Effective healthcare cleaning — saving lives and healthcare costs every day

Housekeeping staff responsible for cleaning within the healthcare environment are often at the forefront of patient safety and infection prevention, yet they do not always receive the focus they deserve.

Potentially infectious organisms can persist in the environment for prolonged periods, posing an ongoing risk for transmission and acquisition to patients and healthcare workers.

Contaminated surfaces serve as a mode of transmission for viruses with pandemic potential¹. Touchable surfaces in the environment can harbour harmful microorganisms, including drug-resistant organisms, cold & flu viruses and coronaviruses^{2, 5}.

A Healthcare-associated infection (HAI) is an infection occurring in a patient during the process of care in a hospital or other healthcare facility, which was not present or incubating at the time of admission. They are associated with increased morbidity and mortality and excess healthcare costs². An estimated 170,574 HAIs occur in adults admitted to public hospitals alone in Australia each year, resulting in 7583 deaths¹. This makes HAIs the most common complication affecting patients within the hospital setting.

HAIs can be classed as a potentially preventable adverse event rather than an unpredictable complication. It is possible to significantly reduce the rate of HAIs through effective infection prevention and control, including effective cleaning practices³.

Making surfaces safer

Implementing a bundled approach to environmental cleaning with well executed educational interventions can dramatically improve the frequency and quality of decontamination⁴. A 2017 study by Hall et al.,⁵ Researching Effective Approaches to Cleaning in Hospitals (REACH), evaluated an environmental cleaning bundle for reducing HAI rates in 11 Australian hospitals. Reflecting current evidence, five interventions were introduced.

These targeted improved cleaning practices, with an emphasis on engaging environmental services staff and included:

Training — Tailored for new and existing cleaning staff, with content reflecting cleaning roles and responsibilities⁵.

Technique — Including a defined and consistent cleaning sequence, a focus on high touch points, the use of sufficient pressure and movement, and adherence to product manufacturers’ instructions for use⁵.

Product — Disinfectant for discharge cleans and daily cleans of high-risk rooms, plus wipes at point of care for medical equipment⁵.

Audit — Regular audit feedback for cleaning staff, with summarised results provided to clinical governance committees⁵.

Communication — Promoting a team approach, including daily contact between cleaners and ward managers. Cleaners represented on relevant clinical governance committees⁵.

A follow-up cost effectiveness review concluded that a bundled, evidence-based approach to improving hospital cleaning is a cost-effective intervention for reducing the incidence of HAIs⁶.

Implementing the REACH cleaning bundle generated AUD$147,500 in cost savings. Infections prevented under the cleaning bundle returned a net monetary benefit of AUD$1.02 million and an incremental cost-effectiveness ratio of $4,684 per quality-adjusted life year (QALY) gained⁶.

GAMA Healthcare provides support for all five components of this Cleaning Bundle, further reducing the impact on healthcare facilities as they struggle to find resources to facilitate change.

Contact GAMA Healthcare for more information on safe cleaning and disinfection and how we can support your cleaning team on (03) 9769 6600 or email australia@gamahealthcare.com.

References

^{1. Lydeamore MJ, et.al. Burden of five healthcare associated infections in Australia. Antimicrobial Resistance & Infection Control. 2022 May 13;11(1).}

^{2. Otter JA, et.al. Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: the possible role of dry surface contamination. Journal of Hospital Infection. 2016 Mar;92(3):235–50.}

^{3. National Health and Medical Research Council. Australian Guidelines for the Prevention and Control of Infection in Healthcare [Internet]. National Health and Medical Research Council; 2021 Jul [cited 2022 Jun 7]. Available from: https://www.safetyandquality.gov.au/sites/default/files/2021-08/australian_guidelines_for_the_preventionnd_control_of_infection_in_health_care_-_current_version_-_v11.9_21_july_2021.pdf}

^{4. Zimmerman P-A, Browne M, Rowland D. Instilling a culture of cleaning: Effectiveness of decontamination practices on non-disposable sphygmomanometer cuffs. Journal of Infection Prevention. 2018 Jun 27;19(6):294–9.}

^{5. Hall L, et.al., Researching effective approaches to cleaning in hospitals: protocol of the REACH study, a multi-site stepped-wedge randomised trial. Implementation Science. 2015 Dec;11(1).}

^{6. White NM, et al. Cost-effectiveness of an Environmental Cleaning Bundle for Reducing Healthcare-associated Infections. Clinical Infectious Diseases. 2019 Jul 30;70(12).}

Image credit: GAMA Healthcare Australia