Top concerns in healthcare cleaning
15 May 2015
The most pressing issues affecting healthcare cleaning were explored during a special study day organised by The Association of Healthcare Cleaning Professionals' (AHCP) southern branch. Cleaning Matters reports.
A session on demystifying PAS5748 included discussion on the risk-assessment process. Revised in 2014, the guidance requires organisations to assess both elements (i.e. ceilings, toilets and telephones) and functional areas (i.e. main entrance) on a three-point numeric scale for 'infection risk' and 'confidence risk'.
'Infection risk' is the risk of infection for patients, while 'confidence risk' is the risk of a poor public image and the loss of confidence from patients and staff in the organisation's ability to provide a clean, safe environment for care. The risk-assessment outcomes are then used to inform decisions on the frequency of cleaning tasks.
There were mixed views from delegates on some facilities – for example, some believed that any equipment or items in isolation areas should be deemed high risk and cleaned more frequently.
Delegate Lara Wade, from facility-services company ISS, also voiced deeper concerns about the guidance: "Assessing infection risk and confidence risk is too subjective and PAS is too emotive because everyone has a different opinion."
About Health chief executive Nigel Grinstead, who was MC for the day, told the audience: "PAS is not perfect, but it is a tool that may be of use to some organisations that need to get to a more standardised way of assessing risk." He added: "It is too soon to know how many Trusts will take PAS on – it might cost more to implement than what you get out of it, or it could be used as a way to get more resources."
The Care Quality Commission (CQC), the independent regulator of health and adult social care in England, carries out inspections of health and social care services to make sure that they continue to meet the standards.
In a workshop on CQC visits, there was a lot of debate about the skills of inspectors and their understanding. For example, one Trust was put under the spotlight because of its high mortality rates, but it has a Macmillan unit giving palliative care, so this would be expected.
Others said the inspectors would come in and highlight areas they already knew about. The advantages of the inspections did mean that hospital staff were able to get what they needed to make improvements at the time, although standards were difficult to maintain once resources were no longer available.
One delegate said that during their CQC visit little attention was paid to cleaning and the work that goes into keeping the hospital safe. In the report, only one sentence was written to say that care was given in a clean, safe environment, but the delegate said that more feedback was needed to drive improvements.
AHCP patron David Bedwell, who also works as assistant director of Health Facilities Scotland, spoke about standards and highlighted a small study in which high-touch areas were cleaned with antibacterial wipes as staff moved through the hospital. Testing of the surfaces showed an improvement in standards, but the cost of the wipes was highlighted by the financial department and the practice was stopped, despite the fact that this may contribute to reducing the bioburden in the environment and save lives.
David emphasised the need to improve hand-hygiene compliance and spoke of the work that NHS Scotland had done to educate children. He said children were able to sing a song as they washed and that this had become the norm, and they were then setting examples for adults.
MRSA & HCAI
In his presentation on MRSA and HCAIs, Derek Butler, chair of MRSA Action UK, said: "Our only limitation to providing a first-class cleaning environment is attitude." He added that, to ensure a patient is kept safe from avoidable healthcare infections, there is a need to change mindsets so that there is an expectation that the environment around the patient is clean.
Derek showed that cleaners were the first line of defence against healthcare infections and that this is a team effort from all those who come in to contact with patients, whether that be cleaners, nurses, doctors or visitors.
The most striking part of the presentation for delegates was when Derek spoke about people of different ages who had been lost to avoidable healthcare infections. In many of the cases presented, all the families had mentioned that the area around their loved ones' bed was filthy.
While there is little risk from Ebola in the UK, healthcare cleaning professionals still need to continue to put measures in place, said Rachel Thaxter, who is the lead nurse for infection prevention & control at Cambridge University Hospitals NHS Foundation Trust. In the UK, there are 26 beds for Ebola patients, with isolation cubicles in specialist hospitals, and high-specification personal protective equipment (PPE) available for staff who treat patients.
Rachel added: "Cambridge University Hospitals also has the provision to disinfect rooms using Hydrogen Peroxide Vapor (HPV) fogging methods, and so we have trained some cleaning supervisors to 'don' and 'doff' high-specification PPE – as Ebola can be contracted by donning and doffing incorrectly."
When removing face masks, for example, if the face is touched then this can present a risk. Following removal, disposable PPE will need to be placed into suitable disposal receptacles and treated as clinical infectious waste.
Delegates were asked for ideas for the Cleaning Olympics event planned for the AHCP's annual conference. As the name suggests, there will be healthcare cleaning tasks created for teams to compete in. Ideas included putting items onto a cleaning trolley in the fastest time. The aim is to improve cleaning, encourage team work and have fun.