Written by Ren on Tuesday June 18, 2019
Medical exam rooms see a huge number of patients coming through the doors day in and day out. Keeping those exam rooms clean is essential to the health and safety of the patients you treat and the staff members who interact with them. Improper cleaning or procedures that aren't thorough can have serious consequences, enabling the spread of disease within a facility and beyond.
According to the Centers for Disease Control and Prevention (CDC), 75% of new Clostridium difficile cases happen in people who recently visited the doctor's office. This bacteria causes gastrointestinal distress and causes nearly half a million people in the U.S. to get sick each year. In these cases, C. diff results in a healthcare-associated infection (HAI), also called nosocomial infections.
An HAI is any illness that a patient got after being admitted to a healthcare facility. Pneumonia, urinary tract infections and bloodstream infections are other common HAIs. With a better understanding of exam room cleaning supplies and how to employ them effectively, your facility can reduce the risk of HAIs and serve your patients safely.
Thorough Exam Room Cleaning Procedure
An exam room cleaning supply guide isn't complete without a clear vision of what a thorough cleaning looks like. The CDC provides a comprehensive set of environmental guidelines for infection control in healthcare facilities, but there is room for interpretation on how to implement the recommendations into a routine for environmental services personnel. Here's one example of a highly detailed cleaning routine used by some Canadian hospitals upon patient discharge:
- Assess risk. Estimate the risk of germ exposure and wear the right personal protective equipment (PPE) to complete the job safely.
- Tidy the room. All dirty linens go into the hamper, large pieces of debris go into the trash can, and if any needles or other dangerous equipment are present, follow sharps procedure.
- Clean up fluids. Blood and other bodily fluids should be cleaned and disinfected first. Always remove gloves and wash hands after cleaning up a spill. Change out the disinfecting solution if using a bucket, and put on new gloves before any further tasks.
- Inspect walls. As low-touch areas, walls don't often get soiled and don't pose a high risk of infection. Spot cleaning is usually enough to suffice.
- Clean wall fixtures. Use disinfectant or cleaner to wipe down any medical devices and dispensers. Be sure to get the front of cupboards, shelves and door handles.
- Clean glass. Any glass surfaces like windows and mirrors, as well as any chrome fixtures, should be polished with glass cleaner.
- Wipe down surface areas. The window sill, desk, tables, chairs, phones, sinks and taps should all be wiped down with disinfectant cleaner and cloths. Move any items off surfaces before cleaning and replace them when surfaces are dry.
- Wipe patient-use items. Anywhere the patient sits or reclines and anything they touch should be disinfected. Exam tables, step stools, IV poles and more should be wiped down.
- Wipe the linens hamper. After removing the used linen bag, disinfect the hamper before swapping in a new linens bag.
- Prep the floor. Using a brush with a dustpan, sweep up any dirt and dispose of it in the trash can.
- Empty trash cans. Then use cleaning cloths to wipe the inside and outside of the garbage can thoroughly.
- Mop the floor. First remove any sticky spots, then dry mop the floor. After that, wet mop the floor. Be sure to move items like chairs out of the way to reach as much of the floor as possible.
A thorough cleaning of the exam room following a procedure like this is a critical step in keeping your facility sterile.
Exam Room Disinfectants
Of all the types of exam room cleaning supplies, the most important is disinfectant. There are three levels of disinfectant need for medical items, according to the Spaulding classification used by the CDC.
- Noncritical items: These tools come into contact with patients' intact skin, but they don't penetrate the body's mucous membranes. These items are the lowest priority for disinfection because the skin is effective in preventing microorganisms from entering the body.
- Semicritical items: Items receive this designation when they contact nonintact skin or mucous membranes. Examples of semicritical items are respiratory therapy equipment, anesthesia equipment and some endoscopes.
- Critical items: Any instrument that enters tissue or the vascular system needs to be sterilized at the highest level.
The majority of items in an exam room are noncritical. However, if blood or bodily fluids make it onto a surface or piece of equipment, high-level disinfection may be necessary. The CDC's environmental guidelines define high-level disinfection as inactivating vegetative bacteria, some bacterial spores, mycobacteria, viruses and fungi. The sporicidal chemicals that meet these criteria include:
- Peracetic acid
- Hydrogen peroxide
These chemicals are highly toxic and not suitable for use on regular surfaces. For semicritical items in the exam room, intermediate-level disinfection is adequate. This level of disinfection doesn't always kill bacterial spores, but it does make Mycobacterium tuberculosis var. bovis inactive. This mycobacterium is much harder to kill than most other types of bacteria, fungi and viruses. Medium level hard surface disinfectants include:
- Compounds that contain chlorine
For the most part, exam room cleanings only require low-level disinfectants. These inactivate fungi, vegetative bacteria and some viruses. These disinfectants are similar to intermediate-level disinfectants as they contain quaternary ammonium compounds, some phenolics and some iodophors.
For spot disinfecting small surfaces like thermometers or rubber stoppers on medication vials, ethyl alcohol and isopropyl alcohol is an appropriate choice when applied in concentrations from 60% to 90%. Because it evaporates so quickly, alcohol isn't suitable for disinfecting larger surfaces.
When purchasing disinfectant for exam rooms, you have a choice between wipes and solution. Disinfectant wipes have the distinct advantage of convenience. A staff member cleaning an exam room can often do it faster when all they need is to pull a few wipes out of a container and then toss them upon completion of the process. However, disinfecting wipes also come at a higher price point due to their convenience and disposability.
Another option is to purchase disinfectant in larger sizes — usually in increments of one gallon each. For example, a small clinic may opt to buy 1-gallon containers of disinfectant in cases of four. Larger practices and hospitals may want to buy in bulk, with drums of disinfectant up to 55 gallons. This is the ideal form of disinfectant for practices that use reusable cloths and buckets of disinfectant.
Disinfectant occasionally comes in concentrated form but is more commonly found in ready-to-use formulas. A ready-to-use formulation is the safest option, as it eliminates the potential for human error.
Between the convenience of wipes and the cost-effectiveness of disinfectant solutions, you'll find pre-filled spray bottles. These will save time on prepping disinfectant bottles, and can then be refilled from larger-sized bottles.
Ideally, someone cleaning an exam room will have access to all three forms of disinfectant to maximize resource use. It wouldn't make sense to clean an entire exam room with only wet wipes or to try to spot disinfect smaller pieces of equipment like stethoscopes with a large bucket and cloth.
Best Disinfectant Brands
A variety of generic disinfectants are capable of disinfecting to the required degree, but going with a recognized brand name has its benefits. Brands create proprietary formulations that can perform specific tasks better than a general product, while better preserving your surfaces and equipment. Here are three brands that make some of the best exam room cleaning materials available.
Micro-Scientific manufactures a range of disinfectant products to fit all the cleaning needs of a healthcare facility. These are the top products for exam rooms:
- Opti-Cide Max: These wipes clean and disinfect surfaces with a unique double-sided design. One side cleans, and the other side disinfects with a 20% alcohol formula. Notably, it doesn't leave behind residue on surfaces like other high-alcohol cleaners.
- Opti-Cide3: Opti-Cide3 combines cleaning, sanitizing and disinfecting into one double-sided wipe. It's suitable for high-touch areas and kills fungi, bacteria and viruses with a 21% alcohol formulation.
- Multi-enzyme detergent: Whether you're pre-soaking surgical instruments or need a manual cleaning solution, multi-enzyme detergent makes use of four enzymes to break down different types of organic and inorganic material on your surfaces. This disinfectant also comes in a more affordable version with two enzymes.
- Glutaraldehyde disinfectant: When you need high-level disinfectant, glutaraldehyde is the way to go. Micro-Scientific's proprietary glutaraldehyde formula turns green to show when it's ready for use and can be used for up to 28 days after activation.
Professional Disposables, Inc. (PDI) is one of the leading manufacturers of single-use wipes for medical professionals. Their Sani-Cloth line of disposable wipes includes the following popular entries:
- Sani-Cloth Plus: Plus wipes are low-alcohol but still effective against 16 microorganisms including Staphylococcus aureus and Escherichia coli. They are ideal for non-porous surfaces as well as equipment.
- Sani-Cloth Prime: PDI's prime wipes can clean and disinfect in one minute and protect against 54 microorganisms, including several multi-drug resistant organisms.
- Sani-Cloth HB: A brand-new specialty wipe, Sani-Cloth HB is the first germicidal wipe that can kill the Hepatitis B virus.
3. Sklar Instruments
Sklar Instruments is best known for their surgical tools, but they also make disinfectants suitable for both instruments and hard surfaces. Sklar's products are known for being affordable rather than offering unique benefits, making them an ideal brand for ordering in bulk when you need basic disinfection and cleaning.
- Surface disinfectant: Sklar's surface disinfectant works on plastics, stainless steel, chrome, glass and baked-on painted surfaces. It offers a two-minute kill time for many microorganisms and meets OSHA requirements for blood-borne pathogen disinfection.
- Sklar-Cide: A surfactant-free solution, Sklar-Cide offers high-level disinfection required for surgical instruments and medical equipment.
- Enzymatic detergent: Like other detergents of the same nature, Sklar's enzymatic detergent is useful for cleaning surgical instruments or equipment heavily soiled with organic material.
Buckets for Cleaning
A set of quality buckets is a must for any facility. Sometimes, the cloth and bucket method is the only way to get an exam room clean and disinfected quickly enough. Many facilities use the same type of buckets for cleaning that they use in the OR. Buckets should be made from stainless steel to ensure that cleaning agents don't react with the container and to maximize the life of the product.
Kick buckets are the best for efficiency since they have wheels and can be moved around the room with just a nudge of the foot. To keep the buckets from scuffing walls or equipment, consider ones with a rubber guard ring.
Larger government organizations usually need something more heavy-duty, like a mopping storage cart to carry enough cleaning supplies to get the job done.
If using any bucket-based method, disposable towels are the preferred way to wipe. If a cleaner attempts to use a reusable towel, the disinfectant can become contaminated when the cloth is returned to the bucket after the first wipe. A disposable towel of sufficient size and thickness can take the place of reusable cloth for cleaning.
They are especially suitable for wiping down large surfaces like exam chairs, cabinets and counters. Additionally, disposable towels are an ideal companion for disinfectants dispensed through a spray bottle. Antimicrobial disposable towels are available as well, which offer the attractive benefit of being protected from microorganisms throughout shipping, warehousing and medical facility use.
If disposable towels are to be used for cleaning, it's generally best to go with two or three-ply to ensure they remain intact during wipe-downs.
Gloves are a form of personal protective equipment that every person working in a healthcare facility should have. They create a critical barrier between pathogens and people that's as important in exam room cleaning as it is in procedures. Gloves only work properly when they are the right size, so it's essential to have a variety on hand. If a glove is too tight, it risks tears or bursting. If it's too loose, pathogens can easily invade through the open wrist.
General purpose latex gloves are the most affordable option for hand protection during exam room cleanings. However, between 8% and 17% of healthcare workers are allergic to latex, so it may be worth buying more nitrile gloves to avoid any issues. For the most economical choice, go with vinyl exam gloves. They're latex free and provide a freer fit while eliminating concern about static buildup.
Hand Soap and Sanitizer
Gloves can only do their job when hands are clean in the first place. While not technically cleaning supplies in their own right, both hand soap and hand sanitizer play a critical role in keeping exam rooms clean. If a staff member cleans up a blood spill and then doesn't wash or sanitize their hands before putting on a fresh pair of gloves, they create an avoidable opportunity for dangerous microorganisms to stick around.
Medical and antimicrobial hand soap in combination with proper hand-washing technique are the most effective at reducing the number of microorganisms transmitted via touch, especially when paired with a touchless dispenser. However, not every exam room has a sink. In these cases, hand sanitizer is a close second.
Squeeze bottles of hand sanitizer are available at relatively low prices and are highly effective when strategically placed in waiting and exam rooms. If you want a more permanent and cost-effective setup, wall-mounted hand sanitizer dispensers offer the best value.
It's less common to need a spill kit in an exam room than it is in operating environments and labs, but it's no treat to find you don't have a spill kit when you do need one. Spill kits are often designed to contain specific messes. The highest quality, best-selling spill kits all perform the same function — helping cleaning personnel contain and dispose of spills safely. Most kits designed to clean up hazardous chemical spills have these features or similar ones:
- A pre-treatment or neutralizing agent
- Red or Green Z solidifier to make fluid semi-solid
- Vented goggles
- Scoops and scrapers
- Disposal bag
- Twist ties
These items all come organized in a plastic case for easy transport and storage. Rather than having to run around grabbing all the necessary supplies, staff members can simply head to the designated spill kit storage area and have everything they need ready to go.
Spill kits are especially helpful when the person handling the spill is not a medical professional and doesn't know how to clean up hazardous chemicals safely. In addition to general or universal kits, you can find sets that specifically address spills of formaldehyde, glutaraldehyde and mercury.
Instrument Cleaning Supplies
Depending on the facility, exam rooms may have instruments that need to be cleaned. Some unique cleaning supplies can help keep medical instruments clean and functional.
- Lubricant: Providing adequate lubrication to instruments significantly extends their lifespan. This type of lubrication will prevent and wash away rust and fingerprints to keep instruments from corroding and staining.
- Pre-soak: Instrument pre-soaks can come in liquid, spray or gel form. They adhere to any biological materials present, then work to soften and dissolve them so they can't harm the instruments during cleaning and disinfection.
- Stain removal: Even if medical instruments do suffer from water deposits, tarnish and rust, they can be revitalized with stain removal products. Sprays and wipes are available.
- Cleaning brushes: Medical instruments come in all shapes and sizes, and so do the brushes needed to clean them. Cleaning brushes are specialized for endoscopes, biopsy tongs, suction tubes and more.
- Spot removers: Spot remover pads are indispensable when an instrument only needs a touch-up. They can thoroughly clean instruments and are made from plastic so they don't scratch or pit steel.
While cleaning and disinfecting of medical instruments don't technically necessitate these solutions, each of these products goes a long way in making the process easier and faster.
Making the Most of Exam Room Cleaning Supplies
Your exam rooms are the front line for infection prevention, and your cleaning supplies are a critical tool in the battle against HAIs. However, the people who are doing the cleaning are just as important. If your facility doesn't have a culture of cleanliness, personnel may find it acceptable to cut corners or ignore certain steps.
One of the most effective measures you can implement is a cleaning log. The Occupational Safety and Health Administration (OSHA) requires that there be a schedule for cleaning and decontamination, but doesn't go so far as to require a log. Keeping records of who cleans each exam room and when encourages greater accountability. It can also help you spot inconsistencies and room for improvement within your required schedule.
QuickMedical: Your Cleaning Supply Source
Medical cleaning supplies for the exam room are an essential part of keeping your healthcare facility sterile and safe for everyone in the building. Choosing high-quality products registered by the Environmental Protection Agency (EPA) is critical, and QuickMedical makes it easy to get the selection you need while staying within your budget.
Our online procurement experience is quick and easy when you register for an account. If you're looking to expand your supplies or switch to something new, our in-house specialists are happy to make recommendations that fit your facility's needs. Call QuickMedical at (425) 222-5963 to find out more.