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Infection Control

Maintaining nursing homes

September 19, 2010
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In recent years, nursing homes and assisted-living facilities — both of which provide long-term care, usually for older individuals requiring different levels of services — have hired building service contractors (BSCs) to clean, at least, the common areas of the facilities.

They are doing this for two key reasons.

First, the facility or nursing home does not have to add more staff to its payroll, which can save considerable sums of money.

And they do not have to supervise or train the custodians.

The only concern of the facility is that the cleaning crew performs well and meets the necessary cleaning requirements.

Benefits and cautions
Sensing an opportunity, many BSCs have contacted these types of facilities seeking new business opportunities; in many situations, it has worked out well for all parties.

However, before marketing cleaning services to assisted-living centers, nursing homes, and similar facilities, there is something BSCs should know.

These types of facilities usually have specific cleaning needs and demands.

These facilities rank with day-care centers, schools, and some medical facilities as home to a host of infectious diseases, germs, and bacteria that are usually not encountered in other types of cleaning situations, such as offices.

Furthermore, unlike in office settings, the people that live in or use these facilities are usually older, possibly sick, may have weakened immune systems, and are often more vulnerable to disease than the general public.

This means that cleaning for health, an expression often heard in the professional cleaning industry, takes on greater meaning and becomes more important here than in other types of settings.

What’s more, BSCs and their crews will typically encounter cleaning situations not usually found in other locations.
For instance, spills may be more common, as are “accidents,” which must be cleaned up quickly and thoroughly with minimal embarrassment to the resident.

Just as in any cleaning circumstance, the way to tackle the challenges encountered in cleaning long-term care facilities is to have a system — a process that addresses these different cleaning situations and the hygiene and sanitation needs therein.

A long-term care cleaning system
Typically, when we discuss a cleaning system, it is usually in reference to Specialist cleaning, Zone cleaning, or other systems that delegate specific cleaning responsibilities to cleaning technicians.

Although these systems may work in a long-term care facility, these are not the types of systems we are referring to here, nor can they address the specific challenges found in these types of locations.

Instead, an effective long-term care cleaning system includes the following components.

Evaluate residents
Evaluate cleaning needs based on who lives in the facility.

Some long-term care facilities have healthy, active residents who have few special cleaning needs.

Others have older or more infirm residents that require special care, not only from the facility’s staff, but from the cleaning crew as well.

For instance, they may have accidents more often or may spill drinks on floors and carpets more frequently.

BSC’s role
Determine what the responsibility of the BSC is and is not.

Usually, the BSC will clean only common areas, not medical or care station areas.

In addition, the analysis must take into consideration such factors as: How often residents use certain areas; how many residents use the areas; the types of floor coverings (carpet or hard surface); furniture; and other items that can impact cleaning needs.

Formulating a schedule
Create the cleaning schedule based on resident needs.

For instance, a cafeteria floor cannot be mopped and cleaned at breakfast, lunch or dinner time.

Instead, other common areas can be serviced during mealtimes.

This requires supervisors and the cleaning crew to determine which areas can be cleaned at what times.

Worker productivity
Implement effective workloading to use each cleaning worker’s time most effectively.

With an effective workloading system in place, cleaning supervisors know approximately how long it takes to perform all cleaning tasks in each area of the facility as well as the number of custodial workers required.

This includes performing not only cleaning duties, but also “noncleaning” tasks, such as getting equipment, replenishing supplies, and going to and from trash-collection areas.

Timely response time
Workers should be able to handle spills, accidents, and emergencies in a timely fashion.

This usually requires some sort of paging/communication system so custodial workers can be called when they are needed.

Additionally, the supervisor should know exactly who is available and can be called at specific times during the day.

As is often the case, certain cleaning workers will be under tighter time constraints than others during the course of the workday.

Selecting products
In a typical office setting, the chemicals a cleaning worker may carry include an all-purpose cleaner, a window cleaner, furniture polish and possibly a spotter.

Especially if environmentally preferable chemicals are mixed and used correctly, these are usually safe and require little special training.

However, a long-term care facility may require that special cleaning chemicals and disinfectants be used that can eradicate methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and other germs and bacteria.

Use of these chemicals requires thorough training of cleaning personnel.

Another concern that must also be addressed in a long-term care cleaning system is identifying areas of the facility where contact with infected residents, blood pathogens, germs and bacteria are most common.

Special precautions will be necessary in these areas, including protective clothing for cleaning workers.

Additionally, determining who is responsible for these more serious cleanup duties — the BSC or facility staff — must be determined in advance.

Floor care
High-touch areas, such as beds, light switches, ledges, door handles, railings, etc., are of the greatest concern when it comes to infection control in long-term care facilities.

However, floor care is important as well.

For instance, in areas where hard floors are present, safety is a core issue.

Any finish that is applied to floors must meet or exceed the UL requirements for slip resistance.

More important, dirt and spills affect a floor’s traction, making the facility’s floor cleaning program a top priority.

A JanSan distributor, who is well-versed in floor care, can make recommendations regarding the cleaning program that will work best in these facilities.

As to carpeting, many long-term care facilities have had a love/hate relationship with carpeting, just as many schools have.

Usually this focuses not as much on the cleaning needs and care of the carpets as on the debate over whether carpets or hard surface floors are healthier for the facility.

It appears that as long as high-filtration vacuum cleaners are used along with an effective, low-moisture, hot-water extraction system, air quality is protected, as is the health of the environment.

In fact, in studies conducted by Cornell University and independently by Dr. Michael Berry, who is formerly with the U.S. Environmental Protection Agency and now a leading figure in the Cleaning Industry Research Institute, it was found that “the air quality over carpeting was better than it was over hard surface flooring.”

Although they do have special cleaning needs and require more organization and worker training, BSCs looking for new avenues in which to expand their businesses should consider cleaning long-term care facilities.

What’s more, these facilities can offer something not found in office-type settings.

Often, the custodial workers develop close and friendly relationships with the residents, which can increase morale of the entire facility.


Mike Nelson is vice president of Pro-Link, a JanSan marketing and buying group based in Canton, MA.

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