Isolation Room Terminal Cleaning
Isolation Room Terminal Cleaning
Terminal cleaning is the thorough decontamination of a patient room after the patient is discharged or transferred. The protocol depends on the organism the patient was on precautions for.
General principles
- Wear appropriate PPE matching the precaution type (Contact, Droplet, Airborne).
- Clean from clean to dirty and high to low to avoid recontaminating cleaned surfaces.
- Dwell time: respect the manufacturer-specified contact time on the disinfectant label.
- Discard or launder all curtains, bedding, and reusable patient items per facility policy.
Disinfectant selection
| Organism | Disinfectant | Notes |
|---|---|---|
| MRSA / VRE | EPA-registered hospital disinfectant (List H/K) | Standard quaternary ammonium acceptable |
| MDR-GNR (CRE, etc.) | EPA-registered hospital disinfectant | Increase contact time per label |
| Clostridioides difficile | EPA List K — sporicidal (e.g. bleach 1:10) | Quaternary ammonium NOT effective on spores |
| Norovirus | EPA List G or bleach 1:10 | Non-enveloped virus; quat solo insufficient |
| Candida auris | EPA List P | Many common disinfectants ineffective; verify product is on List P |
| TB | Standard disinfectant + airborne precautions during cleaning |
High-touch surfaces (mandatory)
Clean and disinfect, in order:
- Bedside table and over-bed table
- Bed rails (top and bottom)
- IV pole, infusion pump buttons
- Monitor cables and screens (per manufacturer)
- Call button, TV remote, light switches
- Door handles (room and bathroom)
- Sink fixtures, toilet flush handle, grab bars
- Floor (last)
Patient equipment
- Single-use items in the room: discard, even if appearing unused.
- Reusable items: send for high-level disinfection or sterilization per item type.
- Dedicated equipment (BP cuff, stethoscope): wipe down and remove from room.
Verification
Use one of:
- Fluorescent marker audits — 80%+ removal rate target
- ATP bioluminescence — facility-defined RLU threshold
- Cultures — for outbreak situations only
Document the cleaner, date/time, products used, and verification method in the room turnover log.
After C. difficile or candida auris rooms
Strongly consider supplemental no-touch disinfection (UV-C or hydrogen peroxide vapor) per facility policy and outbreak status.