Maintenance, Hygiene, Sanitation and Cleanliness

All devices, equipment and non-disposable products shall be reprocessed, as specified in the table of Spaulding’s Classification on the next page, prior to use with each customer.

Sheets, towels, disposable coverings and headrest covers used in treatment rooms shall be changed after each customer.

General maintenance shall be carried out at least once a day when the establishment is open.

NOTE : Spaulding’s Classification offers a framework to guide decision making concerning the cleaning and reprocessing of devices and equipment coming into contact with people.  It is based on the risk of infection that the expected use of various types of devices and equipment can create.  This method was developed in the mid 1960s by Dr.Earl Spaulding, chair of the Department of Microbiology and Immunology (1949-1972) of the School of Medicine of Temple University in Philadelphia.
SOURCE :  Norme spa du BNQ


Cleaning is carried out to remove dirt, dust and other substances that may harbour microorganisms or allow them to proliferate.  Cleaning is performed according to the following synergy: water+detergent+manual or mechanical action.  While the manual or mechanical action of removing dirt is essential, detergent acts by chemically binding greasy substances and other substances with water.

Disinfection and sterilization are not intended to remove microorganisms, but instead to eliminate them or at least prevent them from proliferating.  The result is achieved through a chemical or physical action (e.g. heat).  Objects and surfaces must be cleaned beforehand.  The difference between sterilization and disinfection lies in the relative degree of certainty (or probability) that microorganisms have been eliminated.

Sterilization is a longer and more complex process than disinfection; it offers a greater certainty that microorganisms have in fact been eliminated.  For example, in the case of an object exposed to a sterilization process, the likelihood that a bacterium will remain alive is less than one in a million.  For the same object exposed to a disinfection process, the probability of a remaining live bacterium will be one in a thousand.  Thus, it is understandable that sterilization is applied to ‘critical’ objects, while disinfection is intended for ‘semi-critical’ or ‘noncritical’ objects.

Moreover, the emergence of multi-resistant bacteria and of more virulent strains, which remain in the environment and resist the usual methods of cleaning, explains why the addition of a disinfection procedure is considered essential in certain cases.  Various factors influence the requirements for cleaning and disinfection.  Upkeep in care equipment must take into account the functional diversity of various equipment, i.e. the medical activities practiced, the type of care provided, the type of patient served (the patient’s susceptibility, whether or not he or she is a recognized pathogen carrier, etc.),  the number of patients served, the presence or absence of sinks, etc.  As such, some areas will require a particular standard of hygiene and sanitation, i.e. operating rooms, intensive care equipment, graft and transplant units, neonatal services, sterilization rooms, etc.