Republic of the Philippines

Department of Health
SAN LAZARO HOSPITAL
Manila, Philippines

PATIENT SAFETY COMMITTEE

TERMINAL AND ROUTINE

ENVIRONMENTAL CLEANING AND DISINFECTION CHECKLIST
FOR PATIENTS’ ROOMS

DATE & TIME OF CLEANING STARTED: _______________ / _______________

CLINICAL/CRITICAL AREA: ______________________ ROOM #: ___________________

STEPS AND PROCESS YES NO REMARKS

1. Prepare all necessary cleaning and disinfection supplies and materials
needed. Ensure availability of fully diluted disinfectant spray solution
(Sodium hypochlorite) of 1:10 and 1:100 dilutions.
2. Conduct risk assessment. Identify and perform safety precautions based
on mode of disease transmission (contact, droplet or airborne).
3. Put safety signage indicating that the room is ongoing cleaning and
disinfection.
4. Perform hand hygiene. Don appropriate PPE.
5. Check the room and open all the windows. If with presence of spill, use
disposable cloth/carton boards to absorb the spill and discard in a yellow
plastic bag, disinfect the area with 1:10 sodium hypochlorite and allow the
disinfectant to dwell for 10 minutes and follow routine cleaning procedure.
6. Tie the plastic lining and remove garbage from ALL the waste bins, spray
with (1:10 sodium hypochlorite) disinfectant and place in the big garbage
cart. Remove (doff) and discard used gloves immediately.
7. Perform hand hygiene or apply alcohol-based hand rub. Don another
pair of gloves.
8. Remove soiled linens and put it in a yellow plastic bag then spray with
1:10 disinfectant solution before bringing to the Linen Department.
TOP TO BOTTOM WALL CLEANING AND DISINFECTION PROCESS:

9. Scrub and clean the wall using detergent soap and rinse with water.
10.Spray the wall with 1:100 disinfectant solutions. Allow to dwell for 10
minutes then wipe down using disposable cleaning cloths then allow air
dry. NOTE: Do not rinse with soap and water.
FREQUENTLY TOUCH SURFACES CLEANING AND DISINFECTION PROCESS:
11. Scrub and clean the frequently touch surfaces (i.e., switch buttons,
mirror, door knob, bed side table, chairs, mechanical bed frame and
railings, IV stand/pole, O2 holder, tackle box, dividers, etc) using
detergent soap and rinse with water.
12. Spray the frequently touch surfaces with 1:100 disinfectant
solutions. Allow to dwell for 10 minutes then wipe down using disposable
cleaning cloths then allow air dry. However;
13. Spray the bed mattress with 1:10 disinfectant solutions. Allow to dwell
for 10 minutes and wipe down using disposable cleaning cloths then allow
air dry.

FM-OMCC-PSC-021
Date Effective: December 15, 2022, Rev. 1
 Republic of the Philippines
Department of Health
SAN LAZARO HOSPITAL
Manila, Philippines

MEDICAL ARTICLES AND EQUIPMENT CLEANING AND DISINFECTION PROCESS (if available inside):
14. Wipe all medical articles and equipment (i.e., infusion pump,
stethoscope, cardiac monitor, BP apparatus, pulse oximeter, etc) with
1:100 disinfectant solutions. Allow to dwell for 10 minutes and wipe
down using disposable cleaning cloths then allow air dry.
15. Replace with clean and new sets of washable medical articles (i.e., BP
apparatus pressure cuff, etc) every after cleaning the room.
FLOOR CLEANING AND DISINFECTION PROCESS:
16. Dust mop the floor using wet mop. NOTE: Use only the dedicated
cleaning mop per room.

17. Mop the floor using detergent soap and rinse with water.

18. Spray the floor with 1:100 disinfectant solutions and allow air dry.

TOILET ROOM CLEANING AND DISINFECTION PROCESS:

19. Scrub and clean the wall, mirror and sink using detergent soap from
TOP TO BOTTOM.
20. Scrub and clean the pail, trash bins, door knob handles and other articles
inside the toilet room using detergent soap.
21. Scrub and clean the toilet bowl using detergent soap.

22. Rinse with water the toilet room wall, mirror, sink, faucet, pail, trash
bins, door knob handles, toilet bowl and other articles.
23. Spray the toilet room wall, mirror, sink, faucet, pail, trash bins and other
articles and toilet bowl with 1:10 disinfectant solutions. Allow air dry.
24. Prepare all the trash bins and put plastic lining (follow correct color
coding). Return all trash bins to its designated locations.

25. Let the room to air dry.

26. Doff PPE and discard properly in a yellow plastic bag.

27. Perform hand hygiene.

Performed by:

_________________________________________________ / _____________________________
Name and Signature of the Nursing Attendant/Utility Worker Date and Time of cleaning ended

Checked and validated by:

___________________________________________ / _____________________________
Name and Signature of the Nurse Supervisor on Duty Date and time checked & validated

This checklist is made to ensure provision of quality and safe healthcare services to our patients, employees and other
stakeholders through the joined effort of the Hospital Infection Control Unit (HICU) and Hospital patient safety
committee (OPSC).
NOTE: For inquiries, please call Hospital Patient Safety Committee at local 175.

FM-OMCC-PSC-021
Date Effective: December 15, 2022, Rev. 1