Imposter syndrome should not be part of infection control

VERY OFTEN I find myself writing these articles, trying to some way sell to the reader that I am a confident cleaning professional. Confident and assured in the knowledge that I am a “specialist” in my background of healthcare.

Well, it’s time to be completely honest. Every year I attend multiple infection prevention and control events, from talks, exhibitions, to webinars and have even presented at some conferences myself, and yet, even after years of working within and around healthcare cleaning, I still find myself with huge bouts of imposter syndrome.

I can’t even begin to tell you the number of times I have sat completely perplexed as an IPC Nurse starts talking about microbial infections, or new treatments tested on Methicillin-resistant staphylococcus aureus. To be frank, sometimes I am left feeling completely lost and as some sort of fraud being recognised as part of the infection control professional community.

Now, I’m not going to sit here and say that I have the answers to microbial resistance, nor I am going to humour you with my home remedies of the flu, (a good old cup of tea and a shepherd’s pie – thank me later). But what I am going to do, is remind you, and in some ways myself, of the role our amazing cleaning industry professionals play in infection control, whether inside or outside of the industry. 

Infection control precautions

Coming from a healthcare background, I am familiar with the NHS England’s ‘Standard Infection Control Precautions’, and although I am aware that there are other precautions outside of this version, I think the premise of these precautions are universal:

1 Patient placement/assessment for infection risk

2 Hand hygiene

3 Respiratory and cough hygiene

4 Personal protective equipment (PPE)

5 Safe management of care equipment

6 Safe management of the care environment

7 Safe management of linen

8 Safe management of blood and body fluid spillages

9 Safe disposal of waste (including sharps)

10 Occupational safety: prevention of exposure (including sharps injuries).

You can probably gather what is going to come next, but I’m going to take a deeper dive now into the role that our cleaning professionals play, both in and out of the normal healthcare setting to follow and promote these standard infection control precautions.

​Patient placement/assessment for infection risk

On a day-to-day basis, all levels of the cleaning services teams carry out risk analysis. Our cleaning operatives assess risk within their cleaning workplaces. A ‘dynamic risk assessment’ should be carried out with every task our operatives do. Yes, they check for pests and damage, but they also protect themselves and check their areas in relation to the infection risk they may be surrounded by. Supervisors and managers write policies to ensure that operatives and stakeholders are kept safe, with adherence to correct PPE, training and use of different chemicals (detergent/disinfection) and even go as far as assessing who is appropriate to work in certain areas, in following guidance and policies around people’s occupational assessments. Our whole cleaning service management is based around risk analysis and solving the problems this presents to the public. 

​Hand hygiene

Unsurprisingly, hand hygiene is considered one of the most important ways to reduce the transmission of infectious agents and the spread of infection. Long before the hand washing epidemic caused by the novel Coronavirus, cleaning professionals held hand hygiene as an imperative practice in the cleaning of any facility. Cleaning professionals have really led the way for correct hand hygiene procedure, ensuring that correct practice is trained into inductions, refreshers, and that the availability of hand washing facilities is available to operatives. 

Respiratory and cough hygiene

Respiratory and cough hygiene is promoted to minimise the risk of cross transmission of any respiratory pathogens. Respiratory and cough hygiene is not too dissimilar to hand hygiene, whereby should any respiratory problems cause a form of contamination of surfaces, whether on a person’s body or on an environment, should be cleaned as necessary. We have already highlighted that cleaning professionals are the leaders of hand hygiene practice, and clearly the removal of contamination on environmental surface. But in this case, we should think about the cleaning community’s adherence to PPE, and the wearing of respiratory PPE not only in accordance with Coronavirus regulations, but in abidance with pro-active risk assessments that our industry readily prepares in its knowledge of infection control. 

Personal protective equipment (PPE)

This brings me very nicely onto PPE, which is 1.4. It is noted in the NHS protocols that before undertaking any procedure, “staff should assess any likely exposure to blood and/or other body fluids… and wear personal protective equipment (PPE) that protects adequately against the risks associated with the procedure”. Our incredible operatives do this every-day, they avoid overuse of PPE, they follow company procedure, and they ensure, to the best of their ability, training and access that they protect themselves and others. Correctly trained cleaning operatives are true PPE specialists. Don’t agree? I challenge you to a PPE donning race against anyone that has cleaned washrooms to BICSc standard before! It is imperative we train our staff in the best use of PPE and the appropriate PPE for differing scenarios. 

Safe management of care equipment

I’m going to change this, so it fits the whole cleaning industry, to safe management of equipment. Any element in a room can be contaminated. Contamination can be blood, other body fluids, secretions, excretions, and most appropriately for this article, infectious agents. Clearly, when our cleaning teams remove this contamination by following correct risk and damage environment assessment, damage assessment of the element, colour-coding, cleaning practice and disposal practice, the operative takes part in the safe management of equipment. 

Safe management of the care environment

With operatives checking the state of repair of each element in a room, we know that they also check the repair of the whole environment. It is key that we have assurance systems in place to ensure that the environments we clean are visibly free from clutter to facilitate efficient and effective infection-controlled cleaning. Whenever we audit, inspect, or re-align our work to safe standard, we are following a safe management of the environment we clean.

Safe management of linen

Whether we immediately think it or not, linen is a big part of the cleaning process. Within healthcare and hotels, linen forms a part of bedding. Within transport, manufacturing, and hospitality, for example, the uses of linen can be endless. So, it begs the question, what involvement do operatives have in this linen process? What safety precautions do we need to introduce to ensure that linen is managed safely? Think it has no relevance? What materials do operatives use on site? Where fabrics are used on site to clean with, such as microfibre, operatives are key in the safe use, laundry process, and storage of this linen management, it is imperative they have the correct training in how to do so. 

Safe management of blood and body fluid spillages

Believe it or not blood and body fluid spillages happen even outside of healthcare, as do blood borne viruses. All appropriate staff should be trained in dealing with body fluids and spillages and responsibilities for the management and cleaning of these should be clear among all stakeholders and cleaning operatives. Whether an operative cleans blood/ bodily fluids or not, they are still key in the safe management of them. 

Safe disposal of waste (including sharps)

The disposal of waste is central to the cleaning service. Not only do our cleaning operatives remove contamination, but within their remit, they remove waste. Central to good waste management is the safety that comes alongside this! Inside and outside of healthcare, different facilities have different waste disposal management, different colours for different waste, our operatives must be specialists in selecting the right method of disposal while remaining safe and free from the potential hazards that this can cause. 

Occupational safety: prevention of exposure (including sharps injuries)

I can’t begin to tell you how many times I’ve heard: “No, we don’t have a sharps box, we aren’t a hospital.” Silly me! I forgot that needles, scissors, safety pins, screws, glass (to name a few!) only exist in healthcare, gosh, they didn’t teach me that in my NHS induction! Cleaning operatives come across sharps in waste and in general cleaning exposure daily, so it is imperative we give them the tools to keep themselves safe. Even if an operative is not responsible for the removal of sharps, accidents can happen, and operatives should have immediate access to first aid and help following the worst-case scenario. 

I think I need these 10 points saving into my mental wellbeing journal every time I start to feel like an imposter when the words 'infection control' appear! It is very easy to forget all we do as members of the cleaning industry, and all that our amazing operatives do. When we recognise the assurance systems, safety systems, and risk systems we put in place off the ground floor, and we think of the amazing skill, adherence, and practice that our cleaning operatives follow on the ground, it is imperative to remember that we, our industry, are part of a cog in a bigger life-saving model. Infection control isn’t just present in healthcare, and it isn’t only nurses that are infection control specialists.

Well, what a reflective 1500-word journey we have been on! I’m off now to change my Linkedin bio!

Kelsey Hargreaves is technical specialist at BICSc.

For more information visit www.bics.org.uk

Tel: 01604 678710