An insight into environmental cleaning practices through the eyes of nurses and midwives

Environmental cleaning is one of the fundamental principles of infection prevention. Contaminated hospital surfaces play an important role in the transmission of some dangerous pathogens such as COVID-19, influenza, norovirus, Clostridioides difficile (C.diff) and Multi drug Resistant Organisms (MROs). It is well documented that improving cleaning practices and compliance reduces exposure to pathogens and therefore reduces the incidence of infection.

In many facilities the assumption is that hospital cleaning staff perform the majority of the environmental cleaning and disinfecting duties within a hospital. This usually includes patient bed spaces, bathrooms, treatment areas and common areas. Hospital cleaners have usually participated in some form of training and education on how to clean, when and correct use of their cleaning products; but is this really reality? Do they always clean bed spaces? Who cleans the shared patient equipment? Has everyone received the same amount of training and education on environmental cleaning?

As frontline carers, nurses and midwives also play a critical role in the cleaning and disinfecting of the environment. A recent Australian study by Prof. Brett Mitchell, Phillip Russo, Martin Kiernan and Cassie Curryer (2021) explored the cleaning knowledge, attitudes and practices of nurses and midwives. The sample size consisted of 96 participants, who accessed an online survey and was made up of predominantly female nurses and midwives varying in age, academic qualifications, location, and duration of work across all states of Australia.

Just like anyone, nurses and midwives have many reasons why they do not comply with cleaning duties. Organisations have policies and procedures that differ from one hospital to the next. The monitoring and enforcement of cleaning compliance can vary across a ward and at an organisational level. How to clean effectively is not a common topic that is taught. There are so many people with cleaning responsibilities within a hospital which often leads to confusion on whose responsibility it is to clean certain items and when to clean them. Often items are left dirty and contaminated with no one claiming cleaning responsibility. The study by Mitchell et al, showed 10% of participants did not know whose responsibility it was to clean shared medical equipment such as an IV pole and pump. Many nurses know that cleaning is vital for infection prevention and although they may feel it is not their job to perform certain cleaning duties, nurses often inherit these duties as no one else is assigned and items still require cleaning. Mitchell et al, identified many of these above issues but despite these issues, 94% of the clinical participants understood that the main reason for cleaning was to reduce the risk of infection transmission.

Understanding, knowledge and practice of cleaning were also explored. With 81% reporting using wipes for the cleaning of shared equipment, only 61% of participants selected the correct answer on how to clean a surface using a wipe; that is cleaning in an ‘S’ shape pattern. When asked about items that posed the greatest risk for infectious transmission the majority alluded to an image of a cluttered room, however, the correct answer was ‘Don’t know’ as pathogens are invisible to the naked eye — any item can pose a risk.

Nurses and midwives clean! The study showed they want clarity with cleaning products, role responsibility and increased accountability from staff and management. With most nurses and midwives concluding that they did not feel comfortable being admitted to a room where the previous patient had an MRO, the findings from this study have further highlighted the risks associated with the environment and provide the healthcare community with valuable information for healthcare organisations to improve practice but emphasises the need for medical and cleaning manufacturers in healthcare to step-up and provide further training and education on their products and the basic foundations of infection prevention.

Reference

Mitchell, B., Russo, P., Martin, K., Curryer., C. (2021) Nurses’ and midwives’ cleaning knowledge and practice: An Australian study. Infection, Disease and Health 26, 55-62 https://doi.org/10.1016/j.idh.2020.09.002.