Nurse Aide Increased Infection Control
Module 5: Environmental Cleaning and Disinfecting


 Thank you


Welcome to Module 5: Environmental Cleaning and Disinfecting. We are glad you're here!


What you learn in this class will help keep you, and your residents, safe. 


Module 5 will describe the role environmental surfaces play in pathogen transmission and the Centers for Disease Control and Prevention (CDC) recommended practices for cleaning and disinfecting environmental surfaces.




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Order of Modules

This course is designed to increase your infection control knowledge in long-term care environments. Information from this CBT can be directly applied to your daily activities as a nurse aide.


This course has five modules. You must save or print the certificate at the end of each module. Keep these certificates as proof of completion.

  • Module 1: Introduction to Pathogens
  • Module 2: Chain of Infection/Modes of Transmission
  • Module 3: PPE
  • Module 4: Standard and Transmission-based Precautions
  • Module 5: Cleaning and Disinfection


There is no way to create a lost certificate of completion without taking or retaking the course. If you do not keep a copy for your records, you will need to repeat this course.


Let's get started!

Lesson Objectives


In this CBT, we will:


  • Describe the role of environmental surfaces in the transmission of pathogens;
  • Discuss recommended practices for cleaning and disinfecting environmental surfaces; and
  • Identify best practices for collection and cleaning of linens.


Environmental Surfaces


Before we describe the role of environmental surfaces in pathogen transmission, we should define what we mean by environmental surfaces.


"Environmental surfaces" refers to the surfaces of resident care equipment and housekeeping surfaces like floors, walls, bed rails, and doorknobs.


Housekeeping surfaces can further be divided into those with minimal hand contact, such as floors and ceilings, and those with frequent hand contact, which are referred to as high-touch surfaces. High-touch surfaces include doorknobs, bed rails, light switches, and wall areas around the toilet.


This module will focus on the role of housekeeping surfaces in pathogen transmission.


Environmental Surfaces & Pathogens

Environmental surfaces in the healthcare environment are frequently contaminated with pathogens.


Once pathogens like C. diff have contaminated environmental surfaces, they can survive for long periods of time if proper cleaning and disinfection are not performed.


Let's look at the duration of survival of some common pathogens in healthcare settings on dry, inanimate surfaces.



Survival Time

C . Diff

5 months

E. coli

15. hours-16 months


8 hours-7 days


7 days-7 months

Hepatitis B

1 week




Environmental Surfaces & Cleaning

Environmental surfaces are considered non-critical because they only contact intact skin.


As such, environmental surfaces should be cleaned according to either low-level or intermediate-level disinfection.


Let's review the definitions of cleaning, low-level disinfection, and intermediate-level disinfection.


nursing home

Cleaning vs. Disinfection

Cleaning refers to the removal of visible soil from surfaces through the physical action of scrubbing with detergents and surfactants or detergent and water.


This step is important to reduce the volume of organisms on the surface and remove foreign material that could interfere with disinfection.




Disinfection refers to the reduction or killing of pathogens using chemicals.


Low-level Disinfection

Low-level disinfection refers to the use of an agent that destroys all vegetative bacteria (except tubercle bacilli) and destroys most viruses - including Hepatitis B virus (HBV), and human immunodeficiency virus (HIV). These agents are not effective against bacterial spores.


Examples of low-level disinfectants include hospital disinfectants registered with the Environmental Protection Agency (EPA), with a HBV and HIV label claim.


Low-level disinfection is generally appropriate for most environmental surfaces.


Intermediate-level Disinfection

Intermediate-level disinfection refers to the use of an agent that kills a wider range of pathogens than a low-level disinfectant but does not kill bacterial spores.


EPA-registered hospital disinfectants with a tuberculocidal claim are intermediate-level disinfectants.


Intermediate-level disinfection should be considered for environmental surfaces that are visibly contaminated with blood.


However, a low-level disinfectant with a label claim against HBV and HIV could also be used.


Product Selection

Decisions about product selection should be made in consultation with environmental services staff.


Even if your facility has a contract for environmental services, you should be aware of the cleaning and disinfection products that are being used and ensure that they are appropriate.


You should select and use disinfectants that are EPA-registered and labeled for use in healthcare settings.


These will typically have "hospital-grade disinfectant" or "hospital disinfectant" on the product label.


There are many factors to consider when selecting the ideal disinfectants for use in your facility.


Let's review a few on the next slides.


Product Selection: Kill Claims

Kill claims, or information about which pathogens the disinfectant kills, are available on the product label. The EPA maintains lists of registered products organized by the pathogens the disinfectant kills.


These lists are available at the EPA registered disinfectants web page.


For most situations in a nursing home, any of the EPA-registered hospital-grade disinfectants are adequate and should kill many bacteria and bloodborne viruses.


You will also want to ensure the availability of products that are effective against norovirus and C. difficile. 


Product Selection: Contact Time


Contact time refers to the time a disinfectant should be in direct contact with a surface to ensure that the pathogens specified on the label are killed.


Disinfectants with long contact times, such as 10 minutes, may require more than one application to ensure that the contact time is met. For ease of use, you may consider selecting products with shorter contact times.


If the contact time is not followed, residual pathogens could be left on the surface.


Product Selection: Ease-of-use

  • Does the product clean and disinfect in a single step?
    • Some products are labeled as a one-step cleaner and disinfectant, and a distinct cleaning step may not be required if the surface is not grossly soiled. If you select a one-step cleaner and disinfectant, you should review the instructions for use to ensure that the product is being used correctly, as there may be different instructions if the product is being used as a cleaner versus a disinfectant.


  • Are the directions for use simple and clear?


  • Does the product come in forms that meet your facility's needs?
    • Forms like liquids, wipes, and sprays may be needed.


  • Can the product be used in the form provided?
    • Or, is mixing or dilution required? Some facilities may select ready-to-use products to limit potential errors with mixing or dilution or exposure of staff to concentrated products.


It is important that you understand the directions for use of the product that your facility uses.


Cleaning and Disinfecting Practices

Following the instructions for use included in the product labeling is important to ensure that the pathogens specified on the label will be killed. 


Here are a few instructions you should make sure not to overlook:


  1. Is the disinfectant in a ready-to-use format? 
  • Do not mix or dilute unless specified in the label.
  • Follow instructions for how frequently fresh solution should be prepared.
  • Label diluted cleaning solutions (dilute solutions can be a reservoir for pathogens, particularly if the solution is prepared in a dirty container, stored for long periods of time, or prepared incorrectly)
  • Do not "top off" or add new solution to containers of old solution.
  • Ensure the product is not past its expiration date.


  1. Is a cleaning step required before application?
  • Even if you are using a one-step cleaner and disinfectant, if the surface is grossly soiled, a distinct cleaning step may be required before application of the disinfectant.


  1. Read the label:
  • How should you apply the disinfectant?
  • How long should it remain in contact with the surface?
  • How many towelettes or how much disinfectant do you need to use for the area you are disinfecting?


  1. Is the disinfectant compatible with the surface on which it is to be used? 
  • Do you know which disinfectants are intended to be used on which surfaces and under which circumstances if your facility uses multiple disinfectants? For example, stainless steel surfaces may require the use of specific products to protect against damage.



Standardized Process

If you clean surfaces in the wrong order or if you don't follow the recommended practices for the use of cleaning equipment, you may spread pathogens in the environment. Therefore, you need to develop a standardized process to ensure that you are cleaning and disinfecting surfaces appropriately. 


Lapses that can result in the spread of pathogens in the environment include:

  • Failure to clean and disinfect all surfaces.
  • Cleaning and disinfecting surfaces in the wrong order.
  • Failure to follow recommended practices for use of cleaning equipment.


Your facility should have a standardized process with a recommended order for cleaning/disinfecting surfaces.


The process may include the following principles: 


  • Always work from the cleanest surfaces to the dirtiest surfaces. For example, when cleaning a resident room, the bathroom should generally be cleaned last. 


  • Work from top to bottom. This builds on the principle of working from clean to dirty. Higher, harder-to-reach surfaces are less likely to be contaminated. Also, if any debris falls from the higher surfaces, you will have a second chance to clean it when you move to the lower surfaces. 


  • Consider establishing a consistent process or pattern for cleaning and disinfecting surfaces in the room. This helps ensure that surfaces won't be skipped. 


  • Wipe surfaces in a manner to prevent recontamination. For example, don't wipe clean surfaces with a used cloth. This way you won't risk recontaminating a surface that you've already disinfected.




Using Cleaning Equipment Appropriately

You should ensure that cleaning equipment is used appropriately. Consider the following practices:


  • Change cleaning cloths frequently. You will need to use multiple cleaning cloths per room.
    • If you are using a bucket system to dispense your disinfectant - do not dip the cloth back into the bucket after it has been used to wipe a surface.
  • As best practice, change mop heads after use in each room. This may not be the practiced procedure in your facility. You should ALWAYS refer to your facility policy, as you may be held to different requirements
  • Environmental services carts should not enter resident rooms, and supplies brought into the room should be limited to the minimum necessary for that space.


  • Any equipment that enters the room of a resident on Contact Precautions should be cleaned and disinfected before use in another location.



Note: Carts are commonly used by staff to transport supplies throughout the facility. However, if they are not regularly cleaned and disinfected, carts can also serve as a source of pathogen transmission. To minimize the role of carts on pathogen transmission, they should not enter resident rooms and should be cleaned and disinfected at least daily.


Cleaning Resident Rooms

Multiple studies have demonstrated that patients admitted to a room in which the prior occupant was infected or colonized with a pathogen were more likely to acquire that pathogen during their hospital stay than patients who were admitted to rooms in which the prior occupant was not infected or colonized.


You must consider cleaning and disinfection frequencies of resident rooms both for routine purposes and during terminal cleaning. 


Routine cleaning and disinfection for resident rooms:

  • Horizontal surfaces with infrequent hand contact, like floors and window sills, should be cleaned:
    • On a regular basis (i.e., daily);
    • When spills occur; and
    • If the surfaces become visibly soiled.


Terminal cleaning of a room is performed when a resident has been discharged or transferred and the room is being prepared for another resident.

  • All high-touch surfaces should be cleaned and disinfected.
  • Horizontal surfaces with infrequent hand contact, like floors and window sills, should also be cleaned and disinfected.
  • All linens, including sheets, towels, and privacy curtains, should be bagged and removed for laundering.


Cleaning Resident-Care Equipment

For non-critical equipment, such as blood pressure cuffs or blood glucose monitoring devices, your facility should use either dedicated, disposable items or clean and disinfect equipment with an EPA-registered disinfectant prior to using them with another resident.



washing machine

The nursing facility must have available, at all times, a quantity of linen essential for the proper care and comfort of residents.


Linens must be handled, stored, and processed to control the spread of infection.


While contaminated laundry and fabrics may contain pathogens, the risk of disease transmission during the laundry process is low.


Contaminated textiles and fabrics often contain high numbers of microorganisms from body substances, including blood, skin, stool, urine, vomitus, and other body tissues and fluids.



Much of the disease transmission from contaminated laundry is due to handling soiled fabrics inappropriately.


Handle soiled laundry as little as possible, and never shake/agitate the dirty laundry. Don't "hug" the soiled items - Always carry soiled laundry away from your body. In addition, always wear gloves and follow standard precautions.


This includes washing your hands both after handling soiled linen and before handling clean linen.


Bacteria ( SalmonellaBacillus cereus ), viruses (hepatitis B virus [HBV]) and ectoparasites (scabies) presumably have been transmitted from contaminated textiles and fabrics to workers via:

  • direct contact or
  • aerosols of contaminated lint generated from sorting and handling contaminated textiles.



According to the CDC , there is an estimated 5-billion pounds of items laundered in health care settings annually.


Because there are relatively few cases of transmission due to laundry alone, we can assume that existing control measures are effective in reducing the risk of disease transmission to residents and staff.


Through a combination of soil removal, pathogen removal, and pathogen inactivation, contaminated laundry can become hygienically clean.


The Laundry Process: Collection

The laundry process starts with the removal of used or contaminated textiles, fabrics, and/or clothing from the areas where such contamination occurred.


Contaminated linens and fabrics are placed into bags at the site of collection. These bags are then securely tied or otherwise closed to prevent leakage.


A single bag is usually sufficient for containing laundry, but leak-resistant containment is needed if the laundry is wet and capable of soaking through a cloth bag.


If the outside of the collection bag is wet or visibly dirty, double bag the laundry.


Bags containing contaminated laundry must be clearly identified with labels, color-coding, or other methods so that health-care workers handle these items safely, regardless of whether the laundry is transported within the facility or destined for transport to an off-site laundry service.


Personal clothing that is not soiled with body wastes may be stored in a closed container in the resident's closet. The clothing must be collected and cleaned at least weekly.


The Laundry Process: Storage and Transport

laundry cart

Soiled linen and clothing must be stored separately from clean linen and clothing. Soiled linen and clothing must be stored in well ventilated areas and must not be permitted to accumulate in the facility.


Soiled linen and clothing must be transported in accordance with procedures consistent with universal precautions. Bags or containers must not be reused to transport or store clean items.


When transporting contaminated linens via cart, be certain that you do not use the same cart for both dirty and clean linens. If you must utilize the same cart, you should thoroughly clean and disinfect the cart between clean and dirty transports.


The Laundry Process: Sorting and Washing

Soiled linen must not be sorted, laundered, rinsed, or stored in bathrooms, resident rooms, corridors, kitchens, or food storage areas. The exception is soiled linen and clothing that is not contaminated with blood. These may be rinsed in a resident's toilet.


Sorting of laundry should be done in the designated laundry area. The order of sorting depends on the needs of your facility


Sorting after washing minimizes the exposure of laundry workers to infectious material in soiled fabrics.


Sorting laundry before washing protects both the machinery and fabrics from hard objects (e.g., residents' property) and reduces the potential for recontamination of clean fabrics. Sorting laundry before washing also allows for customization of laundry formulas based on the mix of products in the system and types of soils encountered.


Sorting Laundry

Linen must be washed, dried, stored, and transported in a manner which will produce hygienically clean linen. The washing process must have a mechanism for soil removal and bacteria kill. Normal laundry cycles should be used according to the washer and detergent manufacturer's recommendations.


Cleaned wet textiles, fabrics, and clothing are then dried, pressed as needed, and prepared (e.g., folded and packaged) for distribution back to the facility.



Policies & Procedures

You are responsible for knowing the recommended practices for cleaning and disinfecting laid out by your facility's Infection Prevention Control (IPC) program.


Your knowledge of the cleaning and disinfection policies and procedures should include:

  • An understanding of the terms "cleaning" and "disinfecting."
  • The purpose of the policies and procedures. 
  • Identifying the supplies that are necessary for cleaning and disinfecting
  • The frequency of cleaning and disinfection in different locations throughout the facility.
  • Knowing which products should be used under different circumstances.
    • For example, if a resident has been placed on transmission-based precautions, you would want to ensure that the products used to clean and disinfect surfaces in their room are effective against the pathogen of concern.  
  • An outline of the steps and workflow processes for cleaning and disinfecting surfaces.
    • Measures that should be taken to minimize contamination of cleaning equipment (such as not dipping a used cleaning cloth or mop back into disinfecting solution).
  • Which PPE should be used when cleaning and disinfecting environmental surfaces. 
    • The PPE should protect against both exposure to blood and body fluids and the cleaning and disinfecting products.
  • The steps for cleaning and disinfecting spills of blood or body fluids.



Objectives Review


In module 5 we have:

  • Described the role of environmental surfaces in the transmission of pathogens;
  • Discussed recommended practices for cleaning and disinfecting environmental surfaces; and
  • Discussed best practices for collection and cleaning of linens.


The following slides will include a short concept check to help you demonstrate your understanding of the content provided.





You have successfully completed Module 5: Environmental Cleaning and Disinfection


Please review your score.

Save or print your certificate for your records.

Remember, there is no way to create a lost certificate of completion without retaking the course. If you do not keep a copy for your records, you will need to repeat this course.