Patient safety is at high risk, particularly in high-risk environments like intensive care units and operating theatres which need the highest levels of sterility. Yet, they are always vulnerable to contamination. This is due to invasive procedures, frequent patient turnovers and the continuous movement of healthcare workers. Transmission of pathogens in such critical zones is often linked to gaps in environmental cleaning, inadequate waste management, inconsistent hygiene practices and insufficient involvement of non-clinical stakeholders, primarily patients and visitors. Ajay Brahma, General Manager of Gleneagles Hospital in Mumbai shares the challenges of and solutions for tackling HAIs effectively.
Cleaning practices must be continuously enhanced. This involves integrating both technology and standardisation to ensure optimal sanitation outcomes.”
— Ajay Brahma
Preventing Infections through Rigorous Cleaning
Preventing HAIs is an institutional priority of the highest order in intensive care units and operating theatres which can be categorised as high-risk zones. A rigorous multi-layered cleaning protocol ensures the microbial safety of these critical areas. This protocol is based on Centre for Disease Control and Prevention (CDC) and World Health Organisation (WHO) guidelines which the Hospital Infection Control Committee approves and implements.
In the intensive care units and areas of patient movement, all high-touch surfaces must be disinfected. These surfaces include bed rails, ventilator panels, monitors and infusion pumps. Disinfection can happen twice every shift and additionally if needed. Hospital grade cleaning solutions are used. A strict color-coded system ensures cleaning materials are kept separately, reducing the risk of cross contamination. Terminal cleaning is carried out after every patient is discharged. This involves full sanitisation of the bed space, medical equipment and surrounding surfaces.
In the operating theatres, a standardised cleaning routine is followed. This happens before, between and after surgical procedures. Preoperative cleaning involves damp dusting of all equipment and surfaces. At the end of the day, a terminal cleaning is carried out which covers all surfaces, ceilings and scrub areas. Weekly deep cleaning and fogging further ensure a sterile environment. All cleaning activities need to be supervised, logged and audited.
In addition to cleaning, barrier nursing practices should be rigorously enforced. Visitor access can be limited. All healthcare workers must practice hand hygiene using hand rubs before and after patient contact. The use of single use disposables and sterile gloves for all invasive procedures will ensure enhanced containment efforts, effectively reducing cross infection.
Engineering controls further elevate infection control practices and maintain ideal environmental conditions. In operating theatres, unidirectional laminar airflow systems provide 35 to 40 air changes per hour significantly reducing the microbial load. Positive pressure ventilation ensures clean air flows outwards. This prevents unfiltered air from entering the sterile space.
Triple layer air filtration captures airborne contaminants efficiently. This filtration comprises pre filters, micro filters and High-Efficiency Particulate Air filters (HEPA). Similarly, temperature and humidity in intensive care units, operating theatres and other critical areas can be monitored. They help in maintaining within optimal ranges to prevent microbial growth and support patient recovery.
Regular air sampling and surface swabbing are conducted in intensive care units and operating theatres. Results are recorded and reviewed periodically. HEPA Filters in operating theatres, transplant intensive care units and other areas undergo integrity tests every six months. Environmental surveillance serves as a critical quality check for cleaning and engineering systems. This helps in taking corrective actions if needed. It also reinforces a data driven approach to infection prevention.
Maintaining Consistent Hygiene with Efficient Manpower
Maintaining hospital-wide hygiene standards around the clock needs careful manpower planning, structured workflows and strong coordination amongst all stakeholders. A shift-wise cleaning standard operating procedure should be put in place. It categorises the hospital into high risk and low risk zones and defines occupancy-based manpower allocation. It also establishes clear cleaning frequencies and protocols.
High risk zones include intensive care units, CAT labs, emergency rooms, dialysis units and procedure rooms. These can be cleaned twice per shift and additionally whenever needed. Colour coded mops and dusters are used to differentiate between patient care areas and sanitation zones. This reduces the risk of cross contamination. Cleaning staff follows standard operating procedures under supervision. They should use only approved disinfectants.
A well-trained and accountable housekeeping workforce is key to maintaining consistency. Staff undergo structured induction and regular refresher training. This training covers infection control, chemical handling, biomedical waste management and personal protective equipment usage. Clear job roles help ensure accountability. Supervisors and the Infection Control Team can monitor compliance and escalate issues as needed.
Housekeeping services can be managed through carefully selected vendors. These vendors are contractually bound to uphold quality benchmarks, legal compliance and workforce welfare. This includes timely payment of wages, adherence to minimum wage regulations and provision of statutory benefits. These measures ensure sufficient manpower availability round the clock.
Engineering controls also support reduced human dependency. For example, homogeneous vinyl floorings, antimicrobial wall panels and seamless cove base designs eliminate dust traps. They also allow for easier maintenance.
Safe Segregation and Disposal of Biomedical Waste
Proper biomedical waste management is crucial to preventing environmental contamination and occupational hazards. One can follow a colour coded segregation protocol. This is in line with Maharashtra Pollution Control Board (MPCB) guidelines and Biomedical Waste Management Rules 2016. Waste should be segregated at source. It can be stored temporarily in Dirty Utility rooms on patient floors. These rooms are equipped with colour coded bins and adequate negative pressure ventilation to control any potential exposure.
At scheduled intervals, the waste should be safely transported from Dirty Utility rooms to the Central Biomedical Waste Storage Room. This should happen using closed trolleys via dedicated service lifts during non-peak hours. This minimises contact with patient areas. All staff involved in waste handling can wear appropriate personal protective equipment like gloves, aprons, masks and gumboots. They must be regularly trained on correct segregation, collection and internal transport protocols. The hospital can have a formal agreement with a vendor authorised by the MPCB or similar authority depending on location for final disposal of biomedical waste. Compliance is monitored through routine audits and documentation.
Leveraging Advanced Cleaning Technologies
Cleaning practices must be continuously enhanced. This involves integrating both technology and standardisation to ensure optimal sanitation outcomes. Manual cleaning remains a core part of environmental hygiene. However, it is strengthened through structured established protocols and the adoption of modern cleaning systems.
Apart from automated cleaning equipment, the 3-bucket method can be used. This is a best practice in hospital cleaning. It helps maintain the effectiveness of disinfection while minimising cross contamination. This system involves separate buckets for cleaning solution, rinsing and soiled water. By clearly separating these functions, the risk of redistributing contaminants across surfaces is reduced. It also ensures that the disinfectant applied remains potent and effective.
In addition, automated cleaning solution dispensers can be installed in the Dirty Utility rooms on every floor. These dispensers deliver accurate dilutions of cleaning and disinfecting agents ensuring consistency and reducing the margin for human error. This not only improves cleaning efficacy but also promotes safety for the housekeeping staff who handle these chemicals daily.
Fogging needs to be done in hard-to-reach corners and airspaces. Alcohol-based disinfectants can be used for rapid surface disinfection of medical equipment, monitors and high touch points. Air-handling unit filters need to be cleaned regularly. This contributes to better indoor air quality and infection control.
All cleaning activities can be validated by regular microbiological surveillance. This includes surface swabs and air sampling. This validates the effectiveness of disinfection efforts. The data gathered helps tailor the frequency and method of cleaning in different zones based on actual microbial load trends.
Adopting innovations like UV C sterilisation units, AI driven hygiene compliance monitoring and eco-friendly disinfectants are new ways to enhance efficiency and sustainability.
Engaging Patients and Visitors in Hygiene Standards
Infection prevention is a collective responsibility. It extends beyond the clinical workforce. At hospitals, patients and visitors can be actively involved in upholding hygiene standards. This happens through structured communication and awareness. Visitor access to critical care units should be strictly regulated. Where permitted, individuals are educated on hand hygiene, mask wearing and movement limitations.
In paediatric and neonatal care areas, mothers are guided on personal cleanliness and hygienic feeding practices. Educational signage in multiple languages and periodic awareness campaigns reinforce key practices throughout the hospital. In isolation scenarios for infectious diseases, families can be informed of the transmission risks. They need to be trained on appropriate precautions. Infection Control Nurses also serve as frontline educators. They ensure patients and their families understand their role in infection prevention.
Additional Measures for Infection Control
Infection control can be supported by a multi-layered approach. This goes beyond routine cleaning. Engineering controls play a vital role. These include negative pressure rooms for airborne infections, unidirectional laminar airflow in operating theatres and the use of dedicated isolation rooms to minimise cross contamination.
Hospitals maintain a strong focus on infection surveillance. It tracks rates of surgical site infections, catheter associated urinary tract infections, ventilator associated pneumonia and urinary tract infections. Regular air, water and surface sampling is carried out in critical areas. Findings can be reviewed by the Hospital Infection Control Committee. This committee also oversees policy updates.
Staff safety can be ensured through annual health checks and vaccinations, ongoing training and a robust incident reporting system. Every clinical department follows standardised infection control protocols. These are based on risk level and patient profile.
Hygiene is viewed as a continuous process. It is strengthened by monthly reviews, staff feedback and cross functional audits. Hospitals also explore innovative solutions such as AI-driven cleaning solutions & monitoring and eco-friendly disinfectants.
