Green Theatre Checklist Explained – How to Make Your Theatre More Environmentally Friendly

The Intercollegiate Green Theatre Checklist was developed by a number of UK and Ireland surgical colleges. It provides some guidelines for how operating theatres can cut down on their carbon emissions and work towards sustainability in healthcare.

In this post we’ll provide an essential overview of the Green Theatre Checklist, and the guidance it contains.

A Brief Introduction to the Green Theatre Checklist

Studies show that surgery is a carbon intensive process. A single operation is estimated to generate up to 170kgCO2e, which is about the same as driving 450 miles in a petrol car.

The Green Theatre Checklist is divided into four sections:

  • Anaesthetic care
  • Surgery preparation
  • Intraoperative practice
  • Postoperative measures

Each section contains a number of guidelines and policies to support surgical teams in working towards better environmental, social, and economic impacts.

How To Make Operating Theatres More Environmentally Friendly

Below we’ll provide a quick overview of the guidelines contained within each section of the Green Theatre Checklist.

Anaesthetic Care

  • Source anaesthesia from your local area wherever possible.
  • Limit your Nitrous Oxide use to specific cases, and regularly check your equipment for possible leaks.
  • For inhalation anaesthesia, use sevoflurane instead of isoflurane, as it has a lower “global warming potential”.
  • Switch to reusable equipment wherever possible (such as laryngoscopes, underbody heaters, slide sheets, and trays.)
  • Minimise your drug waste. Introduce the policy: “Don’t open it unless you need it.”

Surgery Preparation

  • Switch to reusable textiles wherever possible, including theatre hats, sterile gowns, patient drapes, and trolley covers.
  • Reduce your water and energy consumption. Install automatic or pedal controlled water taps and adopt a “rub not scrub” approach: After your first water scrub of the day, use alcohol rub for all subsequent hand hygiene procedures.
  • Avoid clinically unnecessary interventions, such as the use of antibiotics and catheterisation.

Intraoperative Practice

  • Review and rationalise your surgeon preference lists, your single-use surgical packs, and your instrument sets. In each case, separate the essential vs. the optional, identify the surplus, and only open what you need when you need it.
  • Avoid any unnecessary equipment, again taking the approach: “Don’t open it unless you need it.”
  • Switch to reusable, hybrid, or remanufactured equipment wherever possible.
  • Switch to low carbon alternatives wherever appropriate (e.g., skin sutures instead of clips).

Postoperative Measures

  • Recycle wherever possible or use the lowest carbon appropriate waste streams. Use domestic or recycling waste streams for all packaging and use the non-infectious waste streams unless there’s a clear risk of infection.
  • Encourage active equipment maintenance and aim to repair damaged reusable equipment rather than replacing it.
  • When the theatre’s not in use, turn off all lights, computers, ventilation, and temperature control.

Access the Full Green Theatre Checklist

For more, you can access and download the full Intercollegiate Green Theatre Checklist.

Disclaimer – Infection Control Procedures

Bear in mind that these are just suggestions. They should not override your existing policies and procedures.

For example, working towards a green theatre should not come at the expense of infection prevention and control. Standard Infection Control Precautions and most PPE guidelines stress the importance of using disposable products so as to reduce the chances of cross-infection.

In this way, the Green Theatre Checklist seems to contradict infection control guidelines, as the checklist recommends switching to reusable equipment wherever possible.

As an operating theatre manager, you’ll have to carry out a thorough risk assessment so as to ensure that none of your Green Theatre policies compromise your infection prevention and control measures.

Help for Operating Theatre Managers

At Cairn Technology, we specialise in helping operating theatre managers improve efficiency, surgical outcomes, and staff and patient safety.

Find out more about our products and services for hospitals.

Or why not get in touch to talk to one of our experts today.

What is Clinical Waste and How To Dispose of it Safely?

In this post we’ll list some examples of clinical waste before discussing how you can safely dispose of it. We’ll also explore some solutions for fast and effective clinical waste disposal that may help you improve operational efficiency in your healthcare setting.

What is Clinical Waste?

Clinical waste is any waste that contains infectious, or potentially infectious, compounds derived from either medical treatments or biological research.

Clinical waste might also be referred to as biomedical, healthcare or hospital waste.

Examples of Clinical Waste

  • Discarded sharps. Whether they’re contaminated or not, all discarded sharps are considered medical waste, partly because they can cause injury and/or infection when they’re not properly disposed of. Examples include needles, scalpels, lancets, and any other device that could penetrate the skin.
  • Human or animal tissue. This includes identifiable body parts and organs, body fluids such as blood, and used bandages and dressings.
  • Used medical supplies. This includes any gloves or other items of PPE, whether they’ve been contaminated with body fluids or not.
  • Laboratory waste. Including unwanted microbiological cultures and stocks.
  • General waste from a medical or laboratory setting. Due to the risk of cross-contamination, any other waste that’s recognisably from a medical or laboratory setting should also be considered clinical waste and handled accordingly. Examples include packaging, unused bandages, and infusion kits.

The Risks of Clinical Waste

Many types of clinical waste carry an infection risk. Even if an item does not appear to have any visible signs of soiling, if it was used in a medical or laboratory setting, then it may be harbouring pathogens that are invisible to the naked eye. Coming into contact with clinical waste could therefore encourage the spread of communicable diseases.

Clinical waste can be harmful in other ways, too. For example, whether they’ve been used or not, discarded sharps can seriously injure anyone who comes into contact with them.

How to Safely Dispose of Clinical Waste

To protect the public and the environment, clinical waste must be processed to allow for safe handling and disposal. This usually requires incineration, to destroy any pathogens and sharps in the waste, and to make any source materials unrecognisable. Autoclaves can also be used to sterilise medical waste before it’s safe for disposal.

Clinical waste is usually disposed of in a dedicated environment using specialist equipment. As most healthcare settings and laboratories do not have the space or budget for such measures, clinical waste is usually accumulated onsite before being collected for offsite disposal.

As such, for most medical and laboratory settings, managing clinical waste is usually a case of using the right PPE to handle or clean any waste items or tissue, before disposing of the waste in the appropriate steam.

What are Waste Streams?

A standard infection control precaution is to maintain four separate waste streams, each of which is colour coded. Clinical waste should be disposed of based on the infection risk it carries. It’s classed as orange or light blue if it’s low-risk or “laboratory” waste, or yellow if it carries a high-risk of infection. Healthcare settings should also make use of sharp boxes to safely collect used sharps.

The containers for collecting and transporting clinical waste are usually designed to be as robust as possible, to prevent any tearing, spilling, and contamination. For example, rigid boxes are generally used for sharps.

Effective Clinical Waste Management for Hospitals and Other Healthcare Settings

Safely managing your clinical waste is a critical part of any infection prevention and control strategy. Certain techniques and equipment can make clinical waste management a lot safer and a lot easier, which in turn can improve your hospital’s operational efficiency.

For example, use absorbent mats to capture fluids during surgical procedures, or to contain splashes when you’re scrubbing up. The T-Mat, for example, gels liquids and becomes dry to the touch within minutes. It hygienically binds fluids, allowing for safe, quick, and easy disposal in the appropriate waste steam. Through cutting down on the time you spend cleaning and decontaminating, the T-Mat can significantly improve your turnaround time between procedures.

As well as a range of absorbent mats, we also stock a selection of clinical waste disposal kits. Our range includes the safe, sturdy and dependable Microb-in Lab waste Disposal container case, and specialist Biohazard Spill Kits and Body Fluid Spill Kits.

Get in touch to discuss how we can support you in safe and effective clinical waste management.

Veterinary Clinic Cleaning and Disinfection Protocols

Cleaning protocols and procedures are a vital part of effective infection prevention and control in all healthcare settings. This includes veterinary clinics.

In this post we’ll outline the essential principles of a veterinary clinic cleaning and disinfection protocol.

Please note that this post is just intended to provide a basic introduction to the subject, to give you an overview of what you should include in your veterinary clinic cleaning and disinfection protocol. Also, cleaning protocols are just one of many standard infection control precautions. Read our full guide to standard infection precautions.

Why Do Veterinary Clinics Need Cleaning and Disinfection Protocols?

Infections can spread in any healthcare setting, and veterinary clinics are no exception. Regular and thorough cleaning is a vital part of infection control, as it can remove any pathogens that might linger on surfaces and objects.

Common Healthcare Associated Infections (HAI)

Common healthcare associated infections (HAI) include:

  • Surgical site infections.
  • Clostridium difficile.
  • Colds, Flus, and Covid-19.
  • Veterinary specific infections, including peritonitis and calicivirus.

Read our full guide to healthcare associated infections.

How HAIs Spread

These infections spread in a number of ways. Some can spread as a result of treatments. Others are communicable diseases, which can be spread from person-to-person, or through indirect contact with surfaces and objects containing pathogens.

In veterinary settings, as well as spreading from person-to-person, infections can also spread from person-to-animal, from animal-to-person, and from animal-to-animal.

Veterinary Clinic Cleaning and Disinfection Protocols – Essential Principles

To begin with, make sure that all areas of your veterinary clinic are as well-organised and clear of clutter as possible.

This will improve your operational efficiency, as everyone in your practice will always know where everything is. But it will also help with infection control and cleaning.

The less clutter in your clinic, the less you’ll have to clean. Less clutter also means there’ll be fewer objects on which pathogens can take hold.

Infection Risk Assessment for Veterinary Clinics

Carry out a risk assessment of every area of your veterinary clinic, identifying any areas where infections may be more likely to take hold and spread. High-risk areas include any areas where members of the public gather and share facilities, such as your waiting room, along with all consultation and treatment areas.

You should also carry out a risk assessment for all of your medical equipment. Depending on how and where it’s used, your equipment will either carry a low, medium, or high infection risk. And you’ll have to carry out different decontamination procedures depending on the risk. Read our full guide to the different levels of risk and decontamination for medical equipment.

You should also carry out a risk assessment of any cleaning products and disinfectants you intend to use in your veterinary clinic. This involves ensuring that the products you use won’t damage any delicate equipment, and that they’re safe for use in public areas (e.g., they won’t produce any potentially harmful fumes).

Standard Operating Procedures for Veterinary Clinic Cleaning and Disinfection

Aim to create a standard operating procedure (SOP) regarding your cleaning and disinfection protocols. Your risk assessments will help you create your SOP, as you’ll be able to outline which areas, and which equipment, requires the most care and attention.

The SOP can also advise on the safe and effective use of any cleaning products and disinfectant. For example, you can advise staff on the steps they should take if they accidentally spill a product or splash it in their eyes. You can also advise on the correct storage procedures for your disinfectants, based on the manufacturer’s guidelines.

Overall, your cleaning and disinfection SOP should provide clear guidelines for cleaning and disinfecting every area of your veterinary clinic. Ideally, you could include checklists to help your staff ensure they don’t overlook any key areas or procedures when carrying out their responsibilities.

Make your SOP easily accessible to all members of staff and be sure to review it regularly to ensure it’s still fit for purpose. For example, following an infection outbreak, you should conduct a thorough audit into how the infection started, and how it spread. You may choose to review your SOP based on your findings.

Advanced Infection Control Products for your Veterinary Clinic

We stock a full range of infection control products suitable for use in a veterinary clinic.

Our range includes:

  • Clinic Cleaning Products. Including the Virusolve+ range of one step cleaner, sanitiser, and disinfectant solutions.
  • Washroom Hygiene Supplies. Including automatic hand sanitiser dispensers.
  • Absorbent Mats. For faster and more effective fluid management, to help you reduce infection risks and cleaning times.
  • Spill Kits. For fast and effective responses to potentially hazardous spillages.

Learn more about how we support veterinary clinics to meet their infection prevention and control needs.

Operating Theatre Must-Have Equipment Checklist

Three things are vital to delivering an efficient operating theatre:

In this post, we’ll discuss the must-have equipment for any operating theatre.

Why Does Equipment Make a Difference in Operating Theatres?

Obviously, all operating theatre procedures depend upon specialist surgical equipment. You need surgical equipment you can depend on. But it’s just as important to carefully consider the rest of the equipment you use in the operating theatre.

Between each procedure, you’ll have to clean, decontaminate, or sterilise the operating theatre environment, your surgical instruments, and your medical equipment.

Any equipment you use will either be reusable or disposable. With single-use equipment, so long as it’s adequately stored and handled, you can use it during the procedure safe in the knowledge that it’s clean and sterile, and simply dispose of it in the appropriate waste channel following the procedure. But with reusable equipment, you’ll have to take appropriate steps to ensure everything’s adequately processed before and after each procedure.

In this way, the specific equipment you choose for your operating theatre can make a huge difference to your patient outcomes, and to your turnaround time.

Your choice of equipment can also influence your operational efficiency (through reducing clutter while providing ease of access, for example), and the comfort and safety of your theatre team.

Operating Theatre Must-Have Equipment Checklist

Surgical Lights

For illuminating the surgical site while eliminating shadows. Surgical lights can either be LED or halogen. Of the two, LED is more energy efficient. It also provides a brighter, whiter light, and it generates less heat, which can make things more comfortable for surgical teams.

Operating Table

The table upon which the patient lies for the duration of the procedure. Operating tables are often adjustable and with moving parts, to help the surgical team position the patient as necessary for the procedure.

Equipment Management Systems

These provide storage and ease of access for all the necessary surgical equipment, alongside housing for wires and cables.

This can improve operational efficiency through allowing the surgical team to easily access the equipment they need as soon as they need it. These systems can also reduce clutter, helping to remove tripping and slipping hazards.

Operating theatres may also contain warming cabinets, which can be used to keep fluids, linens, and blankets warm, to help reduce the risk of hypothermia during certain procedures.

Surgical Displays

Display systems can either provide up-to-date information about the patient’s status, or they can provide an intricate, magnified view of the patient’s inner anatomy during certain invasive procedures.

Surgical displays may be wall-mounted, or they may be attached to arms or columns.

Surgical Instruments

A surgeon’s tools of the trade. Surgical instruments are used exclusively in sterile spaces, and they’re specifically designed to penetrate a patient’s skin or mucous membrane. Different procedures will require different instruments.

We specialise in supplying high quality instruments for use across a broad range of surgical disciplines. If you’d like to discuss your surgical instrument requirements, get in touch to talk to an expert today.

Scrub Sinks

Operating theatre teams use scrub sinks to wash their hands and forearms before performing surgical procedures. Good hand hygiene is an essential part of effective infection prevention and control in operating theatres.

This is one area where the specific choice of equipment can make a huge difference to your theatre’s operational efficiency. An absorbent floor mat in the theatre or scrub room can help reduce slippery floors and can also reduce turnaround times between procedures.

The most superabsorbent mat, the T-Mat, can absorb up to 8.5 litres of liquid during a procedure, and afterwards your team can quickly and easily dispose of it in the clinical waste. This will dramatically cut down on your cleaning time, with no need for any noisy, time-consuming suction devices and tubing.

We Can Help You Deliver Exceptional Care Quality Standards in the Operating Theatre

Cairn Technology are approved suppliers to both NHS and private healthcare providers. We specialise in helping operating theatre teams improve efficiency and care quality standards.

As well as stocking a range of surgical instruments and specialist infection control products, we can provide expert advice on improving operational effectiveness in the theatre. Get in touch to discuss our products and services with  one of our friendly experts today.

How To Manage an Outbreak of C. difficile

Clostridium Difficile Infections (CDIs) are among the most common hospital acquired infections.

In this post we’ll discuss what C. difficile is and how it spreads. We’ll then explore how robust cleaning protocols and procedures can help you manage a C. diff outbreak.

What is C. difficile?

Clostridium difficile is a type of bacteria which usually lives harmlessly in your bowels. However, certain antibiotic treatments can change the balance of bacteria in the gut, which can trigger a C. difficile infection.

Symptoms of C. difficile Infection

Common symptoms of a C. difficile infection include:

  • Diarrhoea
  • Loss of appetite
  • Stomach ache
  • Nausea
  • High temperatures

How is C. diff Transmitted?

As one of the main symptoms of C. diff is diarrhoea, C. diff infections can spread quickly. When outside the body, the C. diff bacteria can turn into spores which are capable of surviving for long periods on hands, surfaces, objects, clothing, and linen.

Without regular washing and cleaning, it’s all too easy for these spores to transmit from a surface to a person’s mouth, which could result in an infection. For example, a person might touch a surface containing C. diff spores with their hand. They might then, without thinking, wipe their mouth with their hand.

Read our full guide to how communicable diseases spread.

What Places are Most At Risk of a C. diff Outbreak?

Any healthcare setting where patients or residents share facilities is particularly at risk of a C. diff outbreak.

This might include:

  • Care homes
  • GP clinics
  • Hospital wards
  • Dental surgeries

Who is Most At Risk of a C. diff Infection?

As well as people taking certain antibiotic treatments, people aged 65 or over are particularly at risk of C. difficile infections.

How to Manage a C. diff Outbreak

A person with a C. diff infection may carry an infection risk until 48 hours after their symptoms have passed. So ideally, anyone with a C. diff infection should stay at home until at least 48 hours after their symptoms have cleared up. Though in a healthcare setting such as a care home or a hospital, this might not be possible.

As a result, only stringent cleaning procedures and protocols can help prevent and control C. diff outbreaks:

  • Practice good hand hygiene. Staff should adopt the appropriate hand washing technique, and commit to washing their hands at certain key moments – such as before and after touching patients or their surroundings. You should also provide patients and residents with appropriate hand sanitiser so that they too can practice effective hand hygiene.
  • Clean the care environment as often as possible. Your cleaning procedures should already ensure you’re carrying out thorough cleaning at least once a day. But your cleaning procedures should intensify in the event of an outbreak, paying particular attention to any surfaces that people might touch, such as toilets, light-switches, and door handles.
  • Wash any contaminated clothes and sheets as soon as possible, and separately from other washing.
  • Advise visitors to take extra precautions – or to avoid visiting completely – for the duration of the outbreak.

Read our full guide to managing outbreaks in care homes.

How We Can Help You Manage a C. diff Outbreak

We stock an advanced range of highly effective cleaning and containment products that will help you prevent and control C. diff and other infections in your care setting.

Our range includes:

  • Virusolve+ WipesA one-step solution, all-in-one cleaner, sanitiser, and disinfectant that can kill C diff bacteria on surfaces in as little as 5 minutes. It then creates a residual barrier that can help prevent infection for up to 7 days. You can use them on any surface, including carpets, upholstery, and mattresses. Also available as a trigger spray and a concentrate.
  • VirusanAntimicrobial hand sanitiser and hand scrub capable of removing up to 99.999% of the most common germs in less than a minute, designed to eliminate the risk of cross-infection from hand transfer within 30 seconds of application. Also available as a gel.

We also stock hospital-grade air purifiers. In the event of a C. diff outbreak, they can quickly and effectively catch and kill airborne spores, completely cycling the air in a room in as little as 12.5 minutes.

For more information about how we can help you manage C. diff outbreaks in your care setting, call us on 0333 015 4345 or email

Infection Control Legislation For Care Homes

In this post, we’ll take a closer look at how this legislation relates to infection prevention and control in care homes.

Relevant Legislation for Care Homes

If you manage a care home, you have a legal obligation to implement stringent infection prevention and control policies and procedures.

The Health and Social Care Act 2008 gives the Care Quality Commission powers to enforce best practice regulations in all health and adult social care sectors.

You can read the full wording of The Health and Social Care Act 2008 here.

The Health and Social Care Act 2008 only applies to England. There are different legislations in Scotland, Wales, and Northern Ireland. We are focusing on the English legislation in this post because it provides an effective introduction to how the regulatory systems works in the UK.

Regardless of the specific legislation that might apply, your obligations are effectively the same:  If you don’t prioritise your residents’ health and wellbeing, regulatory bodies can and will take action against you.

What Are Regulated Activities?

The Health and Social Care Act 2008 defines a “regulated activity” as “an activity of a prescribed kind”.

“Prescribed activity” essentially refers to activity that “involves, or is connected with, the provision of health or social care in, or in relation to, England”.

Regulation of Regulated Activities

The Act gives the Secretary of State powers to “impose requirements … necessary to secure that services provided … cause no avoidable harm to the persons for whom the services are provided.”

This includes making provisions and imposing requirements as to the:

  • Fitness of premises.
  • Keeping of records and accounts.
  • Management and training of anyone who works for the purpose of carrying out the regulated activity.

And crucially, the Act outlines that regulations “may make provision for the prevention and control of health care associated infections and may include such provision as … appropriate for the purpose of safeguarding individuals … from the risk, or any increased risk, of being exposed to health care associated infections or being made susceptible, or more susceptible, to them.”

The Act also gives the Secretary of State powers to issue codes of practice relating to health care associated infections.

What Happens If You Don’t Meet Infection Control Regulations?

The Health and Social Care Act 2008 makes it clear that you have a legal obligation to meet any codes of practice relating to infection prevention and control. If you do not meet these regulations, the Care Quality Commission can take action against you.

This might include:

  • Issuing notices outlining improvements you must make, and by when you should make them.
  • Imposing conditions or restrictions on your practices for a given time.
  • Putting special measures in place to supervise your activities.
  • Holding you to account through issuing cautions, fines, or even through prosecution.

You can read some examples of instances where the Care Quality Commission has used its powers of prosecution.

How To Meet Your Infection Control Regulatory Requirements

We’ve put together a number of guides to help you ensure effective infection control in care homes:

We specialise in supporting healthcare settings, including care homes, in the delivery of effective infection prevention and control policies:

Want to talk about how we can help you meet your infection control regulatory requirements? Get in touch to talk to one of our friendly experts today.

Dental Decontamination & Infection Control Checklist

Just like any other healthcare setting, dental surgeries need to adopt numerous infection prevention and control measures. Key to this is understanding the key sources of infection, and the means by which infections might spread.

Key Sources of Infection in Dental Practices

Communicable diseases usually spread via direct contact with a person carrying the infection. Dentists and dental nurses work in very close proximity to their patients, and with each other. Such close contact can make cross-contamination more likely – whether that’s from staff to patient, patient to staff, or from staff to staff.

Yet pathogens can also survive on surfaces for hours, days, or months. A patient or a member of staff could quite easily pick up an infection through simply touching a door handle that an infected individual also happened to touch. But much more serious would be a dentist or a dental nurse using a contaminated device on a patient. Given the nature of dental treatments, this could easily introduce pathogens into the patient’s bloodstream.

How to Prevent and Control Infection in Dental Practices

Dental practices should follow the same Standard Infection Control Precautions (SICPs) as other healthcare practitioners. These precautions include:

  • Personal Protective Equipment (PPE) policies – including using adequate PPE for the task at hand, and effective storage, handling, and disposal of any PPE used.
  • Good hand hygiene techniques – not just in terms of how to wash your hands, but also in terms of when you should do so.
  • Cough and sneeze etiquette – catch it, bin it, kill it.

Other key infection prevention and control precautions include safe management of the care environment, and of any equipment used on or around patients. In short, this means following robust cleaning and decontamination procedures.

Dental Decontamination & Infection Control Checklist

The NHS Infection Prevention and Control team recommends dental clinics perform weekly audits to ensure that they can maintain their environmental cleanliness standards.

Following a checklist could help ensure you don’t overlook any crucial areas of your dental practice.

Here are some things that your dental decontamination and infection control checklist could cover:

  • Reception and Waiting Areas
  • Corridors
  • Surgeries
  • Utility Rooms
  • Toilets
  • Storage (with separate checks for the cleaners’ storage room, and anywhere dental supplies are stored).

For each area, there should be at least two levels of checks:

  • Essential Check – The area is visibly clean, and free from any clutter or unnecessary items.
  • Thorough Check – A more detailed audit of any surfaces or items that might act as vectors for cross-contamination. Different areas of the clinic will require different checks. But in general, you should pay attention to anything that staff or patients might touch, and any surfaces where pathogens could thrive. This could include light switches, furniture, magazines, pictures, pamphlets, carpets, curtains, and so on.

Though high standards of cleanliness are essential throughout the dental practice, you’ll likely need to follow more stringent cleaning procedures in any areas where treatment take place.

You’ll find a good dental decontamination audit tool template on the NHS IPC team’s website.

Effective Decontamination of Dental Equipment

When it comes to dental equipment, dental staff must consider three separate levels of decontamination: cleaning, sterilization, and disinfection.

All dental equipment and devices will have different risk levels depending on how frequently they’re used, and where they’re used. This risk level will determine the level of decontamination required, and how often the decontamination procedure should take place.

Read our full guide to the three levels of decontamination for medical devices here.

Essential Support for Effective Infection Prevention and Control in Dental Practices

We stock a full range of highly effective hospital cleaning and containment products, including the powerful Virusolve+ range of wipes and concentrates. Browse our complete range of infection control products.

With our air purifiers, we can also help you trap and kill up to 99% of airborne viruses and bacteria in your dental surgery, along with up to 99.9% of potentially hazardous pollutants, such as VOCs, inhalable dust, and particulate matter. Browse our range of air purification solutions.


Environmental Decontamination: Stages & When to Implement

In a healthcare setting, “environmental decontamination” refers to the process of thoroughly cleaning surfaces as part of effective infection prevention and control.

In this post we’ll discuss the various stages of environmental decontamination in hospitals and healthcare settings and explain when these should be implemented.

The Role of Environmental Decontamination in Infection Prevention and Control

Staff and patients carrying communicable diseases can shed pathogens in a number of ways. These pathogens can survive on surfaces for hours, days, and even months.

In this way, contaminated surfaces can contribute to the person-to-person transmission of pathogens in healthcare settings. This presents a serious risk for certain high-risk patients, including the elderly, the immunocompromised, and the immunosuppressed.

Patients from high-risk groups may be more likely to contract infections from contaminated surfaces. And if they do pick up an infection, they’ll be more likely to experience severe symptoms.

While manual cleaning can contribute to infection prevention and control, if the cleaning agent itself becomes contaminated with pathogens, then the cleaning process could actually contribute to the spread of infection. Environmental decontamination goes beyond surface level cleaning. It’s a strategy for removing and destroying infectious pathogens and contaminants.

The Three Stages of Environmental Decontamination

  1. Cleaning
  2. Enhanced cleaning
  3. Disinfection

Stage 1: Cleaning

The cleaning stage of the environmental decontamination process involves physically removing dirt, dust, and other contaminants from surfaces.

In most healthcare settings, cleaning should take place at least once a day.

Using a combination of mops, brushes, cloths and detergents, cleaning will remove the sort of organic matter from surfaces on which pathogens can take hold. However, it is unlikely to eliminate potentially harmful microorganisms entirely.

As such, cleaning might suffice for items and surfaces that will not come in direct contact with the patient.

Stage 2: Enhanced Cleaning

Some infection prevention and control procedures will call for enhanced cleaning processes. This might simply extend to an increased frequency of fundamental cleaning processes. Or it may call for the use of more specialised disinfectants or equipment.

In some areas of the hospital, such as an operating theatre, enhanced cleaning procedures may take place as a matter of course as part of a wider infection control protocol. Otherwise, enhanced cleaning might be recommended as a response to an outbreak of a communicable disease (such as norovirus); or as part of a containment response to a spillage (of bodily fluids, or chemicals etc.)

Stage 3: Disinfection

Enhanced cleaning may remove microbes and pathogens, but it will not necessarily kill them. Manual disinfection can actively reduce the levels of infectious agents in the area.

As with enhanced cleaning, disinfection may extend to simply making use of specific disinfectant agents as advised. And as with enhanced cleaning, disinfection might be standard practice in some healthcare settings, or it might be recommended as part of the response to a specific event.

For example, any surface contaminated with bodily fluids, such as blood or diarrhea, will require disinfection. Cleaning and enhanced cleaning processes will first serve to make the area visibly clean. Meanwhile, manual disinfection will serve to remove as many lingering microbes as possible.

Different Decontamination Procedures for Medical Equipment

As the name suggests, environmental decontamination is all about removing pathogens from the healthcare environment. This might involve floors, surfaces, windows, items of furniture, and so on.

When it comes to medical equipment – particularly items that might come into contact with a patient’s mucous membrane – healthcare workers must consider three separate levels of decontamination: cleaning, sterilization, and disinfection.

All medical equipment and devices will have different risk levels depending on how frequently they’re used, and where they’re used. This risk level will determine the level of decontamination required, and how often the decontamination procedure should take place.

Read our full guide to the three levels of decontamination for medical devices.

Essential Support for Effective Environmental Decontamination

We stock a full range of highly effective hospital cleaning and disinfectant products, including the powerful Virusolve+ range of wipes and concentrates. Browse our complete range of infection control products.

With our hospital-grade air purifiers we can also help you reduce the levels of airborne pathogens in your hospital, along with other potentially hazardous pollutants, such as VOCs, inhalable dust, and particulate matter. Browse our range of air purification solutions for healthcare settings.

How Does Infection Spread in a Hospital?

In this post we’ll discuss how infections spread in hospitals and explore some ways you can prevent and control infections in your hospital.

Ways Infections Spread in Hospitals

Most hospital-acquired infections (HAIs) spread in one of two ways:

  • As a result of treatment.
  • From person-to-person, or via another communicable disease vector (pathogens on a surface, or in the air, for example).

You can read our guide to the most common hospital-acquired infections.

How Infections Spread as a Result of Treatment

Some hospital-acquired infections can spread as a direct result of certain medical treatments.

Examples include:

  • Surgical Site Infections (SSIs) – Invasive procedures involve making incisions in a patient’s skin. Though such procedures are performed in highly controlled sterile environments, it’s possible for incision wounds to get contaminated by microorganisms from the patient’s own body, or from outside sources.
  • Clostridium difficile infections (CDIs) – diff bacteria can exist harmlessly in the bowel. But a course of antibiotics can sometimes cause a bacterial imbalance in the gut, triggering a CDI.

How Communicable Diseases Spread in Hospitals

A patient or a member of staff might bring an existing infection into a healthcare setting such as a hospital. Or a patient may develop an infection during their hospital stay while receiving treatment for an unrelated condition.

These are communicable diseases, and they can spread in a number of ways:

  • From Person-to-Person – Coughs, sneezes, and even touches can spread viruses and bacteria from person to person. CDI, for example, is a common hospital-acquired infection because a major symptom is diarrhoea, which can act as a vector for the spread of bacteria. And of course, during the 2020 pandemic it became clear just how quickly Covid-19 can spread from person-to-person in a hospital.
  • Indirect Contact – Viruses, bacteria, and other pathogens can survive for hours, or even days, on surfaces and inanimate objects. A patient may cough or sneeze into their hand. If they then use a doorhandle or a light switch, any staff member or patient who subsequently touches that item may pick up their germs. And if they then touch their mouth, nose, or eyes, they may introduce the germs into their bloodstream.
  • Contamination – Finally, eating or drinking contaminated food or water can spread communicable diseases. E. coli, for example, is a common hospital-acquired infection, and it can be contracted from eating undercooked meat.

How To Prevent The Spread of Diseases in a Hospital

The National Institute for Health and Care Excellence (NICE) issued recommendations that could help prevent SSIs in hospitals. These include a series of steps for the preoperative phase (including showering and nasal decolonisation), recommendations for staff and patient theatre wear, and a series of checks to make both before and after the procedure. Read the full NICE guidelines for preventing SSIs here.

When it comes to controlling communicable diseases, hospitals must follow the standard infection control precautions (SICPs):

These include:

  • Patient placement – Perform a comprehensive infection risk assessment for each patient, and isolate patients with a high risk of cross-infection.
  • Hand hygiene – Follow a specific hand-washing technique to thoroughly clean your hands at key touchpoints – such as before and after interacting with a patient and their surroundings. Also advise patients to follow good hand hygiene guidelines and provide plenty of handwashing stations throughout your hospital.
  • Personal protective equipment (PPE) – There should be clear procedures for what PPE to use and when. You should also have procedures for storing, applying, removing, and disposing of PPE.
  • Cleaning – Commit to safe management of both care equipment and the care environment. Thorough cleaning should take place regularly and on an ongoing basis. You should also have specialist procedures for cleaning, disinfection, and sterilization in the event of outbreaks, and for high-risk equipment and environments.

Read our full guide to standard infection control precautions in hospitals and healthcare settings.

Control the Spread of Hospital-Acquired Infections

At Cairn Technology, we’ve been helping both NHS and private hospitals prevent and control infections for over 20 years.

We can help you with:

To discuss how we can help you prevent and control infection in your hospital, get in touch to talk to one of our friendly experts today.


How To Manage an Outbreak of Infection in a Care Home

Any outbreak of infection in a care home must be considered a high-priority issue. Infections can easily spread in any location where people share facilities, and care home residents are high-risk groups: If they develop an infection, they’re more likely to experience severe symptoms.

What is an Outbreak?

The NHS defines an infectious disease outbreak as “when there are more people with the disease than you might normally expect.” There may be a different criteria for declaring an outbreak depending on the setting. When it comes to COVID-19 in a care home setting, for example, the NHS recommends declaring an outbreak when “there are two or more staff, residents, or visitors testing positive within 14 days of each other.”

If you don’t take steps to control an outbreak, the number of people infected could increase rapidly. This will have a huge impact on staff and resident wellbeing, and on the quality of care you’re able to deliver.

When is an Outbreak Over?

The NHS advises that you can declare an outbreak as over when 28 days pass without any new cases of the infection. Again, this advice is specific for COVID-19, but you can use a similar criteria for other infectious diseases in a care home.

What Are The Most Common Infections in Care Homes?

COVID-19 remains a major risk for care homes. But you must treat any outbreak of any infection just as seriously.

More than 50% of all care home infections can be linked to:

  • The influenza virus
  • Norovirus
  • Salmonella
  • Streptococcus Pyogenes

Read our full guide to the most common infections in care homes.

How To Manage an Outbreak of Infection in a Care Home

You should have dedicated policies and procedures covering your response to infection outbreaks in your care homes. These documents should be easily accessible for all staff, and you should review them periodically to ensure they reflect current risk levels and best practice guidance.

Your policy should include:

  • A list of the most common infections in care homes, along with some of the symptoms to look out for.
  • A definition of an “outbreak”. At what point will your outbreak response plan come into effect? Also define at what point you can declare that the outbreak’s passed.
  • Immediate response – what are the most critical steps to take once you’ve declared an outbreak? Think about who you’ll inform, how you’ll inform them, and what you’ll tell them. You’ll have to brief staff, inform residents, and contact their relatives too.
  • High-risk residents – some residents might have existing conditions that make them particularly vulnerable to infection, or they might be immunosuppressed or immunocompromised.
  • Your outbreak response policy should outline how you’ll shield your most high-risk residents, such as through zoning infected residents elsewhere in the care home and temporarily restricting any time spent in shared spaces.

Staff Training for Managing Outbreaks

Your staff should receive specialist training in managing outbreaks. The training should include:

Resident Zoning and Isolation

Throughout the COVID-19 pandemic, it became common practice to isolate any patients who might be carrying an infection risk, to reduce the chances for the infection to spread from person-to-person. Similarly, any staff members testing positive were advised to self-isolate.

Your care home infection outbreak response policy should consider resident zoning and isolation. Ideally, you should have single rooms available for emergency quarantine. And in the event of an outbreak, you should carry out an infection risk-assessment for every resident, reserving your emergency isolation and zoning procedures for the most high-risk individuals.

At the same time, you need to consider your residents’ physical and psychological wellbeing. How can you continue to deliver a high quality of care even while they’re in isolation? How will you keep the resident and their visitors informed throughout their quarantine? And crucially, how long will the isolation last? At what point will they be able to safely mix again with the rest of the care home population?

For more information, and for actionable tips for managing outbreaks in your care home, be sure to read the latest Department of Health and Social Care and Public Health England guidance on infection control in care homes.


Cleaning is an essential part of infection prevention and control. Pathogens can survive on surfaces for hours, or even days. So regularly cleaning your care home environment can significantly reduce the risk of cross-infection.

You should already have cleaning policies and procedures in place for your care home, outlining where to clean, how to clean it, what products to use, and how often to do so. Your cleaning policy should pay particular attention to any area of your care home where residents share facilities, along with any area where food is prepared or consumed.

In the event of an outbreak, you should implement even more robust cleaning procedures. This might involve carrying out more regular cleaning or switching to using specialist cleaning products that can kill viruses and bacteria on surfaces.

Be sure to read our full guide to effective environmental decontamination for infection control.

Air Purification

As well as lingering on surfaces, the viruses and bacteria that cause infections and outbreaks in care homes can also be airborne.

Good air filtration can actively contribute to infection prevention in care homes, while helping to prevent the spread of infection during an outbreak. Air filtration can even help prevent the spread of COVID-19. One study found that an air filtration system successfully removed almost all traces of the airborne virus in a quarantine ward.

Our range of HealthProtect air purifiers are specifically designed for healthcare facilities such as care homes. They can deliver complete air filtration every 12.5 minutes, trapping and killing up to 99% of viruses and bacteria – including those responsible for all of the most common outbreaks in care homes.

We can advise on effective infection outbreak management in your care home. As well as supplying specialist healthcare air purifiers, we also stock a full range of infection control products, including the Virusolve+ range of one-step cleaner, sanitiser and disinfectant solutions.

Get in touch to discuss care home infection outbreak management with one of our friendly experts.