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KEEPING HOSPITALS CLEAN
Cleanliness of the healthcare environment is one of the key ways to prevent patients, staff and visitors acquiring a healthcare associated infection.
Cleanliness is intrinsically linked to infection prevention Cleanliness is intrinsically linked to infection prevention and control.
A clean well ordered environment provides the foundation for excellent infection control practice to flourish.
KEEPING HOSPITALS CLEAN
A clean healthcare environment is essential to the dignity and comfort of patients.
All staff are responsible for the cleanliness of healthcare facilities. A clean facility reflects a culture of concern for patients and respect for those working in and visiting the facility.
Environmental cleaning
Therefore the development, standardisation and implementation of environmental cleaning practices and the auditing of those practices and the auditing of those environmental cleaning practices are vital in providing a safe and clean environment for all.
Environmental Hygiene Working Party 2008-?
Subgroup of the Healthcare Associated Infection (HAI) Expert Advisory Sub-Committee
Recommendations from the Working Party will be reported to the HAI Expert Advisory Sub-be reported to the HAI Expert Advisory Sub-Committee
Membership included specialists in the areas or environmental cleaning and infection control
Monthly meetings
Terms of Reference
Provide expert advice on environmental cleaning practices across the stateAssist in the development of environmental cleaning policies, procedures and toolsAdvise on the development of an Advise on the development of an implementation strategy for environmental cleaning practices and auditing of those environmental cleaning practicesProvide expert advice on the content of a statewide cleaning manual (SOP)
Implementation Strategy
Environmental Cleaning Policy
Statewide cleaning manual (SOP)
Audit tool/other tools requiredAudit tool/other tools required
Database- data collection
Definition and training of audit teams
Pilot- Full implementation
Other issues
Policy Directives
ENVIRONMENTAL CLEANING
Documents that would be superseded by the manual when developed
Who should use the policyWho should use the policy
Colour coding
General cleaning, equipment, correct use of detergent solutions, additional precautions, protective precautions, discharge clean.
Policy Directives Auditing
IMPLEMENTATION TOOL 1How to evaluate the risksThree way cross referencing matrix1. Functional area: the physical feature being
cleaned, eg. operating theatre, waiting cleaned, eg. operating theatre, waiting room, laboratory.
2. Element: the article or fixture being cleaned, eg. walls, toilets, door handles, refrigerators.
3. Risk of the functional area: Very High, High, Moderate, Low
Policy Directive
IMPLEMENTATION TOOL 2
How clean is your hospital ?
What is an acceptable level of cleanliness? (85% benchmark, will increase)benchmark, will increase)
Preparing your audit
What types of audits, how often, what to audit, risk areas, who conducts the audit
Action in response to an audit, methodology and scoring
Standard Operating Procedures (SOP)The SOP is set out in nine individual modules that cover the issues required to implement an environmental cleaning program in any healthcare facility. These modules are:Module 1: Frequency of cleaningModule 2: Personal protective equipmentModule 3: Work procedures for cleaningModule 3: Work procedures for cleaningModule 4: Specialised patient conditionsModule 5: TrainingModule 6: AuditingModule 7: LinenModule 8: Cleaning equipmentModule 9: Supporting documents
ProblemsNo money for statewide auditing program
Problems with the server ( IPraise)
Still to develop plan for pilot
3 secretariats
No meetings from November 2008-March 2009No meetings from November 2008-March 2009
Audit tool put on hold (now underway,6 months to complete!)
Policy still not released
Awaiting SOP on CEC website
Challenges
Implementation- what that means for the LHDs, extra resources, funding, education LHDs, extra resources, funding, education etc
Back to basics
Why is cleaning healthcare facilities Why is cleaning healthcare facilities important?
WHY CLEANING IS IMPORTANT
Removes harmful microorganisms soil and dirt
Prevents spread of infection
Creates a safe and hygienic environment for patients and staffpatients and staff
Enhances the psychological well being of patients and staff (makes them feel better)
Prevents deterioration of the health care facility
Smells nice!
Back to Basics
Cleaning is an important part of a healthcare facility’s Infection Control Cleaning is an important part of a
healthcare facility’s Infection Control Policy
NSW HEALTH DEPARTMENT INFECTION
CONTROL POLICYPD2007_036
ENVIRONMENTAL CLEANING�Very High Risk- Requires the highest level of intensity and frequency of cleaning (OT, ICU, Transplant Units)Transplant Units)�High Risk- Are maintained by frequent scheduled cleaning and a capacity to “spot clean” (ED, CSSD, general wards)�Moderate Risk- Are maintained by frequent scheduled cleaning and a capacity to “spot clean” (Labs, Outpatients, day activity areas)
NSW HEALTH DEPARTMENT
INFECTION CONTROL POLICYPD2007_036
ENVIRONMENTAL CLEANING
Management and Risk
Low/minimal Risk- Are important for aesthetics and to a lesser extent hygiene and are and to a lesser extent hygiene and are maintained by cleaning on a routine basis with the capacity to spot clean (Admin areas, Record storage)
New policy with timeframe for rectifying problems
YOUR CLEANING PROGRAM WILL DEPEND ON:
Function and role of the area to be cleaned
How busy the area is
The type and condition of surfaces, The type and condition of surfaces, furnishings, and fabric finishes
Infection Control requirements
Age and location of buildings
HEALTH CARE FACILITIES CAN BE DIVIDED INTO:
•Patient Areas
•Clinical Areas•Clinical Areas
•Non-clinical areas
Each of these areas have different cleaning requirements
HEALTH CARE FACILITIES CAN BE DIVIDED INTO:
•Patient Areas
•Clinical Areas•Clinical Areas
•Non-clinical areas
Each of these areas have different cleaning requirements
PATIENT AREASWards – general, surgical, orthopaedics, CCU, ICU, A&E, burns unit, maternity, labour wards
Day procedure unit
Operating room, recovery unit
Treatment roomsTreatment rooms
Endoscopy unit
Renal unit
Patients bathrooms and showers
CLINICAL AREAS
Central Sterilizing Department
Laboratories
Physiotherapy Department
PharmacyPharmacy
Radiology
Mortuary
NON-CLINICAL AREAS
Administration areas
Offices
Board roomBoard room
Medical records
Service areas
Staff bathrooms and toilets
TYPES OF CLEANING
ROUTINE – may be done once a day or several times a day; part of a regular routine
PERIODIC – tasks which are additional to routine cleaning and may be done periodically, eg once cleaning and may be done periodically, eg once a week
PROJECT – may be done as a special project every six months or yearly
CLEANING EQUIPMENT COLOUR CODING CHART
Infectious/ Isolation Areas YELLOW
Toilets/bathrooms/dirty utility RoomsRED
Food service/ Preparation Areas GREENFood service/ Preparation Areas GREEN
General Cleaning BLUE
Operating Theatres WHITE
BEWARE: Use only the coloured equipment for the correct area
NEUTRAL DETERGENT
Used for general cleaning of hard surfaces such as floors, walls, furniture, painted surfaces and benches
Neutral detergents are those with a pH of between 6-8
NEW TECHNOLOGIES
Dual purpose cleaner/disinfectants (Chlorine)
Surfactant which doesn’t inhibit the release of chlorineDetergent removes organic soilingDetergent removes organic soilingChlorine kills microbes by oxidisationSingle step processPotential savings in time and resourcesSensitivity to chlorinePossible erosion of surfaces
Adenosine Triphosphate (ATP) Cleaning Monitors Chemical to measure amount of biological soiling on a surfaceATP molecule present in all living cellsBiochemical reaction, emits a light, bioluminescencebioluminescenceWidely used in food industryDoesn’t differentiate between harmful pathogens and organic soilingNo consensus on acceptable levels of bioluminescenceMight be useful in the training of cleaning staff
Vaporised Hydrogen Peroxide
Vaporised bio-decontamination systemHydrogen peroxide 4.9%Oxidising agent, attacks cell componentsSelf monitoring- ensures the process starts, runs & completes safelyruns & completes safelySelf calibrating- adjusts each process to best suit the environmentUses high frequency ultrasonic vibrations to vaporise solution (fine liquid droplets)
Vaporised Hydrogen Peroxide
Breaks down to oxygen & waterNon wetting, no condensationDesigned to deliver a log 6 reduction to surfacesEffective against C-Diff & NorovirusEffective ward & equipment cleaning programEffective ward & equipment cleaning programWidely used in UKWestmead Hospital-NNICUMOH request to review processIncorporate into regular cleaning protocolsReactive & proactive program
New Technologies
It is vitally important that any new technology is accompanied by thorough training of users Robust evidence of its effectiveness must be present before introduction to the healthcare present before introduction to the healthcare environment
Cleaning standards should reflect the outcomes of a cleaning service
The Cleanliness Quality Cycle
OUTPUTSOUTPUTS
PROCESS
Standards should be designed to focus users’ attention on the outcome or input sought rather than the method by which it is achieved.
AUDITAUDIT
OUTCOMESOUTCOMES
INPUTSINPUTS
PROCESS