Introduction and Summary

Step one –  Establish for Protection  – involves laying out the specific parameters of the cleaning, disinfection and infection control program including, the standard of cleanliness expected, what cleaning/sanitizing/disinfecting tasks are required to achieve the standard, when such tasks will be performed, who is responsible for performing tasks, and what products, tools and equipment will be used.

Note: The protocols set forth in the PiP program are based on best practices but should be viewed as recommendations. LTC facilities must review their specific circumstances and the unique features of the facilities when establishing a scope of work.

 Setting Standards 

Long-Term Care facilities must first determine the level of cleanliness they wish to attain. This helps with monitoring, inspections, and accountability.

The  Partners in Protection  program recommends two cleanliness rating systems:

  • Triple S Inspection and Evaluation Rating System for Cleanliness (TIERS-C) – Based on a “reasonable” person standard, the TIERS-C system sets forth four color-coded levels and includes easy-to-answer questions that help dictate compliance
  • APPA “Five Levels of Clean” – Sets forth five numerical levels from “Orderly Spotlessness” to “Unkempt Neglect”

Additional, detailed information on both rating systems is available under Section Three – Inspect for Protection.

Cleaning Protocols

The “heart” of the PiP program is a series of best practice protocols that set forth:

  • The tasks to be performed
  • When service should specifically take place (how often)
  • Who is responsible for performing the tasks

As such, the protocols serve as a comprehensive scope of work for school facilities. The PiP program provides the protocols in two customizable excel documents. The first lists the protocols by room/area type with each tab at the bottom of the sheet representing a different room (Make sure you scroll all the way to the end of the document to access all 16 room types). There is also a note at the top of the page that defines the room type and specifies applicability. Facilities should use the matrix to outline precisely what tasks will be performed and on which items, surfaces and areas, as well as how often the tasks will be performed. The room/area types included are:

The protocols are also available in an excel matrix that lists the tasks to be performed by day. This makes it very easy to quickly determine what needs to be done on a given day.

Note: The day protocol listing is intended to serve as an example of what a comprehensive program looks like. Facilities will need to carefully review the matrix to ensure tasks are assigned to the right days given their unique situation.

In establishing the protocols for a LTC facility, consider unique circumstances, keeping in mind that the tasks, frequencies, and responsibilities need to be practical and aimed at removing microbes and the conditions that help them survive. Facilities may also find themselves in a situation where they cannot access the recommended or needed products. In such cases, they will need to find an alternative solution.

  • For example, if a Long-Term Care facility is not able to access enough presaturated wipes, they may use a chemical product with either a reusable microfiber wipe or with untreated wipes and a charging bucket.

In establishing protocols, pay special attention to  “high-touch”  and  “high risk”  items and surfaces, including:

  • High-Touch – Surfaces and items that are touched by a variety of hands over the course of a day. Note: Items/areas touched by only one person such as a personal computer keyboard, do not pose as great of a risk even if touched frequently during the day.

Common high touch surfaces:

  • High Risk – Surfaces and items where there is an increased risk for bloodborne incidents, skin contact, object-to-mouth contact or contact with body fluids. Examples of high-risk areas include the nurse’s office, rehabilitation areas and athletic areas (gym mats, exercise equipment, and locker rooms).

There are also things a facility can do to reduce the need to clean or to make tasks much easier, including:

  • Limit or eliminate the number of soft or porous surfaces
  • Consider low-touch or no-touch equipment
    • Paper towel & hand soap dispensers
    • Toilet flush valves
    • Faucets
    • Light switch motion sensors
    • Door opening technology
    • Waste receptacles
  • Remove or limit use of high-touch shared tools such as writing utensils, remote controls, etc.
  • Establish a “non-sharing” policy that disallows the sharing of towels, drinks, mobile devices, etc.

The PiP program package also provides a traditional Scope of Work/Cleaning Plan and a Staffing Productivity Square Footage Chart for easy benchmarking. Individual sheets outlining room-specific guidelines are also available for quick reference.

 Hand Hygiene 

Hand Hygiene is a crucial component of the program and recommendations regarding hand hygiene are included at the top of each excel protocol sheet. Keep the following in mind when developing a hand hygiene policy:

  • Traditional hand washing with soap and water is the primary option. If a sink is available, individuals should wash their hands for at least 20 seconds following CDC recommendations.
  • Patients and staff should be encouraged to wash/sanitize their hands frequently throughout the day, especially after touching high touch items and surfaces, before and after eating, and after all activities that present a risk of transmission.
  • Hand sanitizer dispensers should be placed in the most optimal locations. They must be prominently visible and located in places where patients and staff will constantly pass them, including at the front of the room.
  • Dispenser types include countertop, wall mounted and floor stand. Placing a jug or bottle in a visible and known location is also an option.
  • If patients or staff will use wipes, the best practice is for them to wash/sanitize their hands following use.

 Collaborative Cleaning 

The PiP program is based on an innovative concept called  “Collaborative Cleaning” . Key features of “Collaborative Cleaning” include:

  • An understanding it is the responsibility of everyone – EVS technicians, nurses, staff, and residents/patients- to keep LTC facilities clean and healthy, and everyone will be asked to play an active role.
  • Everyone must understand the need to take care of their individual area and workspace
    • General Staff: Work areas, desks/chairs, and equipment
    • Rehabilitation Staff: Equipment and mats
    • Nurses: Medical spaces and medical equipment
    • Food Service Workers: Food preparation and service areas
  • Safety is paramount. Individuals with compromised immune systems and other vulnerabilities should not be asked to use hazardous products.
  • Nurses, staff, and residents may be asked to use disinfectant products. They must be fully trained on the proper use and storage of such products as well as all elements of the Hazard Communication Law (including how to read a Safety Data Sheet and the location of the sheets).
  • If needed, all classrooms and offices should receive a labeled spray bottle for use.
  • Note: LTC facilities should expect some pushback from individuals who are hesitant to take an active role when it comes to cleaning. Stress the importance of a joint effort given the unique nature of a LTC building and the importance of keeping all areas healthy.

Included in the PiP program package is a document specifically highlighting the “new” protocols that are based on Collaborative Cleaning.

 Products and Equipment 

Selecting the best products, tools and equipment for the job can be a challenge. Once a facility has established a specific scope of work, they should discuss their options with their Triple S partner. When selecting products, the following guidelines apply:

  • Staff should not bring their own products.
  • Carefully review product labels and closely follow instructions.
  • Different ingredients or combination of ingredients kill different pathogens. Ensure the selection of disinfectants that are intended to eliminate the pathogens the facility is concerned with.
  • Ensure product compatibility with the surface on which it will be used.
  • Consider the orientation of the surface (horizontal or vertical) and what application process will work best. Ensure the application will keep the surface wet long enough to meet the dwell time.
  • Price – Review the total in-use cost. It is important to know the per-use spend (e.g. per quantity).
  • Make sure all disinfectants and sanitizers are EPA registered and effective against the specific pathogens you wish to reduce or kill.
  • Unscented disinfectants can help prevent asthma and allergy episodes.
  • Disinfectants should not be used on food contact surfaces. A food surface sanitizer should be used.
  • Microfiber is a preferable option. It has proven to be more effective and increase productivity.
  • Sponges and dishcloths are not recommended due to the risk of cross-contamination and microbial growth.
  • Use buckets with separate areas for clean and dirty water.
  • Vacuums – High-efficiency filtration equipment to prevent the introduction/spread of particulates is preferred.
  • Make sure there is a waste receptacle in all rooms where wipes will be used (for disposal).

A comprehensive list of products that will be needed to fully implement the PiP program is included to help LTC facilities ensure they have a complete inventory of what they need.


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