Topic 2.4 Environmental Cleaning, Disinfection and Equipment Management

The environments in which Occupational Therapists (OTs) practise play a significant role in preventing the transmission of infectious diseases. While much attention is often given to hand hygiene and personal protective equipment, microorganisms can survive on environmental surfaces and shared equipment for extended periods, creating opportunities for indirect disease transmission. Effective environmental cleaning and equipment management are therefore essential components of infection prevention and control and contribute to safer healthcare, community and occupational environments.

Occupational Therapists routinely work across hospitals, rehabilitation facilities, schools, aged care services, workplaces, disability services, community organisations and clients’ homes. Many interventions involve frequent contact with shared equipment, mobility aids, seating systems, adaptive devices, therapy resources and environmental surfaces. Assistance animals further expand the range of equipment and environments requiring consideration, including harnesses, leads, mobility handles, water bowls, toys, grooming equipment and transport vehicles. Maintaining clean environments protects clients, practitioners, assistance animals and the wider community while supporting confidence in assistance animal partnerships.

Environmental hygiene extends beyond simply making surfaces appear clean. Effective infection prevention requires an understanding of the difference between cleaning, disinfection and sterilisation, the selection of appropriate cleaning products, and the implementation of evidence-based cleaning schedules. Occupational Therapists should also recognise that infection prevention must be balanced with sustainability, occupational participation and animal welfare, avoiding unnecessary use of disinfectants where routine cleaning is sufficient.

This topic explores the principles of environmental cleaning, disinfection and equipment management, examines common environmental reservoirs for microorganisms, and outlines practical strategies for maintaining safe clinical and community environments while supporting meaningful occupational participation.

The Role of the Environment in Infection Prevention

Microorganisms may survive on environmental surfaces for varying periods depending on:

• the type of microorganism
• humidity
• temperature
• surface material
• presence of organic matter
• cleaning practices.

High-touch surfaces present the greatest opportunity for indirect transmission because they are contacted repeatedly by multiple people throughout the day.

Examples include:

• door handles
• light switches
• desks
• chairs
• wheelchairs
• keyboards
• touch screens
• therapy tables
• mobility equipment
• shared therapy resources.

Although environmental contamination alone does not necessarily result in infection, contaminated surfaces contribute to the chain of infection when microorganisms are transferred to hands and subsequently to susceptible individuals.

Regular environmental cleaning interrupts this chain by reducing microbial contamination before transmission can occur.

Cleaning, Disinfection and Sterilisation

These three terms are often used interchangeably but describe different processes.

Understanding the distinction is essential for selecting the most appropriate infection prevention strategy.

Cleaning

Cleaning is the physical removal of dirt, dust, organic material and many microorganisms from surfaces.

Cleaning typically involves:

• water
• detergent
• mechanical action (scrubbing or wiping).

Cleaning does not necessarily kill microorganisms but substantially reduces their numbers and removes material that may interfere with subsequent disinfection.

Routine cleaning is appropriate for most environmental surfaces encountered in occupational therapy.

Disinfection

Disinfection uses chemical or physical agents to destroy or inactivate many pathogenic microorganisms remaining after cleaning.

Disinfection is generally required when:

• body fluids contaminate surfaces
• infectious diseases are known or suspected
• high-risk equipment is shared
• organisational policies require enhanced infection prevention.

Importantly, disinfection is most effective when surfaces have been cleaned first.

Organic material such as blood, food or animal waste can reduce the effectiveness of disinfectants.

Sterilisation

Sterilisation completely destroys all forms of microbial life, including bacterial spores.

Sterilisation is primarily used for:

• surgical instruments
• invasive medical equipment
• instruments entering sterile body sites.

Sterilisation is generally outside the scope of routine occupational therapy practice but remains an important concept within infection prevention.

Environmental Risk Assessment

Occupational Therapists should undertake environmental risk assessments before providing services.

Factors to consider include:

• client vulnerability
• environmental cleanliness
• ventilation
• presence of pets or assistance animals
• food preparation areas
• waste disposal
• hand hygiene facilities
• water availability
• shared equipment
• evidence of contamination
• current infectious disease risks.

Risk assessments should be dynamic and adjusted as circumstances change.

Cleaning Shared Equipment

Many occupational therapy resources are used by multiple clients throughout the day.

Examples include:

• wheelchairs
• walkers
• transfer boards
• therapy balls
• exercise bands
• cognitive rehabilitation materials
• adaptive cutlery
• seating systems
• splints
• pressure care equipment.

Shared equipment should be cleaned according to:

• manufacturer recommendations
• organisational policies
• frequency of use
• likelihood of contamination
• client risk factors.

Equipment visibly contaminated with body fluids should be cleaned and appropriately disinfected before reuse.

Assistance Animal Equipment

Assistance animal equipment also requires routine cleaning and maintenance to protect both animal and human health.

Equipment may include:

• harnesses
• leads
• collars
• mobility handles
• capes or jackets
• identification tags
• grooming equipment
• food and water bowls
• toys
• transport crates.

Routine cleaning removes dirt, saliva, hair and environmental contaminants while maintaining the integrity of the equipment.

Items contaminated with urine, faeces, vomit or blood should be cleaned promptly using appropriate infection prevention procedures.

Occupational Therapists should encourage handlers to inspect equipment regularly for wear, damage and cleanliness as part of responsible assistance animal management.

Cleaning in Different Practice Environments

Environmental cleaning requirements vary depending on the setting.

Hospitals and Healthcare Facilities

Cleaning should follow organisational infection prevention policies, with particular attention to high-touch surfaces and shared equipment.

Community and Home Visits

Occupational Therapists have limited control over home environments but should:

• assess environmental hygiene
• identify biological hazards
• adapt interventions where necessary
• educate clients regarding infection prevention
• perform hand hygiene before and after visits.

The goal is not to achieve hospital-level cleanliness but to minimise preventable risks while respecting the client’s home and autonomy.

Schools and Workplaces

Therapy equipment should be cleaned between users where appropriate, and shared resources managed according to organisational policies.

Occupational Therapists should also consider food preparation areas, communal spaces and shared technology.

Waste Management

Appropriate waste management reduces environmental contamination and protects people, animals and wildlife.

Waste may include:

• used tissues
• disposable PPE
• contaminated dressings
• cleaning materials
• animal waste
• food waste.

Occupational Therapists should follow local organisational and legislative requirements regarding waste disposal.

Animal waste should be removed promptly and disposed of hygienically.

Cleaning Products

Cleaning products should be:

• appropriate for the surface
• used according to manufacturer instructions
• compatible with equipment materials
• safely stored
• used in well-ventilated areas where required.

Occupational Therapists should avoid excessive use of disinfectants.

Routine cleaning with detergent is sufficient in many situations and reduces unnecessary chemical exposure for clients and assistance animals.

Environmental Sustainability

Infection prevention should also consider environmental sustainability.

Responsible practice includes:

• avoiding unnecessary disposable products
• selecting environmentally preferable cleaning products where appropriate
• reducing chemical overuse
• maintaining reusable equipment safely
• minimising waste without compromising infection prevention.

These practices align with both One Health principles and sustainable healthcare.

The Occupational Therapist’s Role

Occupational Therapists contribute to environmental infection prevention by:

• assessing environmental risks
• ensuring shared equipment is appropriately cleaned
• educating clients regarding home hygiene
• promoting safe management of assistance animal equipment
• collaborating with cleaning and infection prevention teams
• following organisational policies
• modelling evidence-based practice.

Environmental hygiene should support participation rather than create unnecessary barriers to therapy.

Key Practice Principle

Environmental cleaning, disinfection and effective equipment management are essential components of infection prevention and control. Occupational Therapists should implement evidence-based environmental hygiene practices that reduce biological hazards while supporting occupational participation, protecting assistance animal welfare and promoting safe, sustainable and person-centred care across healthcare and community settings.