Infection Control Today - 02/2003: Environmental Services

First Impressions Start With Public Areas

By Jim Henry, CHESP

Theold adage, "You only get one chance to make a good first impression,"is true; nowhere is it more important to make a good first impression than in ahealthcare facility. A good place to start is in the cleaning and disinfectionof public areas.

 This policy:

• Reassures visitors that their loved ones are in good hands

• Influences every employee who walks through the door by improving their attitude while working in a clean environment

• Influences regulatory inspectors who check the cleanliness of these first-impression areas.

Creating that first impression begins as visitors leave their cars and walkto the entrance of your building. Cleaning of this area should include regularsweeping of the parking lots and garage. Are the waste receptacles well placedand attractive?

Jay Grooten, regional training manager for Crothall Healthcare Inc., whostarted his career working for Walt Disney World, shared some interesting factsaround a guest service measurement (GSM) conducted by Disney that measured howlong people are willing to carry trash before they drop it on the ground. Mostpeople will walk 19 steps or about 50 feet to find a trash can. That is valuableinformation when it comes to making sure you have enough receptacles to maintaina clean entrance to your facility. It is recommended that environmental servicespersonnel check with the local fire department to determine if the receptaclesinside the hospital building must meet a specified fire rating.

Are the sidewalks clean and free of debris? Does the entrance area needscrubbing or pressure washing to remove traffic patterns or gum? Are the windowsand doors cleaned regularly? Here are a few recommendations that might help yoube better prepared to create a good first impression. Use live, seasonal plantsplanted along the sidewalk and in planters located in the lobbies to give theimage that this is an organization full of life. I would argue against usingartificial plants or plants in need of maintenance, as this tends to create anegative image. Have the department responsible for maintaining the grounds andentrances have someone walk all entrances before 8 every morning to see whatyour visitors and staff will be seeing. Also, look to see if there are cigarettebutts lying around or swept into the grass or plants around your entrances.

Once the guest enters your building, do the lobbies, hallways, elevators andrestrooms sparkle? There are four different levels of cleaning needed in publicareas to create a wonderful first impression and make sure it is free of germs.

The first is a good floor-care program. One of the first things noticed bypeople as they enter a building is how clean and shiny the floors are. Make surethe floor looks great. If the lobby has carpet, it needs to be spot free. If ithas a tile floor, then make sure it is well maintained and has a deep shine.Remember to pull the furniture away from the walls to clean underneath on aregular basis; as guests sit down, they will notice dust and trash overlooked bythe cleaning crew. Straw brooms are not recommended for use in a healthcaresetting, due to the difficulty of cleaning the broom. Dust mops are the mostcommonly used broom in the healthcare industry. When mopping the floor, aneutral cleaner will prolong the life of the finish. However, when cleaning up apotentially infectious substance, you should always use a germicidal detergent.

The second level is a weekly deep cleaning (or detail cleaning) that includeshigh dusting of all surfaces 6 feet above the floor. Personnel should wipe allpictures, clocks and window seals, and check high corners for cobwebs. Becausedust carries germs, it is recommended that a high-dust mop be saturated in abucket of germicidal detergent and wrung out prior to being placed on thehigh-dust tool to help absorb the dust into the mop. Feather dusters are notrecommended, as they do not hold the dust particles but simply move the dustfrom one surface to another.

Window seals and blinds should also be dusted weekly. To clean plastichorizontal blinds, close the blinds completely and using the same procedure withthe high-dust tool, start at the top of the blind and move from side to sideworking your way down to the bottom of the blind. Once one side has been dusted,open the blinds completely to expose the other side and clean using the sameprocedure. Make sure to open the blinds so each slat will be able to dry.

Cleaning of windows should be done during daylight hours, as streaking ismuch more visible in the sunlight. Large windows should be cleaned using asqueegee method to speed up the process.

This level of cleaning is also responsible for all wall-washing of spots. Itis imperative to use the manufacturer's recommended procedure and chemical(s) sothere is no bleaching out or damage to the walls. When cleaning a paintedsurface, use a mild cleaner and water solution. It is best to pick an area ofthe wall that is not noticeable to conduct a test to see how the chemical willaffect the surface of the wall. Stains or spots that cannot be removed should bereported to the appropriate department for repainting or replacement of the wallcovering.

Thethird level of cleaning is the daily cleaning that includes the wiping of allsurfaces 6 feet below and sweeping and mopping the floors. This level ofcleaning includes the emptying and relining of trashcans. Trashcans that do notuse liners should be cleaned using a germicidal detergent. Environmentalservices personnel should also straighten magazines and clean doors.Countertops, phones, water fountains, trashcans and most lobby furniture can becleaned using a mild germicidal detergent. Wood furniture can be sealed with afurniture polish.

The fourth level of cleaning is sometimes referred to as "policing thearea." This cleaning procedure is completed several times a day andinvolves walking through an area looking for magazines that may needstraightening, picking up trash that might be on the floor and cleaning up smallspills. Personnel should also clean the doors and immediate area outside theentrances. Usually this area is the sidewalk within a radius of 15 feet or to acurb if the roadway is close by.

Some organizations have been successful implementing an "adopt anarea" program that incorporates the assistance of employees from a nearbydepartment to help by completing the fourth level of cleaning. Organizationswith these programs have reported employees taking ownership of an area and inmany cases there is an increase in pride, as employees enjoy decorating theiradopted areas for the various holidays.

When it comes to cleaning elevator cabs, the first thing noticed by mostvisitors is the condition of the floor. Make sure to detail the corners andedges and take time to clean out the door tracks. Remember that every floor hasan elevator track, not just the cab. Use the same procedure for cleaning thewall coverings as in the lobbies. Clean the elevator buttons with a germicidaldetergent.

Restroomsare often the one area by which visitors judge the cleanliness of the entirefacility. It is imperative that rounds are completed often enough to keep upwith the usage of the restroom. Some areas may require being checked every halfhour or hour, whereas other areas may be able to go several hours betweencleanings. In choosing dispensers for the restrooms, keep in mind theanticipated usage of the restroom and install the appropriate size of dispenserto keep up with the demand. This will help control your labor costs needed toconstantly refill smaller dispensers.

There is no difference between policing and cleaning a restroom. During eachcleaning, all surfaces and each stall should be cleaned thoroughly using agermicidal detergent. The floor should not be dust mopped, as this willcontaminate your dust mop and require changing after every restroom. Simplyusing a wet mop and germicidal detergent is sufficient.

Many organizations have incorporated the help of the staff and public to helpnotify the appropriate personnel should the restroom need any attention byplacing a well-written sign or tent card in each restroom. "If thisrestroom doesn't meet your expectations, then it doesn't meet ours. Please go toany phone and dial "CLEAN" to report any deficiencies."

By making rounds at all the entrances and checking the lobbies and restroomson a regular basis, you will be positioning your team to be one step ahead ofthe general public and therefore able to create a good first impression.

Jim Henry, CHESP, is regional manager of Crothall Healthcare Inc. inWayne, Pa.