Environmental Cleaning
Standard Operating
Procedure
Title: Introduction
Authors: Clinical Excellence Commission, Environmental Cleaning Advisory Committee
Lead: Infection Prevention and Control and Healthcare Associated Infections Program
Active date: October 2024 Review date: October 2029
Applies to: Health workers undertaking Exclusions:
cleaning tasks
Purpose: This module outlines the purpose and set up of the eight modules that, together,
make up the Cleaning of the Healthcare Environment Standard Operating Procedure. It
includes a list of key definitions.
SHPN: (CEC) 240868
ISBN: 978-1-76023-980-0
Introduction
NSW Health is committed to the implementation of environmental cleaning programs
across NSW Health organisations to reduce the risk of healthcare associated infections.
Effective environmental cleaning is an essential component of any effective infection
prevention and control program aimed at providing safe, high-quality healthcare for
patients and a safe working environment for health workers in healthcare settings.
Cleaning of the Healthcare Environment (PD2023_018) requires all NSW Health
organisations to have adequately resourced systems and processes in place to ensure
that:
• routine cleaning of the healthcare environment meets required minimum
standards
• staff undertaking cleaning are trained in all aspects relevant to cleaning in
healthcare environments
• scheduling and frequency of environmental cleaning is based on assessment of
risk to patients, visitors and staff
• the effectiveness of the environmental cleaning program undergoes regular
cleaning audits
• if required, appropriate action is taken to improve cleaning performance.
Environmental Cleaning
Standard Operating Procedure
Introduction, October 2024
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See also actions 3.13 and 3.14 of the Prevention and Controlling Infections Standard of
the National Safety and Quality Health Service (NSQHS) Standards.
The Environmental Cleaning Standard Operating Procedure is set out in eight modules
that cover the issues required to implement and maintain an environmental cleaning
program within a healthcare facility. These modules are:
• Module 1: Frequency of cleaning
• Module 2: Personal protective equipment
• Module 3: Work procedures for cleaning
• Module 4: Specialised patient conditions
• Module 5: Cleaning equipment
• Module 6: Cleaning agents
• Module 7: Evaluation of cleaning
• Module 8: Supporting documents.
This Environmental Cleaning Standard Operating Procedure provides evidence-based
guidance and recommendations for undertaking environmental cleaning in healthcare
facilities. NSW public healthcare facilities should endeavour to comply with the guidance
and recommendations in this procedure.
All staff are responsible for the cleanliness of healthcare facilities.
The Environmental Cleaning Standard Operating Procedure provides evidence-
based guidance and recommendations for cleaning in healthcare facilities.
NSW public healthcare facilities should strive to comply with the guidance in this
procedure.
The allocation of resources for cleaning and the frequency of cleaning will vary per
facility and should be locally determined based on need.
Cleaning procedures for specific settings and activities are set out in module 3.
Time set out for various cleaning procedures or tasks in modules 3 and 4 are
approximate only. Actual cleaning times for specific tasks will depend on local
circumstances; for example, space and size of room and staffing allocated.
It is essential that cleaning equipment is fit-for-purpose, easy-to-use, well-maintained
and regularly reviewed.
All staff who are cleaning must be trained in work health and safety, infection prevention
and control principles and the correct use of personal protective equipment. Training,
education and instructions about how to perform work safely and effectively should be
completed prior to being allocated to specific cleaning tasks. Ongoing refresher training
is essential to maintaining cleaning standards and safety to the health workers.
Prior to purchasing new equipment or refurbishing a facility, cleaning requirements
should be considered in consultation with local cleaning supervisors and infection
prevention and control staff.
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Standard Operating Procedure
Introduction, October 2024
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Definition of terms
Alcohol-based hand An alcohol-containing preparation (such as gel, foam or liquid)
rub (ABHR) designed for reducing the number of viable microorganisms on
dry, unsoiled hands. 1
Australian Register of Public database of therapeutic goods that can be legally
Therapeutic Goods supplied in Australia. 2
(ARTG)
Body substance Any substance produced by, or otherwise expelled, excreted, or
extracted from the body. Body substance is used rather than
body fluid to emphasise the need for precautions to prevent
contact with solid tissue and faeces as well as blood (including
dried blood) and body fluids. This does not include intact skin,
hair and sweat.1
Cleaning The removal of visible soil (such as inorganic and organic
material) from objects and surfaces and is normally
accomplished manually or mechanically using water with
detergents or enzymatic products. 3
Clinical waste Clinical waste with the potential to cause injury, infection or
offence, such as:
• unrecognisable human tissue (excluding hair, teeth, nails
and anatomical waste)
• bulk blood or other body fluids (or body substances)
• material and equipment visibly stained by blood or body
fluids (includes incontinence pads and disposable nappies
that come from an infectious patient)
• lab specimens, cultures or other waste from lab
investigations
• waste from medical or veterinary research
• genetically modified organisms (GMOs). 4
Debris Includes litter and rubbish, such as crisp packets, drink cans
and bottles, chewing gum, cigarette butts, adhesive tape, grit
and limescale. 5
Degreaser Substance or product that removes or dissolves grease.
Detergent solution A detergent product which is intended to be used in the
cleaning of surfaces or other medical devices diluted with water
as per manufacturer’s instructions. 6
Dirt Includes mud, smudges, soil, graffiti, mould, fingerprints,
ingrained dirt, scum.5
Discharge cleaning Cleaning and disinfection process required after patient(s) has
vacated the room, either through room transfer or discharge.6
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Standard Operating Procedure
Introduction, October 2024
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Disinfectant A substance: a) that is recommended by its manufacturer for
application to an inanimate object to kill micro-organisms and b)
that is not represented by the manufacturer to be suitable for
internal use.6
Disinfection A process that eliminates many or all pathogenic
microorganisms, except bacterial spores, on inanimate objects.1
Dual purpose A product that combines a detergent-cleaning effect by
cleaner/disinfectant surfactants and also contains a biocide. The product must be
listed on the ARTG. Dual purpose cleaner/disinfectants are
designed to eliminate the need for separate cleaning and
disinfection processes to be carried out consecutively by
combining them into a single process.3
Dust Includes lint, powder, fluff and cobweb.5
Environment The physical surroundings in which health care is delivered,
including the building, fixtures, fittings and services, such as air
and water supply. Environment can also include other patients,
consumers, visitors and the workforce.6
Element An item within a functional area, or any part of the fabric or
fittings of a functional area, which requires cleaning.5
Functional area Any area in a healthcare facility that requires cleaning. The
functional areas have been grouped under four risk categories:
extreme, high, medium and low. These risk categories reflect
the frequency and intensity of cleaning required to meet
minimum cleaning standards.3
Fluid resistant A single use, fluid-resistant gown, or apron, made of impervious
gown/apron material, provides a barrier to reduce opportunities for contact-
transmission in healthcare settings. 7
Hand hygiene A general term referring to the action of hand cleansing.
Includes washing hands with the use of water, soap, or a soap
solution, either non-antimicrobial or antimicrobial, or applying a
waterless alcohol-based hand rub (ABHR) to the surface of the
hands. When performed correctly, hand hygiene results in a
reduction of microorganisms on hands.1
Healthcare Refers to infections acquired in healthcare facilities and
associated infection infections that occur as a direct or indirect result of healthcare
interventions and which may manifest after people leave the
healthcare facility.1
Healthcare facility Any facility that delivers healthcare services. This includes
hospitals, general practice clinics, dentistry practices, other
community-based office practices, day surgery centres,
emergency services, domiciliary nursing services, long-term
care facilities, aged care facilities, Indigenous medical services,
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Standard Operating Procedure
Introduction, October 2024
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alternative health provider facilities and other community
service facilities, such as needle exchanges.6
Infection The invasion of a host organism’s bodily tissues by
microorganisms and their subsequent multiplication, resulting in
disease-causing symptoms and the reaction of host tissues to
these organisms and the toxins they produce.7
ICP Infection prevention and control professional.
Isolation area A room or area in which patients are isolated or cohorted, who
are known or suspected of having a condition for which
transmission-based precautions are required to prevent
healthcare associated infections.
Microorganisms Most infectious agents are microorganisms. These exist
naturally everywhere in the environment and not all cause
infection (such as “good” bacteria present in the body’s normal
flora). Parasites, prions and several classes of microorganism—
including bacteria, viruses, fungi and protozoa—can be involved
in either colonisation or infection, depending on the
susceptibility of the host.6
Multidrug-resistant Microorganisms, predominantly bacteria, that are resistant to
organisms (MRO) one or more classes of antimicrobial agents.1
NSW Health Refers to local health districts, statutory health corporations,
organisation affiliated health organisations and administrative units within
the Health Administration Corporation, such as the NSW
Ambulance Service, HealthShare NSW and the Ministry of
Health.
Outbreak The occurrence of disease exceeding the expected level for a
given population within a specific timeframe. This includes
single cases of some diseases not previously seen or those that
have previously been eliminated. Typically, in healthcare this
has been defined as two or more cases, which should trigger an
outbreak management process.1
Patient care area The room or area in which patient care takes place.6
Patient surroundings The space temporarily occupied by an individual patient and the
items within it. This will vary between settings and will contain
surfaces frequently touched by the:
1. patient occupying that space (for example, bed, bedside table,
chair and personal belongings); and
2. staff member providing patient care (for example, monitors
and knobs).
Patient surroundings will vary with the patient setting, as
indicated in the samples that follow.
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Standard Operating Procedure
Introduction, October 2024
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Hospital inpatient setting
The patient surroundings will include items such as the patient’s
bed, bedside table, bed linen, monitors, other medical
equipment and personal belongings kept at the patient’s
bedside. The patient observation charts (and healthcare record)
are:
• part of the patient surroundings if, for example, they are on
the end of the patient’s bed
• not part of the patient surroundings if, for example, they are
kept outside the door to the patient’s room.
Patient surroundings do not include curtains, partitions and
doors between separate patient areas.
Operating theatre
The patient surroundings will include, for example, the top of
the operating table, arm board, anaesthetic machine and
trolleys.
Office-based care (for example, clinics or hospital outpatient
setting)
The patient surroundings will usually include any procedural
trolleys used and the examination table if the patient sits/lies on
it.
Patient’s home
The patient surroundings may include all items in the patient’s
home, including medical equipment.7
Personal protective Refers to a variety of protective barriers used alone, or in
equipment (PPE) combination, to protect mucous membranes, skin, and clothing
from contact with recognised and unrecognised sources of
infectious agents in healthcare settings.1
pH A measure of the acidity or alkalinity of a solution, numerically
equal to 7 for neutral solutions, increasing with increasing
alkalinity and decreasing with increasing acidity, as follows:
0 = maximum acidity
3 = moderate acidity
7 = neutral
11 = moderate alkalinity
14 = maximum alkalinity. 8
Risk The chance of something happening that will have a negative
impact. Risk is measured by the consequences of an event and
its likelihood.6
Risk assessment The review of a patient or clinical situation to determine risk of
adverse consequences.7
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Standard Operating Procedure
Introduction, October 2024
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Risk management Actions implemented to minimise or control risk.7
Routine Performed as part of usual practice; as opposed to the use of
additional measures in specific circumstances (for example,
where invasive procedures are conducted or in the event of an
outbreak).6
Soil Natural or artificial contamination on a device or surface
following its use or simulated use.
Soil can protect, harbour or assist the growth of
microorganisms and includes organic matter, inorganic matter,
blood tissue and other biological material. 9
Spillage Includes any liquid, tea stains, sticky substances.5
Staff For the purpose of the Environmental Cleaning Standard
Operating Procedure, staff refers to any person working in any
capacity within NSW Health, including contractors, students
and volunteers.
Standard precautions Standard precautions represent the minimum infection
prevention measures that apply to all patient care, regardless of
suspected or confirmed infection status of the patient, in any
setting where healthcare is delivered. These evidence-based
practices are designed to both protect and prevent spread of
infection among patients and health workers.1
Sterilisation Validated process used to render a product free from viable
microorganisms.9
Terminal cleaning Cleaning and disinfection process required after patient(s) with
transmission-based precautions has vacated the room, either
through room transfer or discharge.
Therapeutic Goods
Australia's regulatory authority for therapeutic goods. 10
Administration (TGA)
Transmission-based Additional work practices in situations where standard
precautions precautions alone may be insufficient to prevent transmission of
infection, such as, contact, droplet and airborne precautions or a
combination of these precautions.1
1
Infection Prevention and Control in Healthcare Settings (PD2023_025)
2
[Link]
3
Cleaning of the Healthcare Environment (PD2023_018)
4
Clinical and Related Waste Management for Health Services (PD2020_049)
5
NHS National Standards for Healthcare Cleanliness 2021
6
Australian Guidelines for the Prevention and Control of Infection in Health Care
7
Infection Prevention and Control Practice Handbook
8
[Link]
9
AS 5369:2023 Reprocessing of reusable medical devices and other devices in health and non-health
related facilities
10
[Link]
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Standard Operating Procedure
Introduction, October 2024
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