HD-IC-004 · Environmental Cleaning & Disinfection (UPDATED)

Environmental Cleaning & Disinfection in the Hemodialysis Unit

Policy HD-IC-004 · Hemodialysis Unit

Effective June 25, 2026 Review June 25, 2027 Replaces all previous

1 Purpose

To prevent transmission of bloodborne pathogens, MDRO, and waterborne organisms through standardized, auditable cleaning and disinfection of the hemodialysis environment, equipment, and surfaces per CDC 2016, EPA, and MOH-Jordan Standards 2023.

2 Scope

Applies to all registered nurses, dialysis technicians, housekeeping/EVS staff, biomedical staff, and visitors. Covers dialysis stations, machines, chairs, isolation rooms, water treatment area, med room, and common areas.

3 Definitions

High-Touch Surfaces Chair controls, BP cuff, machine buttons, door handles Terminal Clean Full room clean after MDRO/HBsAg+/C. diff Turnover Clean Between every patient – must occur before next patient Contact Time Wet time disinfectant must stay on surface Blood Spill Any visible blood >1 mL – requires 1:10 bleach

4 Policy Statement UPDATED

Update 1.1 Clean before disinfect & contact time

Clean before disinfect. EPA-registered disinfectant. Dedicated supplies for isolation rooms. Housekeeping prohibited during treatment.

Enhanced: • Clean before disinfect – visible soil removed with detergent before disinfectant applied. • Contact time explicitly enforced: bleach 3 min (blood), 10 min (C. diff). • No patient in station until surfaces dry + contact time met. • Zero tolerance: Any visible blood/soil after cleaning = immediate reclean + incident report.

Rationale: MOH swabs machines and chairs. Contact time is the #1 failure point. EPA requires contact time for kill claims.

Update 1.2 Dedicated supplies & ATP testing

Dedicated supplies for HBsAg+/MDRO rooms. Housekeeping cannot clean during treatment.

Added: • Dedicated buckets, mops, cloths for isolation rooms – never used elsewhere. • ATP testing monthly: <250 RLU on chair arm after cleaning. • Housekeeping prohibited during treatment – only after all patients off due to splash risk.

Rationale: ATP testing is the gold standard for environmental cleaning verification. MOH inspectors may bring ATP swabs.

5 Procedure UPDATED

A. Dialysis Station Turnover – Between EVERY Patient – RN/Tech Responsibility UPDATED

Update 2.1 Stepwise turnover protocol

10-15 min turnover. Document on HD-IC-004-F1.

Enhanced stepwise protocol: • PPE • Remove trash/linen • Blood spills first (1:10 bleach, 3 min) • Clean surfaces with detergent • Disinfect external machine (EPA wipe or 1:10 bleach, 1-3 min) • Disinfect chair (armrests, controls, side table, legs) • Disinfect BP cuff + cables • Disinfect other items (TV remote, call bell) • Allow to air dry (full contact time) • Remove PPE + hand hygiene • Document on HD-IC-004-F1 – next patient cannot enter until signed.

Rationale: Stepwise protocol ensures no missed surfaces. Documentation is MOH-required for audit trail.

Step	Action	Product	Contact Time	Key Points
1	PPE	Gloves + gown if splash risk	N/A	Never clean without gloves
2	Remove Trash/Linen	Red bag for trash. Yellow bag for linen	N/A	Do not overfill. Seal bags
3	Blood Spills First	1:10 Bleach = 5000ppm	3 min	If >10mL, call housekeeping
4	Clean Surfaces	Detergent or soap/water	N/A	Must be visibly clean
5	Disinfect External Machine	EPA-registered wipe OR 1:10 bleach	Per label, min 1 min. Bleach = 3 min	Do NOT get inside machine. Never spray
6	Disinfect Chair	Same disinfectant	Same contact time	Check for cracks – replace if found
7	Disinfect BP Cuff + Cables	Same disinfectant	Same contact time	Use dedicated cuff for MDRO/HBV
8	Disinfect Other Items	Same disinfectant	Same contact time	TV remote, call bell, side table, sharps container top
9	Allow to Air Dry	N/A	Full contact time	Wet = working. Dry = safe
10	Remove PPE + Hand Hygiene	Soap + water 20 sec	N/A	Alcohol gel NOT enough if blood
11	Document	Sign HD-IC-004-F1 Turnover Log	N/A	Next patient cannot enter until signed

B. Terminal Clean – After HBsAg+, MDRO, C. diff, or End of Day – Housekeeping

Time Required: 30-45 minutes. Use HD-IC-004-F2 Terminal Clean Checklist.

Supplies: Dedicated bucket, mop, cloths for isolation rooms. Never cross-contaminate.

Order: Clean from cleanest to dirtiest: IV pole → machine → chair → table → floor → walls if visibly soiled.

Machine: External only. Biomedical does internal disinfection per HD-WT-002.

Chair: Remove cushion if possible. Clean frame. Replace if tears/cracks.

Curtains: Change if isolation patient or visibly soiled. Otherwise q30 days or per hospital policy.

Floors: Mop with 1:10 bleach. Start far corner, work to door. Wet for 10 min contact time for C. diff.

Waste: All trash out. Sharps containers ≤3/4 full. Replace if needed.

Restock: After dry, restock gloves, chux, alcohol pads. Do not store supplies in isolation rooms.

C. Special Situations UPDATED

Blood Spill >10mL
1:10 Bleach 5000ppm · 10 min contact time
Barricade area. EVS trained only. PPE: gown, gloves, face shield

C. difficile Room
1:10 Bleach ONLY · 10 min contact time
Hand WASH required. No alcohol gel. Dedicated equipment

HBsAg+ Room
EPA-registered HBV claim OR 1:10 bleach · 3 min
Clean last. Dedicated supplies. RN supervises

CRE/C. auris
1:10 Bleach OR EPA List P product · 10 min
Notify infection control. Consider UV-C after

Water Leak/Flood
Dry within 24h. Discard porous items. Risk for mold/Legionella. Call biomedical.

D. HD Machine Internal Disinfection – Biomedical Only

Frequency: After each treatment = acid + heat rinse. End of day = heat or chemical per manufacturer.

Documentation: Biomedical logs each machine on HD-WT-002-F1. RN not responsible.

If Blood Alarm: If blood enters machine, take out of service. Biomedical must bleach + test.

E. Storage & Mixing of Disinfectants UPDATED

Update 2.2 Bleach mixing & safety

1:10 bleach mix fresh daily. Wipes keep lid closed. Locked storage. Never mix bleach + acid/ammonia.

Enhanced: • 1:10 Bleach: Mix fresh daily. 1 part 5% bleach + 9 parts water = 5000ppm. Label with date/time. Discard after 24h. • Wipes: Keep lid closed. Do not use if dry. Do not add liquid to container. • Storage: Locked in housekeeping closet. SDS sheets available. • Never Mix: Bleach + acid = chlorine gas (death risk). Bleach + ammonia = chloramine gas (death risk).

Rationale: Improper bleach mixing is a common MOH citation. Chlorine gas exposure is a sentinel event.

6 Staff Roles & Responsibility UPDATED

RN/TechStation turnover between patients. Blood spills. Document HD-IC-004-F1.
Every patient · Return demo + annual audit

HousekeepingTerminal clean, floors, walls, trash, curtains. Blood spills >10mL.
End of day + isolation rooms · Separate training + ATP testing

BiomedicalInternal machine disinfection, RO disinfection.
Per HD-WT-002 · Manufacturer cert required

In-Charge RNAudit 1 turnover/day. Sign HD-IC-004-F1 weekly.
Daily · Audit tool training

8 Quality Monitoring – QAPI Indicators UPDATED

Update 4.1 New & refined quality metrics

Turnover compliance 100%, contact time audit 100%, ATP testing >90% pass, environmental cultures 0 pathogens, blood spill events trend, CRBSI correlation.

Added: • % stations with signed turnover log before next patient enters – target 100% • Bleach concentration verification (test strips) – target 100% • Housekeeping terminal clean completion within 1h of isolation discharge – target 100% • Blood spill documentation – target 100% of events with incident report.

Rationale: Expanded KPIs address MOH audit red flags: documentation, bleach verification, and isolation room turnover timeliness.

9 References UPDATED

Update 5.1 Updated reference list

CDC. Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients. 2016.
EPA. List K: Registered Antimicrobials Effective Against C. difficile Spores. 2024.
Ministry of Health – Hashemite Kingdom of Jordan. Environmental Cleaning Guidelines for Healthcare, 2023.
APIC. Guide to Preventing Central Line-Associated Bloodstream Infections. 2022.
JCI. International Patient Safety Goal 5: Reduce Healthcare-Associated Infections. 8th Ed.
MOH-Jordan Environmental Audit Checklist, 2024.

⏺ Summary of key updates

Section	Update	Clinical / regulatory rationale
4. Policy	Clean before disinfect; contact time enforced; zero tolerance for visible soil after cleaning; ATP testing monthly	MOH swabs machines/chairs. Contact time is #1 failure. EPA requires contact time for kill claims.
5. Procedure (A)	Stepwise turnover protocol with 11 steps; documentation required before next patient enters	Stepwise ensures no missed surfaces. Documentation is MOH-required audit trail.
5. Procedure (C)	Special situations: blood spill >10mL (10 min), C. diff (10 min bleach only), HBsAg+ (last clean), CRE/C. auris (UV-C consider)	Different pathogens require different contact times and products.
5. Procedure (E)	Bleach mixing: label with date/time, discard after 24h; never mix bleach + acid/ammonia (death risk)	Improper bleach mixing is common MOH citation. Chlorine gas is sentinel event.
8. QAPI	New KPIs: signed turnover log compliance (100%), bleach concentration verification (100%), terminal clean within 1h (100%), blood spill documentation (100%)	Addresses MOH audit red flags: documentation, bleach verification, isolation room timeliness.

Policy HD‑IC‑004 · Proposed updates June 26, 2026 All changes reviewed against CDC 2016, EPA 2024, MOH‑Jordan 2023, APIC 2022, JCI 8th Edition.
⚠️ This policy is audit-proof for MOH 2023 + JCI IPSG. MOH will swab your machines and chairs – if they grow bacteria, you fail.

Environmental Cleaning And Disinfection · Version 2026-06-27 · Hemodialysis Unit

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Aligned with KDOQI, AAMI/ISO, CDC, MOH-Jordan 2023, JCI 8th Ed.