Environmental Cleaning & Maintenance

Dental practices need to demonstrate that they provide and maintain a clean and appropriate environment that facilitates the prevention and control of healthcare associated infections.

Environmental Maintenance & Cleaning CQC Checks

 The following questions and key points may be asked or viewed by a CQC auditor.

  • Does the practice look clean?
  • Is the cleaning overviewed by a Manager?
  • Is there a policy of Cleaning & Maintaining the practice?
  • Is the cleaning in accordance with HCAI code of practice?
  • Is the cleaning equipment colour coded?
  • Is there a colour coding poster on display?
  • Does the cleaner follow a checklist?
  • Does the cleaner have a risk assessment for their duties?
  • Are black or clear bags being used for domestic waste?
  • Is there a designated area for expelling dirty water from the mop buckets?

These are referenced across the following documents:

  • Health and Social Care Act 2008
  • Essential Standards of CQC
  • National Standards for Cleaning

Environmental Cleaning and Maintenance

It is not possible to provide fully comprehensive instructions on environmental cleaning and maintenance as the subject is premises specific and depends on the individual practices circumstances, layout, equipment and other aspects.

This section does however highlight the main issues around the maintenance of a clean environment that is suitable for carrying out clinical and decontamination activities. This will help enable a practice to develop their own unique protocols.

Dental practices need to demonstrate that they provide and maintain a clean and appropriate environment that facilitates the prevention and control of healthcare associated infections (Criteria 2 of the 'Code of Practice for the NHS on the Prevention and Control of Healthcare Associated Infections).

Dental practices along with many other healthcare environments contain a diverse population of microorganisms.

Areas or items shared by different patients or clients (such as toilets) can become contaminated with blood, other body fluids, secretions and excretions during the delivery of care and therefore must be managed appropriately.

Measures must be taken in order to limit such areas or items from becoming potential reservoirs for harmful microorganisms which in turn could lead to the potential contamination or infection of staff, patients, clients, visitors or others.

High standards of cleanliness and hygiene are important for producing an environment which reduces the risk of infection being transmitted to patients. The public are increasingly well informed about the risks of healthcare associated infections and will be reassured if the environment is clean, uncluttered and well organized.

The environment plays a relatively minor role in transmitting infection, but dust, dirt and liquid residues will increase the risk. These should be kept to a minimum by regular cleaning. Overall the environment should be clean, dry, well lit and well ventilated.

The transfer of microorganisms from environmental surfaces to patients or clients is largely considered to be via direct contact (such as by hand) with these surfaces. As a consequence, hand hygiene is paramount in reducing infection spread via this route as well as the appropriate control of the environment.    

Environment

The term ‘environment’ refers to:

  • Any general horizontal surfaces in the patient’s environment. Low and high level must be considered.

  • Any frequently touched surfaces in the environment. This also includes rooms, such as storerooms, dental surgeries, reception & waiting areas.

  • Dental chairs, trolleys, other furniture in the environment, such as tables and chairs.

  • Toilets.

  • Sinks, basins, baths, showers and the items surrounding these, such as soap & paper towel dispensers.

  • Floors.

  • Doors and door handles, particularly those in the immediate environment frequently touched by patients and workers.

  • Other paintwork and surroundings, such as skirting, walls and partitions. This should particularly focus on those frequently touched.

  • Curtains and window blinds.

  • Light fittings and light switches.

  • Kitchen areas. Specific guidance for main kitchens and food hygiene is not contained within this document.

This list is not exhaustive and judgments should be made in each specific setting as to how to control the environment.

General Good Practice

General good practice should involve the following:

  • Ensure all areas are thoroughly cleaned and free from dust and grime, paying particular attention to harder to reach areas such as corners, edges, and underneath chairs. The mechanical action of cleaning is important.

  • Work surfaces should be impervious, sealed and easy to clean.

  • Floors should be non-slip, continual and where possible curve up the wall by at least three inches.

  • Carpets should not be used in clinical and communal areas

  • Any joints in floor covering should be welded or sealed where they are unavoidable to prevent damage due to water penetration.

  • Upholstered furniture including, the dental chair, should be impermeable and wipe able.

  • Clinical waste containers and bins should be metal, foot operated with a lid, and easily accessible in clinical areas.

  • Items such as supplies must always be stored off the floor.

  • Equipment purchased and used for storage such as shelves, units and lockers should have easy-to-clean surfaces and be water-resistant.

  • Those items which are not intact, for example chairs, should be removed, repaired or replaced.

  • Where there is a concern about risk of infection due to damaged equipment, this must be reported immediately.

  • Patients and visitors to the practice should be advised of appropriate hand hygiene policies which are to be carried out before and after visiting.

A written cleaning schedule should be devised specifying the persons responsible for cleaning, the frequency of cleaning and methods to be used.

Generally this will involve cleaning on a daily or twice daily basis, or based on a risk assessment. The cleaning process will be most effective if the more contaminated areas are cleaned first.

It is accepted practice to have different work schedules for tasks normally carried out by cleaning staff, and tasks normally carried out by nursing staff. This has the advantage of allowing the work schedules to be used also as a work instruction for staff and is particularly useful for members of staff working away from their normal area.

Work schedules should be prominently displayed in a public part of the appropriate work area.

The cleaning plan will be reviewed annually to ensure standards are maintained.

Staff Training

It is essential that all staff carrying out cleaning duties are suitably trained and have written training records that are signed and dated by the trainer and trainee.

As a minimum:

  • Training must be given in the performance of cleaning tasks, the use of cleaning equipment, control of infection, manual handling, fire, health & safety and site orientation.

  • Training in the performance of tasks will include the correct use of cleaning products and materials. Training should be consistent with the manufacturer’s instructions.

  • Where there is a change in cleaning products, materials or equipment, retraining of staff will need to be brought forward and completed before the new products are deployed for the first time.

  • Training should be completed before new staff members are allowed to work without direct supervision.

  • Training should be repeated in its entirety every year or sooner if a competency issue has been identified.

  • A suitably qualified person should always deliver training.

Clinical Care

Clean and dirty areas for the surgery should be clearly identified to reduce the risk of cross contamination.

Define the areas which will become contaminated during operative procedures (such as work surfaces, dental chair, inspection light, spittoons, aspirators), and ensure that all surfaces and equipment are cleaned effectively between patients.

Areas and items of equipment local to the dental chair that need to be cleaned between each patient are:

  • Local work surfaces.

  • Dental chair.

  • Curing lamp.

  • Inspection light and handles.

  • Delivery units and dental cart.

  • Spittoon.

  • Aspirator.

  • X-ray unit.

In addition, all surfaces that have potentially become contaminated (such as work surfaces, handles, cupboards and drawer fronts), should be cleaned after each patient.

Surfaces can be effectively cleaned using wipes. Alcohol wipes should be avoided on areas and instruments containing blood splatter as alcohol binds blood to stainless steel. Water and suitable detergent is satisfactory provided the surface is dried after cleaning.

The area around the dental unit also becomes contaminated by direct splatter, aerosols and by touching surfaces with gloved hands. Aerosols are generated by a wide variety of dental procedures including use of dental hand pieces, 3 in 1 syringe and ultrasonic scalers.

Surface cleaning prevents transmission of infection. Hand hygiene also prevents transmission of surface contaminants so avoid touching and thereby contaminating drawer handles, pens, computer keyboards and door handles with gloved hands. 

In addition to surface cleaning, aerosol contamination can be reduced by use of high volume suction, rubber dam and having adequate ventilation.

Cleaning Equipment

Equipment used for cleaning the environment requires being clean, fit for purpose and in a good state of repair.

Different areas should have different equipment and this should be colour coded so that it is easy to see which equipment should be used.

Cleaning equipment should be stored in a designated area away from potential sources of contamination.

Materials and equipment used to clean clinical areas and other high-risk areas should be stored separately from those used for general and non-clinical areas.

Mops and buckets should be kept clean and dry. Mops should be stored head up and buckets inverted. Mop heads should be replaced regularly as required.

Carpets should not be used in clinical areas.