The need for standards in healthcare cleaning

Cleaning is one of the defining issues in healthcare today. According to the Department of Health it is the biggest single factor in successfully reducing the indirect transmission of healthcare acquired infections (HCAIs) such as MRSA and C-difficile.
The Association of Healthcare Cleaning Professionals (AHCP) is the principal organisation which defines the standards and represents the interests of the healthcare cleaning sector throughout the UK. Having grown out of the primarily hospital based Association of Domestic Managers, the AHCP now encompasses all areas of healthcare cleaning including NHS and private hospitals, Primary Care Trusts, care and nursing homes, dental and GP clinics and surgeries as well as the mental health field.
To say that the AHCP is the most influential force in healthcare cleaning in the UK today is not an overstatement. AHCP members are present in every healthcare trust in England, Scotland and Wales and in a growing number of hospitals and clinics in both Northern Ireland and the Republic. Individual membership is steadily growing as is the network of regional branches. Expertise is shared and best practice encouraged through local branch and national study days, workshops and conferences.
There is very little the AHCP does not know about healthcare cleaning and the government recognises the AHCP’s expertise, knowledge and experience. The current Revised Healthcare Cleaning Manual, commissioned by the Department of Health, was researched and written by the AHCP’s members. It sets out the best practices and processes which are followed throughout the NHS.
The Association is now working on a new BSI standard for healthcare cleaning, due to be published later this year. This involves an evaluation of current cleaning regimes and systems, focussing in particular on risk within each healthcare facility. It will result in a new set of procedures and standards for cleaning, and aligns to the Revised Healthcare Cleaning Manual, providing working schedules and procedures which will become the standard for all healthcare establishments to follow.
A clearly defined set of common standards is essential if we are to make further progress in improving healthcare cleaning and reducing indirect transmission of HCAIs. Organisations have sometimes been left to define their own standards and best practices and there has been insufficient research into what actually works in different environments.
Correct processes
The need for standards is particularly critical when you consider that one of the biggest challenges in healthcare cleaning is that implementation of correct processes can often be difficult to achieve. Practice can at times appear to be very remote from policy. There are a number of reasons for this.
Cleaning processes are commonly delivered by cleaners who are employed on short term contracts and paid close to the minimum wage. Some may not even have a good command of the English language and are unable to understand written directions.
Centralisation of services and increased use of outsourcing in some regions has lead to an impression of a lack of clear lines of accountability.
In the case of outsourcing, there is the widely held view that this has lead to a fall in standards. There is in fact no evidence to support this view. Contract cleaning companies are employed on rigid contracts incorporating clearly defined standards. They are subject to internal and external independent checks with stringent financial penalties if standards are not met.
Other factors affecting implementation of healthcare cleaning processes include poorly designed and outdated hospitals, increased numbers of beds on wards, increased occupancy rates, the use of temporary staff, absence of isolation or decant facilities as patient lounges are changed into bed bays, and extended visitor access.
More controversially, internal pressures resulting from clinical needs and the need to meet performance targets of, for example, bed turn around time when beds are in high demand can also have a significant impact on implementation.
Too often in the past cleaners have taken the brunt of comments apportioning blame for things over which they have little or no control. This may be partly as a result of the previously low status accorded to healthcare cleaning, which is in sharp contrast to the very high level of importance given by patients and the government to the need for cleaner clinics and hospitals.
Nobody working in the sector would disagree with the need to introduce greater accountability, and clearly defined and realistic standards are essential to achieve this.
In healthcare cleaning we all remember that the patient is our ultimate customer. Patient surveys apparently regularly show a mistrust of cleaning standards in healthcare. The AHCP is working hard with the cleaning  industry manufacturers and technologists to improve healthcare cleaning and environment standards and patient and public confidence.
Proper research to define what actually works in different environments and establishing a clear set of standards and procedures is the cornerstone of improving healthcare cleaning and reducing HCAIs in the future.
Ever increasing pressures, patient activity and on going infections highlight this as the most opportune time for everyone involved in healthcare cleaning to stand tall and drive forward the level of expertise and introduce new ways of working to improve the patient experience. The AHCP is committed to improving standards and working as a powerful voice to achieve cleaning excellence and leading the way in healthcare cleaning.

About the author
Carina Bale has been working in the healthcare cleaning sector for over 20 years. Her past experience includes working within the leisure industry and the private mental health sector. Having been recently elected as National Chair for the Association of Healthcare Cleaning Professionals, she is delighted to lead the association which provides access through a professional avenue to national cleaning excellence and best practice.