in-wales-key-standards-for-environmental-cleanliness-revision-2-0-dec-2021/ 
Use of Mobile Devices in the Care Environment:phw.nhs.wales/services-and-teams/antibiotics-and-infections/infection-prevention-control/outbreak-management/standards-for-infection-prevention-control-in-the-use-of-mobile-devices-md-in-healthcare/