KEEPING HOSPITALS CLEAN

Novel systems and practical issues

Jo Tallon

Keeping Hospitals Clean

Up to speed MOH/CEC

Basics/novel technologies

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Documents that would be superseded by the manual when developed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 IS THE CLEANING SOLUTION OF CHOICE FOR ENVIRONMENTAL SURFACES

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