No matter what the establishment, the means typically used to gauge an organization’s cleanliness is the restroom. When a restaurant restroom appears dirty, patrons may wonder about its kitchen and its food. If a hospital’s main lobby restroom is unclean, visitors may question the safety of the operating room.

“Restrooms are the No. 1 source of complaints in a facility,” says Bill McGarvey, director of training and sustainability at Philip Rosenau Co., a jan/san distributor in Warminster, Penn. Patrons may complain trash is overflowing, supplies are not stocked, toilets are not clean or floors are unmopped.

Their critiques are as they should be, McGarvey adds. “Restrooms meet all the requirements that bacteria and germs need to sustain their lives.” In fact, Dr. Charles Gerba, an environmental microbiologist with the University of Arizona, who has studied restroom cleanliness for years, reports microorganisms, such as Shigella, Salmonella, Hepatitis A, E.Coli and Norovirus, are routinely found in restrooms and have been associated with outbreaks of illness.

Effective restroom cleaning programs help minimize the spread of these infectious agents. But what makes up a good cleaning program? Following are six steps to help put the cleaning operation on the road to better restroom health.

Step 1: Protect Thyself

First, an effective cleaning program provides personal protective equipment (PPE) to cleaning technicians. “We still have some folks in the industry, who don’t see the need to put on gloves,” McGarvey explains. “But any time we are working with chemicals, we should be exercising personal care.”

Darrell Hicks, director of environmental services and patient transportation at St. Luke’s Hospital in Chesterfield, Mo., states disposable nitrile gloves should be the first line of defense. Many times cleaners don latex exam gloves, which may break down upon contact with cleaning chemicals.

McGarvey prefers disposable gloves to reusable ones. Often, the glove itself is a source of cross-contamination.

Beyond being chemically resistant, cleaning managers must consider whether gloves fit properly. They cannot be too small or too large, which might discourage use.

Training is also essential. But according to McGarvey, industry training runs the gamut from no training at all to quality training that covers PPE, the hazard communication standard and cleaning procedures.

“The biggest thing you can do to protect the cleaner is to train them well,” agrees Hicks. He recommends teaching them to don their PPE, then clean from the cleanest parts of the restroom to the dirtiest, from the back to the front and from top to bottom, then wash their hands when finished.

Step 2: Hot, Hot, Hot

Gerba offers the following points to consider about restroom cleanliness:

• With multiple stalls, the dirtiest stall is usually the middle one, which gets the most traffic.

• The cleanest spots are the doorknob and the toilet seat.

• The dirtiest spots are generally the floor, the outside of the sanitary napkin disposal container, the sink and the taps.

An effective restroom-cleaning program considers the primary hot spots for germs and bacteria, Gerba says. These areas would be the ones most often touched by human hands, for instance the door latch on the inside of the bathroom stall, the sanitary napkin box, the paper towel dispenser, the faucets, the floor and the area around the sink.

Unfortunately, some of these hot spots are often missed when cleaning, says McGarvey, who adds that cleaners tend to push the door open when cleaning stalls, perform their work, then back out, after which they mop the floor and clean around the sink — missing many germ-laden areas.

Step 3: Killing With Chemicals

“Washing or scrubbing a surface physically removes soil and organic material such as blood and bodily fluids and takes with it many germs,” writes Hicks, in his book Infection Control for Dummies, which offers disinfecting strategies to prevent the spread of infection. Hicks recommends first removing germs and then, when necessary, using the mildest chemical possible to kill germs left behind.

Cleaning operations should select a disinfectant with the broadest spectrum of kill claims possible. For this, cleaning supervisors must correctly read and interpret labels and fully understand the basic categories of disinfectant. According to Infection Control for Dummies, the following disinfectant categories exist:

• Limited disinfectant — Effective against a specific group of major microorganisms, generally Salmonella and Staphylococcus aureus bacteria

• General disinfectant — Effective against Salmonella and Staphylococcus aureus and often referred to as a broad-spectrum disinfectant

• Health care disinfectant — Effective against Salmonella, Staphylococcus aureus and Pseudomonas aeruginosa

• Tuberculocidal disinfectant — Protects against everything that a hospital disinfectant does but with an additional claim; it also protects against mycobacterium tuberculosis (the bacterium that causes tuberculosis)

Hicks recommends a tuberculocidal disinfectant for restrooms because they inactivate a broad spectrum of pathogens, including hepatitis B, hepatitis C and HIV.

Step 4: Equip Your Arsenal

The arsenal of equipment for today’s restroom cleaning continues to grow. It ranges from microfiber cloths to restroom cleaning machines that can clean and sanitize the restroom from ceiling to floor. (See box.) An effective program puts the correct tools into cleaner’s hands.

Hicks recommends using microfiber cloths, which do an excellent job of removing soil and attached microorganisms. “With microfiber, you’re breaking down the biofilm that can build up on surfaces,” he says. “If you’re just wiping, without doing a lot of rubbing, the biofilm will create a cover, preventing disinfectants from reaching germs.”

Many facilities use color-coded labels on chemicals and equipment to ensure they are used appropriately. A color-coded system lets workers know that certain color tools belong in the restroom, while others belong in patient rooms and so on. “This helps prevent cross-contamination from restrooms to other areas of the facility,” says Hicks.

Posters throughout a facility show what colors should be used where. “That way if someone is cleaning a water fountain with a cloth meant for restroom use, it is identified and reported,” McGarvey says.

He recommends cleaners also use more than one cloth while cleaning — one for each new surface. “That way you’re always reaching into the solution and grabbing a clean, charged cloth and are never cross-contaminating the disinfectant,” he says.

Step 5: Go Touchless

Modern restrooms have everything from automatic flush systems and faucets to hands-free towel, tissue and soap dispensers. Even auto-opening trash cans and doorways are possible. The more touchless a facility can go the better, says McGarvey, who also recommends facilities consider adding no-touch cleaning systems. “These systems do a more thorough job of cleaning the restroom without putting cleaners in the position of having to touch surfaces no one else wants to touch,” he says.

St. Luke’s Hospital utilizes touchless faucets, soap and towel dispensers, and Hicks states he’d like to eliminate door handles as well. He indicates he’s currently looking at a wall-mounted system that will enable users to exit the restroom by waving a hand in front of a sensor.

Step 6: Police The Restroom

While cleaning frequency must be based on the traffic the restroom receives, effective restroom programs give each restroom a good thorough cleaning and police the facility several times during the day.

Policing a restroom does not simply entail checking paper towels and toilet paper supplies, warns Hicks, who points out that it also involves wiping down high-touch surfaces with a disinfectant and emptying trash.

Effective policing also includes regular checks by supervisors to ensure cleaners tackle critical areas. Checks like these are one of the benefits of a good quality assurance program, adds McGarvey.

Restrooms are a dirty job, but one that must be done effectively to maintain a facility’s image and keep occupants healthy. These six steps will put the cleaning operation on the right track to restroom health.

Ronnie Garrett is a freelance writer and photographer based near Milwaukee.

Restroom Cleaning Systems

Cleaning restrooms is not easy. Getting behind fixtures requires cleaners to get down on their hands and knees and up close and personal with harmful germs and bacteria.

Touch-free cleaning systems — pressure washing or vapor/steam cleaning units — can change that. These systems, generally on rolling carts, save time, clean more efficiently and protect employees from strong chemicals and contaminated surfaces.

Pressure washing systems utilize an indoor pressure washer, chemical mixing system and dispenser and a built-in wet vac. These systems first apply chemicals to various restroom surfaces, from walls to floor, then spray water at high pressures to dislodge soil and finally a wet vac picks up the water and dries the floor. Steam cleaning systems, however, heat water to high temperatures and release steam to loosen debris. A wiper over the steam head absorbs steam then the operator uses a wiper cloth to remove dirt.

These systems get into tough areas. For instance, they remove grime from hinges on toilet seats, grout lines and door latches.

Cleaning operations use these systems in a variety of ways. Some operations have one person operate the machine for their entire shift every day. In other operations, the units rotate among staff to hit all restrooms at least once a week. Still others pull these units out once or twice a year to give restrooms a deep clean. Experts recommend using the systems frequently as the more often they are used, the more proficient cleaners become with them.

Although these systems can be extremely effective and work well in restrooms with tiled or cinder block walls, they are not designed for use on drywall or wallpapered rooms.