Safe and spotless

It’s not that long since cleaning a doctor’s surgery was essentially the same as cleaning his or her home, but with added disinfectant. Times change. As individual surgeries group together as medical centres, as medical centres grow in technical and therapeutic versatility and as more and more new and devastating infective organisms become potential adversaries at the primary care level, cleaning has to be more comprehensive, planned in detail and costed to the last detail.

Demonstrating compliance

But even that is far from the whole story.  From 1 April 2012, all 8,500 GP practices in England will be required to register with the Care Quality Commission, and practices will be required to demonstrate compliance with sixteen key standards, including the safety and suitability of premises, in order to maintain their registration. Practices will have to demonstrate that they have processes and systems in place to ensure that they meet the standards, and could be deemed to be operating illegally if they continue to provide GP services while not meeting the standards, and will potentially face prosecution and penalties if they fall out with the new watchdog1.
Those systems covered by the CQC standards include cleaning. The Care Quality Commission is providing information on the standards required in all areas of GP practice maintenance, including cleaning, and information is available from
Clearly, all GP Practice Managers should be obtaining full information now so that they know what changes will have to be made and budgeted for well in advance of April 2012.

Sustainability too

If that were not enough, loud voices from various environmental lobby groups insist that cleaning in all medical premises must achieve sustainability. So how does a cleaner in a GP medical centre work more sustainably? Sustainability can be applied to machines, materials and techniques.
Cleaning chemicals should be considered.  Regularly review the list of cleaning chemicals that the practice’s cleaners use and check whether safer and greener alternatives have become available. According to SafeWorkers reference organisation2, there are around 100,000 different harmful substances recognised across Europe as being used in workplaces, and at the top of their list of places where potentially dangerous substances are found you will find cleaning chemicals. You really do not want to exacerbate existing asthma or dermatitis with cleaning chemical residues in the waiting room or consulting rooms.
In the case of floor cleaning machines, look for machines that have been made greener by reducing their energy consumption and cutting down on the need for replacement wheels, brushes, squeegees and consumables, without also reducing their operating efficiency.  
In areas close to where patients are being treated – perhaps minor surgical procedures – noise from cleaning machines can also be a big issue, since noise pollution has a direct bearing on health and speed of recovery. Cleaning machine manufacturers such as Truvox International are actively reducing noise from machines, whether by using smaller motors, replacing metal with engineering plastics in the gear trains, or designing vacuum cleaners differently, and it has been shown to be entirely practical to reduce noise emissions from cleaning in health centres. The pressure to achieve sustainability is causing manufacturers to design machines differently, so why not design them to run more quietly at the same time?

Standards and training
As standards of asepsis are pushed ever higher, cleaning has to be more efficient – to achieve greater safety and a better hygiene standard for less effort, less expense or both. This is true both of emergency cleaning and of routine cleaning, which is nowadays usually by specialised medical cleaning contractors.  

In the case of emergency cleaning, safety for all concerned can be achieved only by surgery staff knowing the correct procedures for dealing with, for example, spillages of body fluids, such as blood or vomit, which are far more rigorous than they once were. Training of surgery staff in such emergency cleaning is essential, as is the provision of protective clothing and equipment to modern standards. For example, when dealing with blood spillages3.
•    Move patients and anybody else in the vicinity as far as possible away from the spillage.
•    The person dealing with the spillage must wear a face visor, gloves and disposable overalls, use disposable cloths and have a yellow clinical waste sack available.
•    Open windows and make sure the room is well ventilated before starting.
•    Cover the spillage with dichloroisocyanurate granules in solution (read the instructions to get the strength of the solution correct). Leave this in place for seven minutes and stay clear of the spillage while the solution is acting.
•    Mop up the spillage with disposable cloths until the area is clean.
•    Dispose of cloths, gloves and protective overalls in the yellow sack, seal the sack and send it for incineration.
•    Wash and dry hands.
•    Spot clean the area with detergent and hot water.

For routine cleaning, check carefully that the cleaning contractor that you are using is fully conversant with the standards that the Care Quality Commission will be enforcing from April 2012 (insofar as the detail is available) and is keeping up to date with the latest developments in machines and/or materials that are fully efficient at removing soil and materials that harbour pathogens.

Various surfaces

Most GP medical centres have areas of hard floor, such as tiles or cushioned vinyl. The majority also have areas of carpet – usually consulting rooms and corridors. Keeping both clean is labour and energy intensive. The practice manager and his or her management team therefore need to know about all developments that can help their budgets and objectives, while saving some cash – and maybe also helping their sustainability.
An important recent development where there is a lot of carpet is encapsulation technology. This encapsulates soil from among carpet fibres so that, instead of trying to vacuum unmodified oily grime or tar residues from carpet, the cleaners vacuum hard brittle encapsulated dirt which is easy to pick up.

Practical safety first
It is essential to eliminate the risks of wet or damp hard floors, which can cause accidents and claims for compensation. Here again cleaning machine manufacturers have a key role to play.
For example, the Truvox Multiwash washes, mops, scrubs and dries on both hard and soft floor coverings in a single pass and leaves floors ready to walk on in minutes. The Multiwash is good at ‘difficult’ floors like non-slip safety floors, low pile carpets and entrance matting.  It offers a medical centre cleaner the ability to achieve greater speed, improved cleaning efficiency and dryer floors immediately after cleaning to reduce the risk of accidents.
Then there is the issue of tiled floors, which have a tendency to retain dirt, and potentially infection, in the recesses where the floor has been grouted. Cleaners in medical centres and clinics need machines that scrub deeply into the recesses, so should always ask the supplier the depth to which a scrubber scrubs. Deep scrubbing uses less water and a smaller quantity of chemicals than shallow scrubbing to remove grit and soil. Machines with cylindrical brushes, like the Multiwash, exert greater pressure on floors and can dig more deeply into tile and grout areas. Less use of chemicals means lower costs; deeper scrubbing means cleaner results and better asepsis.

Summing up
It is vital that every surgery and medical centre fully understands what the Care Quality Commission will be requiring of them from April 2012 and takes steps to meet the new standards as soon as possible. The CQC changes will be happening at the same time as the massive changes to General Practice announced by the coalition government and the consequent establishment of the new NHS Commissioning Board and GP Consortia to manage NHS financing. GP practices are likely to have so many changes happening at one time that a degree of confusion could result, and anything that can be tackled sooner rather than later should be organised before the funding changes take effect.
As part of the GP practice review to ensure that it meets next year’s CQC criteria (which include security, for example, as well as cleaning and asepsis) it is also essential that necessary additional training for surgery staff is organised and carried out.
A full review of the practice’s contract cleaning arrangements should be carried out as soon as possible to ensure that the business carrying out the cleaning is fully conversant with CQC requirements. The contractor should be asked to produce a written plan showing changes that will be necessary to conform to CQC standards.

Ceris Burns is marketing consultant to Truvox International


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