Hospital Cleaning - What Next?

By the time you are reading this article, the much publicised “deep clean” of hospitals in the UK should be over, and both the medical and cleaning professions will be considering how worthwhile the exercise has been. Many of the members of the Cleaning and Support Services Association (CSSA) have been involved in undertaking these deep cleans, which puts me in a central position to report back on the process and ask the question: “what next?”

What were the Deep Cleans?

The hospital deep cleans have been controversial. For some they are an essential element of the fight against hospital acquired infections. For others they are an expensive waste of time. My view is more nuanced than that. I welcome the deep clean process and the fact that it will deliver a cleaner hospital estate in the short term. But I and many others in the cleaning industry believe strongly that without further sustained investment, any benefits from the process will be lost over time.

The deep clean is very much more extensive than an ordinary cleaning routine in a hospital. It necessitates the closure and clearance of wards of both patients and equipment so that cleaning can be undertaken using steam cleaners and fumigation techniques that simply could not be done while patients were in situ. The deep cleans also involve the cleaning of a number of items that would not normally be handled by cleaning staff, be they in-house or outsourced. This includes blood and catheter stands, medical trolleys and commodes, inside radiator covers and high and inaccessible areas.

The UK’s hospitals will be a lot cleaner as a result of this process, but whether or not it turns out to be more than just a £50 million flash in the pan depends very much on what happens after the deep clean is over.

How were they undertaken?

The deep cleans have not been implemented to a uniform standard. It has been up to each Trust to decide where they should invest their money. On the one hand this is a reasonable approach, reflecting differences in the condition of hospitals. But on the other, as in some cases entire hospitals have not been touched, it is difficult for the Government to argue that everything has been cleaned to the same standard. Some hospitals have received much more attention than others.

The deep cleans have also required an unprecedented degree of coordination between the Trusts, the Government for funding, and both in house and outsourced cleaning teams. At the time of writing, it remains possible that the end of March 2008 deadline for all the deep cleans to be completed could be met. However, to achieve this would require a very substantial commitment from the Trusts as well as a smooth flow of funds from Government. It looks likely that that at least in some cases, the deadline will be missed and deep cleans will be continuing in April 2008.

What Next?

Let’s be clear about this. The hospital deep cleans will not on their own eradicate MRSA or any of the other hospital acquired infections. Minimizing these infections is a matter not just of cleaning, but also of antibiotic prescribing practice, bed management, effective infection screening and segregation, patient and visitor hygiene as well as good personal hygiene practices from the medical staff.
What the deep cleans can do is help to bring hospitals back to a certain level of cleanliness. I welcome this, as do those cleaning companies carrying out the work, but it can only be a start. Unless there is extra money to maintain the improved level of cleanliness that the deep cleans achieve, then it will have been a publicity stunt, and at £50million, an expensive one at that.

Without extra funding for the cleaning of hospitals – then the deep cleans will have achieved nothing. The annual UK hospital cleaning budget is substantial, perhaps approaching £1 billion (say 2% of the NHS budget), and many hundreds of millions of pounds more will be required to raise cleaning frequencies to the levels required to maintain the post deep clean standard. But, recent US figures suggest that the direct costs of hospital acquired infection in the UK is of the order of £850 million per year and the real figure is much more if the indirect costs to the economy and people affected are included. It looks like increasing the budget for hospital cleaning would make a lot of sense. Over to you Secretary of State….