Deep Clean?

Hospital cleanliness is a vital ingredient in the fight against healthcare associated infections (HCAIs). It is also important in its own right. Patients have the right to expect to be cared for in an environment that is clean and fit for purpose.

Cleanliness across the NHS has been improved, with 98.5% of hospitals rated acceptable, good or excellent in the 2008 PEAT scores. The latest Healthcare Commission in-patient survey shows the NHS achieving it’s highest ever cleanliness rating, with 93% of adults reporting that their ward was clean.

The Government has invested 57 million pounds in the Deep Clean programme, to help trusts achieve a good starting point from which to assess their ongoing cleaning requirements. The programme encouraged trusts to focus on what they needed to deliver, in order to achieve improvements in the patient experience.

Patients and the general public are consistently saying a clean hospital is important to them. They tend to use cleanliness as a proxy for general quality.

Cleanliness is also essential for the comfort and dignity of patients, particularly those for whom a hospital is home for any length of time.

Poor standards of cleanliness, in addition to superbugs and MRSA, have regularly been in the top five issues mentioned as the biggest problems facing the NHS. In June 2008, the issue stood at 22%, ranking third overall in the Public Perceptions of the NHS Tracking Survey, in June 2008.

Furthermore, when offered a list of 12 factors that patients thought would make them feel that they were being treated with privacy and dignity, more chose a clean hospital (58%) than any other factor, in the Public Perceptions of Privacy and Dignity in Hospitals Survey, in March 2007.

The Deep Clean programme was announced by the Prime Minister in September, 2007. The programme encouraged Trusts to assess the current state of their hospital environments and identify areas that would benefit from a thorough deep clean or refurbishment.

Deep cleaning is not ‘new’ cleaning. It is a concentrated programme of activity over and above the routine and ad-hoc cleaning activities undertaken on a day-to-day basis. The Deep Clean programme encouraged Trusts to take stock of their hospital cleaning plans, providing a baseline of cleanliness, which would inform their ongoing programmes of routine and deep cleaning.

The details and timetable of each Trust’s deep clean plan varied according to local need and the configuration of local services. Trusts used a variety of activities in order to deliver real improvements in the experiences of patients and staff using the facilities. Activities ranged from steam cleaning patient bed spaces to the development of a mobile cleaner that can be moved across sites. Some Trusts already had deep cleaning projects in place prior to the launch of the Deep Clean programme, and therefore quite rightly assessed their requirements in light of what they already had in place.

The programme is an initiative designed to support the delivery of clean, safe care, such as:

Introducing MRSA screening for all elective admissions by March 2009, and all emergency admissions by 2011;

The Healthcare Commission undertake annual infection control inspections of all acute trusts, using teams of specialist inspectors;

A new regulator – The Care Quality Commission – established 1 October 2008;

Over 5000 matrons with clear responsibility for the patient environment;

A dress code for all episodes of direct patient care;

Additional staff for the NHS, such as infection control nurses, antimicrobial pharmacists and nurses to care for patients in isolations.

Patients have the right to expect clean, safe care. Patients consistently tell us that hospital cleanliness is one of the most important issues for them. A clean, clutter-free hospital provides a sound foundation from which staff can tackle healthcare associated infections. Clean hospitals are important in their own right: important to patients and important to staff.

Measuring the success of cleaning programmes is not always straightforward. Each site has different needs and will see different benefits.

However, much can be done to improve Trustbased intelligence on hospital cleanliness. Trusts do not need to be restricted to existing methodology, if that data is not giving a local meaningful picture.

Cleanliness is everybody’s responsibility. The whole health economy must take a proactive approach to ensuring that hospitals are clean.

Sustained success needs a board to ward approach with cleanliness at the forefront of everyone’s minds, with everyone playing their part – not just cleaners.

Trusts should encourage a multi-disciplinary approach to planning for hospital cleaning, with staff from infection control, nursing, and estates and facilities all contributing to the agenda.