Cleaning beneath the surface

The effective cleaning of surfaces and equipment is considered a key measure of cleanliness in hospitals. But cosmetic cleaning alone will do little to control the spread of healthcare-associated infections unless combined with regular ventilation duct cleaning, says Darren Ling, a director of System Hygienics

In June this year,The British Standards Institute (BSI) launched its Publicly Available Specification (PAS) 5748 to provide a framework for the planning, application and measurement of cleanliness services in hospitals. Sponsored by the Department of Health, the lengthy and detailed document specifies requirements for governing cleanliness, including the provision of cleaning tasks, but the importance of ventilation cleaning has barely been touched upon.

Cleaning surface dust and dirt on the outside of ventilation grills may be adequate for a quick visual inspection but it will not address the very serious consequences of contaminated air ducts.

Ventilation duct accumulation Over time, biological agents from outside a building, including fungal spores and pollen grains, and particles generated indoors, including human skin flakes and faecal material from dust mites, can accumulate in ventilation ducts. Such microorganisms only require nutrients, oxygen, a little moisture and temperatures between 15oC and 25oC to grow. Since these conditions are common in most hospitals, highly infectious bacteria like MRSA, Clostridium difficile (C.

diff) and Staphylococcus aureus can multiply at a vast rate and travel through a ventilation system with potentially fatal consequences.

According to data from the Office of National Statistics (ONS), the number of death certificates mentioning MRSA, C. diff and Staphylococcus aureus infections in England and Wales decreased by 31 per cent in 2010, down to 4,461 from 6,468 in 2009. Although these figures are encouraging, the British Cleaning Council is urging hospitals to take a multifaceted approach that maintains a focus on high-levels of cleanliness, best practice guidance and more infection control staff in order to drive down infection rates even further.

No matter how diligent hospital staff are in wiping surfaces and equipment and scrubbing floors, if a hospital fails to undertake regular internal cleaning of ventilation ductwork, their efforts for controlling infection will be pointless.

Although the BSI's latest guidelines on cleanliness services in hospitals does not acknowledge the importance of duct cleaning, hospitals are in fact duty bound by legislation to maintain ventilation systems in line with the Department of Health's Health Technical Memorandum 03-01: Specialised ventilation for healthcare premises (HTM 03-01).

Failure to do so could leave those responsible for managing hospital premises vulnerable to prosecution.The HTM 03-01 states: 'Increased health risks to patients will occur if ventilation systems do not achieve and maintain the required standards.The link between surgical site infection and theatre air quality has been well established. If the ventilation plant has been installed to dilute or contain harmful substances, its failure may expose people to unacceptable levels of contamination. Proven breaches of the statutory requirements can result in prosecution and may also give rise to a civil suit against the operators.' System Hygienics was selected to conduct a pre-commission clean at the site of the new Peterborough City Hospital - one of the biggest healthcare initiatives in the UK to date.

The company's most recent hospital contract involved the postcommission cleaning of ductwork in the new Paediatric and Maternity wards at St Mary's Hospital in Portsmouth. System Hygienics cleaned the ductwork using its remote cleaning method, the Jetvent system.The system uses compressed air and a powerful filtered vacuum to achieve a fast and effective clean to the standards prescribed by HVCA TR/19.

Due to the sensitive use of hospital wards, projects in these areas demand extra care and attention to ensure a thorough and effective clean.To offer reassurance to the client, System Hygienics provided detailed reports with before and after photos of all aspects of the ventilation systems, along with a certificate of cleanliness and third party analysed HVCA TR/19 Vacuum Tests to verify the high level of cleanliness achieved.