1. Training on Disinfecting and Cleaning

2. Environmental Services Department (EVS)
Mission Statement
It is the mission of the Environmental Services Department to
function as an integral part of Children's Hospital & Research Center
at Oakland and provide quality patient care by maintaining a high
standard of aseptic and physical cleanliness as well as a cheerful
environment, consistent with Children's Hospital & Research Center
at Oakland mission, goals, and values.
These services are vital to patient care providers in their mission of
“providing comprehensive pediatric inpatient and outpatient services
within the hospital’s total resources.”

3. New Regulations
During the past two decades, health-care-associated
infections (HAI), especially those that are resistant to
commonly used antibiotics, have increased dramatically
in California. MRSA is one example of an HAI. In
response to this growing issue, CA Senate Bill 1058 and
Senate Bill 158 were passed; which are known as the
Medical Facility Infection Control and Prevention Act or
Nile’s Law. This law was passed to manage and
minimize health-care-associated infections.
This new law requires more thorough cleaning and
sanitation to help control the transmission of infectious
diseases such as MRSA, VRE.

4. Regulatory Impact on EVS
 Regular disinfection of all restrooms, countertops, furniture, televisions,
telephones, bedding, door knobs office equipment, and surfaces in patient
rooms, nursing stations, and storage units. SB1058 (e)(2)
 Cleaning and disinfection of all movable medical equipment and transportable
medical devices within EVS responsibility. SB1058 (e)(3)
 Regular cleaning and disinfection of all surfaces in common areas in the facility
such as elevators, meeting rooms, and lounges. SB1058 (e)(4)
 Environmental services staff shall be trained by the hospital and shall be
observed for compliance with hospital sanitation measures. The training shall be
given at the start of employment, when new prevention measures have been
adopted, and annually thereafter. Cultures of the environment may be randomly
obtained by the hospital to determine compliance with hospital sanitation
procedures. SB158 (d)
 Hand Hygiene Compliance
 Knowledge of Universal Precautions

5. Center For Disease Control
The Center for Disease Control (CDC) report that
studies show there is a decrease in disease
transmission when housekeeping personnel
persistently follow cleaning procedures, which includes
increased cleaning and disinfection of frequently-
touched surfaces (e.g., bedrails, bedside commodes,
doorknobs).

6. Training Content
Hand Hygiene Compliance
Universal Precautions
Blood and Body Fluid Spills
Review of equipment,
furniture, and other areas that
Environmental Services
(EVS) is responsible for
cleaning and disinfecting
Cleaning procedures

7. Hand Hygiene
When do you need to wash your hands with soap and water?
Hands are visibly soiled
Before eating
After using the restroom
After cleaning every third patient room
Each time entering and exiting isolation rooms
When do you use an alcohol-based hand rub or hand washing with water
and soap?
Before and after direct patient contact
Before donning sterile gloves
After removing gloves
After contact with objects and equipment in the patient’s immediate vicinity
Between patient rooms

8. Hand Hygiene Policy
 Wash hands often and well, paying particular
attention to around and under fingernails and
between fingers. Sing “Row Row Row Your
Boat” (for 15 seconds) while washing your hands.
 All healthcare workers entering or working in the
patient care areas are not permitted to have
jewelry on fingers, artificial/acrylic nails, overlays,
tips, nail wraps, and/or any type of accessory.
This includes but is not limited to applications of
glue, and or any other substances that may
infringe upon the nails natural integrity. Natural
nails must not be longer than 3 millimeters above
the base, however 1 millimeter is preferred.

9. Universal Precautions
Standard Universal Precautions
 Are used for all blood, body fluids, secretions,
and excretions of all patients.
 Include wearing Personal Protective Equipment (PPEs)
whenever it is anticipated that you will come in contact with the
blood, body fluids, secretions, or excretions of any patient.
Personal Protective Equipment (PPE)
 Gloves should be used when performing a task where your hands may come in
contact with blood, body fluids, sections, or excretions of any patient.
 Gown should be worn when performing a task where it is anticipated that your
clothing will become contaminated with blood, body fluids, sections, or excretions of
any patient or when entering an Isolation Room and the OR.
 Mask/Eye Protection should be worn when performing a task where it is anticipated
that your eyes, nose and/or mouth will be contaminated by the splashing of blood,
body fluids, secretions or excretions of any patient or when entering an Isolation
Room (N95 for TB, surgical mask for Chicken Pox). Must be fit-tested for N95
respirator.

10. Handling Blood and Body Fluid Spills
 Wipe up all visible blood and body fluid spills
immediately using a mop or rag. Gloves must be worn.
 Disinfect the area with a hospital approved germicide.
 Floors which are wet should contain a safety sign to
prevent slips and/or falls.

11. Needles, Syringes & Other
Sharps
Environmental Services Responsibility
Use extreme caution when handling sharps.
Clean sharps container holder or bracket daily using damp cloth with
disinfectant.
Remove full sharps container from the Soiled Utility Room daily. Wear
gloves and ensure that the sharps container lid is securely closed.
All full disposal units are placed on an infectious waste cart and taken
to the outside medical waste storage area. Ensure the medical waste
storage area is locked.

12. Non-Sharps Biohazardous Waste
All bio-hazardous waste shall be segregated from other waste and
will be placed in single red plastic bags labeled “DANGER” -
BIOHAZARDOUS WASTE”.
Bio-hazardous waste bags shall be placed in bio-hazardous waste
receptacles located in the soiled utility room.
Biohazardous waste receptacles shall have tight-fitting lids and be
labeled “BIOHAZARDOUS WASTE”.
Daily: Reusable containers will be cleaned using one of the
following two methods:
 Thoroughly wash the container for 15 seconds using a hot water supply
of at least 180 degrees Fahrenheit, OR
 Clean with an approved germicide.

13. Non-Sharps Biohazardous Waste Continued
Standard biohazardous waste containers
are used to hold and transport single-
bagged bio-hazardous waste separate from
regular trash and soiled linen.
Remove the biohazardous waste from the
unit at regular intervals, tie a double knot at
the top of the bag and transport it to the
secured holding area wearing personal
protective equipment during transport.
The floor and general area will be cleaned
daily using an approved germicidal
detergent.
Ensure biohazardous waste storage areas
are locked.

14. What is EVS responsible for cleaning?
COMMON AREAS AND SHARED EQUIPMENT
Frequency: Cleaned upon discharge or transfer of patient and
daily as per Environmental Services (EVS) policy.
Cleaning Method: Quaternary Ammonium & upholstery cleaner.
Furniture Responsible
Department
Toys – Only wall mounted units, play
tables
EVS
Elevators EVS
Lobby Furniture EVS
Office Equipment EVS
Nursing Stations EVS
Storage Units EVS
Staff Lounge EVS
Public Restrooms EVS
Doorknobs EVS

15. What is EVS responsible for cleaning?
(continued)
PATIENT FURNITURE
Frequency: Cleaned upon discharge or transfer of patient and daily as per
Environmental Services (EVS) policy.
Cleaning Method: Quaternary Ammonium and upholstery cleaner.
Furniture Responsible Department
Crib EVS
Bassinet EVS
Bed EVS
Bedside Cabinet EVS
Bedside Table EVS
Closet doors EVS
Chair(s) EVS
Nightstand EVS
Overbed Table EVS
Television EVS
Telephone EVS
Counter tops EVS

16. What is EVS responsible for
cleaning? (continued)
REFRIGERATORS, ICE MACHINES, AND PIXIS
Frequency: Cleaned as needed and per department policy.
Cleaning Method: Use disinfectant.
Equipment Responsible
Department
Comments
Ice Machine EVS,
Engineering
EVS daily; Engineering for
PM
Pyxis EVS EVS surface only
Refrigerator, Staff Food EVS Cleaned once monthly,
defrost as needed

17. What is EVS responsible for cleaning? (continued)
PATIENT ROOMS AND EQUIPMENT
Frequency: Cleaning between each patient and as needed.
Cleaning Method: Quaternary Ammonium, unless otherwise noted.
Equipment Responsible
Department
Comments
All Surfaces in Patient Rooms EVS Including bathrooms and floors
Bed Overlay EVS
Commode EVS, Nursing Emptied by Nursing, disinfected by EVS.
Hardwired BP Monitor – ICU EVS Upon discharge
Highchair EVS, Nursing Upon discharge
Isolation cart EVS
IV Pole Nursing, EVS Nursing cleans as needed; EVS wipe down upon
discharge
Monitors/Lead Wires Monitor Tech,
Nursing, EVS
Discharge Clean: EVS
Between Patients: Nursing, Monitor Tech
Scale - bed EVS, Nursing EVS upon discharge
Scale - standup EVS
Sleep Chair EVS
Sliding Board EVS OR Only
Warming Table EVS

18. General Cleaning Instructions
 VIREX is the approved disinfectant used at Children’s Hospital
Oakland.
 Use the automatic mixer for proper dilution of cleaning chemicals.
 When dispensing chemicals, use the following personal protective
equipment: chemical splash goggles, chemical resistant gloves of natural
rubber latex, protective clothing and footwear.
 Use proper and approved supplies and equipment – being sure NOT TO
USE spray bottles.
 Establish a safe, clean environment within the seven steps and scope of
cleaning.
 Utilize cleaning and disinfectant methods prescribed in policies and
procedures.

19. Chemicals
Wear PPE
Know where MSDS (Material Safety Data Sheet) is located.
You should review the MSDS before using the product for the
first time.
Never store chemical near heat or electrical equipment.
Never mix chemicals. Never mix Ammonia and Bleach. Fumes
from this combination are deadly.
All bottles must be labeled. Never try to guess what is not
labeled.

20. Cleaning Occupied Patient Room Daily
 Follow seven step process
 Empty wastebasket, wipe, and
replace liner.
 Damp wipe furniture, fixtures, &
telephone.
 Damp wipe doorknobs.
 Damp wipe the door and door
frame.
 Spot clean walls, windows, and
baseboards, as needed.
 Inspect cubicle curtains for stains
damage and notify the
supervisor/manager if they need
to be replaced.
 Clean sink and wipe sink top
 Wipe bathroom light fixture; sink
pipes, mirror, towel box, and grab
bars.
 Wipe down shower walls and
door, and mop the shower floor.
 Wipe outside of toilet bowl and all
seat surfaces with disinfectant.
 Scrub toilet bowl with approved
toilet bowl cleaner.
 Replenish paper towels, toilet
tissue and seat covers, and
soap.

21. Cleaning Occupied Patient Room Continued
Daily
 Clean the top and sides of the television
 Dust the walls, clock, and picture.
 Clean ceiling lights (surface).
 Dust vents (outside only).
 Damp mop carpet, if any, along the baseboards.
 Scrub body oil, soap scum and rust from shower walls, door, and fixtures.
 Scrub vinyl furniture and/or vacuum fabric.
 Spot clean the windows and sills.
 Vacuum or damp wipe drapery valence/blinds.
 Wet mop floor with disinfectant.
 Report cracks, chipped paint, broken floor tiles, water-stained ceiling tiles
and other repair needs to supervisor/manager.
 Wipe sharps container holder/bracket. (For OPC, replace sharps container
when full)

22. Follow seven step process.
Notify nursing of patient items left behind.
Put patient assistance tent card on bedside stand. (if
applicable)
Re-arrange all furniture and do a visual check of the
room.
Notify nursing that the room is ready for occupancy.
Cleaning Patient Room After Discharge
Continued

23. Cleaning Isolation/Airborne Disease Patient
Room - Daily
 Wash hands.
 Put on mask and gloves, as required, immediately
before entering the room (and no sooner).
 Clean room using seven step process (same as
other patient rooms).
 Use three black bags for trash, two red bags for
medical waste, and two blue bags for linen.
Double bag trash, medical waste, and linen. Use
black trash bag for rags.
 Remove personal protective equipment and
properly dispose.
 Wash hands.
 Exit the room.

24. Cleaning Isolettes, Incubators, Cribs, and Ohio
Tables
Thoroughly clean the equipment using an
approved disinfectant.
After cleaning, use the Cleaning Log to verify
cleaning of equipment by lacing ID of bed, date
cleaned, attach a “clean YELLOW sticker”, and
initial the equipment.
EVS management will inspect the equipment to
make sure that it has been properly cleaned
and then date and initial the YELLOW sticker,
noting their approval of the equipment for use.
No equipment will be taken to the patient floor
area unless both the EVS Aide and
Management approval has been clearly noted
on the bed, with date included.
Equipment will be covered with plastic for
storage and during delivery to Nursery.

25. Main Hospital Bed Storage
Nursing will call Children’s EVS department
stating a need for bed(s) to be removed from a
floor. EVS will take the following action:
All beds removed from any patient care area
must be sanitized with a hospital approved
germicidal solution before removal and placed
in bed storage. This sanitation is the
responsibility of the area cleaner assigned to
the room from which the bed is removed.
No linen, toys, charts, etc. will remain on any
bed going to storage.
Nursing personnel will be responsible for
assuring the beds are sanitized and the
removal of the aforementioned items has
occurred.

26. Between Case/Terminal Cleaning Of
Surgical Suite
Environmental Services Aide
will change into scrubs before
entering the surgical suite.
Proper hand-washing
technique must be followed
before entering the surgical
suite.
Housekeeping equipment
used in the surgical suite is
not to be shared by any other
area.

27. Cleaning Of Surgical Suite
Continued
Post Case Cleaning
 Prepare equipment, clean, and check.
 Prepare germicidal solution in the mopping bucket and small plastic
pail.
 Proceed to the surgical suite, remove trash and soiled linen. Reline
trash receptacles and soiled linen hampers.
 Clean and disinfect the table bed, covering every surface.
 Disinfect all furniture (ring stands, kick buckets, tables, etc.), rinsing
cloth after each item in the same room.
 Disinfect (spot clean) walls and lights over the table bed.
 Damp mop floor with germicidal-detergent solution (move table bed for
mopping).
 Replace furniture and table bed in their proper place.

28. Between Case/Terminal Cleaning Of
Surgical Suite (Continued)
Post Schedule Cleaning
 Disinfect ceiling, walls, and fixtures on the walls, being careful not to get solution in or
behind hemostats, thermostats, X-ray screens, sterile cabinet doors, electrical
outlets, etc.
 Using double buckets lay germicidal-detergent solution on the floor, scrub and
vacuum up solution, leave a 12-inch wet strip close to and around the furniture that is
still in middle of the room.
 Replace the furniture, being sure to roll its wheels through the wet strip to disinfect
them. Then roll the table bed through the solution to one side of the room.
 Disinfect the light fixtures.
 Lay solution on the floor in the middle of the room, scrub and vacuum up the solution.
 Replace the table/bed to its proper place.
 Clean all equipment used with germicidal solution thoroughly and store properly.
 Corridor ceilings and walls will be disinfected monthly, spot wash as needed.

29. Micro Mop System
Micro Mop is used in all patient
rooms.
One or more micro mops must be
used (according to the condition of
the room) for each patient room.
Used micro mop must not be reused
in another room.
Dirty micro mops must be deposited
in the area located on the 1st
Floor
EVS Supply Room.

30. Micro Mop System Continued
Get the amount of mops for the number of
rooms, plus two (2) extra.
Use germicidal solution only.
Attach the micro mop to the base of the handle.
Place the wet sign outside the door before
starting to mop following the Seven (7) Steps
standard cleaning procedure.
To use the bottle chemical solution, pour the
chemical directly to the micro mop until you get
the right consistency to wet the mop. Mop the
floor following the Seven (7) Steps standard
procedure.

31. Cleaning Procedure (Linen Carts/storage)
Exchange Carts
Carts shall be wiped down weekly with a germicidal solution.
Exchange Cart Cover
Cover shall be wiped down weekly using a germicidal solution.
Linen Room
Dusting shall take place once a week with a germicidal
solution (including fans, vents, shelves, desk, tables,
chairs, etc.). The floor shall be swept and mopped daily.
The floor shall be buffed every other week and waxed as
needed. Empty trash daily.
Clean Linen Closets
Once a week shelves shall be dusted with a germicidal
solution.

32. Soiled Linen
 All soiled linen must be disposed of in the proper plastic liner
(blue), which is designated by color to identify it as soiled
linen. The bags must be tied at the top to prevent spills.
 EVS is responsible for the removal of soiled linen and will
transport the individual bag(s) to a designated holding area.
 EVS personnel disposing of the soiled linen will unlock the
door to the interim holding area and place the bag(s) in the
transport carts. The door will be locked after each use.
 Soiled Linen Collection Room:
o Carts will be located in the collection room to receive
the bagged linen. These carts will be transported on a
specified schedule.
o The cart used for transporting soiled linen will be loaded
onto the trailer provided by the linen supply vendor and
picked up by the linen vendor per the agreed upon
schedule.

33. Cleaning Public Restrooms
Daily: Using the Seven (7) Step Process
 Replenish soap and paper supplies as needed.
 Remove trash, clean container and replace liner.
 Empty sanitary napkin receptacle. Replace liner.
 Clean sinks.
 Damp wipe light fixtures and mirrors.
 Damp wipe walls and partitions (including top of partitions). Report any
graffiti, which cannot be removed.
 Clean toilets and urinals. Wipe outside of toilets and urinals and all seat
surfaces of toilets with germicidal detergent. Scrub inside of toilet bowls and
urinals with approved toilet bowl cleaner.
 Damp mop floor.
 Clean vent.

34. Public Restrooms (Continued)
Per Periodic Cleaning Schedule
Machine scrub the floors.

35. Cleaning Elevators
Daily
Lock off elevator; place caution signs at doorway.
Pick up large pieces of debris.
Clean surface with germicidal solution.
Clean elevator tracks. Vacuum using a crevice tool
and damp wipe to remove spots and dried on soil.
Dust mop or vacuum floor, as appropriate.
 Remove gum and other sticky substances with putty
knife.
Wet mop floor.
Polish all stainless steel, particularly door edges.
Remove caution signs and turn on elevators.
Weekly or Per Periodic Cleaning Schedule
 Machine scrub and buff floor.
 Re-apply floor finish.

36. Cleaning Lobbies And Waiting Rooms
Daily
Straighten magazines, discard
unattended or day old
newspapers.
Damp wipe all furniture and
fixtures, including door knobs
with germicidal detergent
Spot clean walls.
Clean windows and glass.
Spot clean and vacuum carpet.
Empty trash receptacles, clean
and reline.

37. Cleaning Lobbies And Waiting Rooms
Continued
Daily Continued
 Clean the baseboards.
 Scrub furniture as needed with cleaner and
scrub pad or spot clean fabric, as appropriate.
 Clean windowsills and blinds.
 Dust walls and wall fixtures.
 Damp wipe furniture surfaces, door, door
frame and door knobs with germicidal solution.
 Clean vents.
 Clean carpets.
 Clean ceiling light fixtures.

38. Cleaning Conference Rooms
Daily (And Between Conferences, As Needed)
If food and beverage is still in the room, check
to ensure conference is over.
Empty trash, wash receptacles if necessary,
replace liner.
Damp dust all furniture, telephones, counters,
doorknobs with germicidal solution.
Spot clean walls.
Vacuum and spot clean carpet.
Clean baseboards.
Remove fingerprints and spots from glass and
windows.
Clean chalkboards and/or greaseboards.
Set up conference for next meeting as per
schedule.

39. Cleaning Conference Rooms Continued
Daily (continued)
Damp dust lights and walls.
Clean wall hangings, pictures and clocks.
Clean vents.
Per Periodic Cleaning Schedule
Shampoo carpet.
Clean windows.
Damp dust ceilings.
Vacuum chairs per schedule.

40. Monitoring Success
 EVS Manager and/or Supervisors will observe and document compliance with
sanitation measures daily
 Infection Control will ensure random cultures of the environment are obtained to
determine compliance with hospital sanitation procedures.
 Documentation tools include:
• Attendance Roster at Mandatory meetings held three times per year
• New Employee Orientation records
 EVS will work with Infection Control to ensure hand hygiene compliance.
 The EVS Manager and/or Supervisor will observe hand hygiene compliance and
document staff actions at least weekly and submit a monthly report.
 The Hand Hygiene Audit Compliance Tool will be used.
 The EVS Manager and/or Supervisor will audit and document (e.g. through
environmental tours) staff for knowledge and ability to describe Universal Precautions.
 EVS will be evaluated through an EVS focused objective survey on infection control
practices at least annually.