Introducing enhanced infection prevention and environmental cleaning workshops for hospital cleaning staff

Current evidence recognises that contamination of hospital surfaces plays a significant role in the transmission of healthcare associated infections (HAI) (1,2). Not all staff clean surfaces as recommended: less than 50% of hospital room surfaces are adequately cleaned when manual cleaning techniques are used (3,4). Ongoing education is a vital part of multi-modal strategies to improve cleaning compliance and efficacy.

Cleaners have limited exposure to topics such as HAI, chain of infection, transmission of organisms and other infection prevention principles, and may have a limited understanding of ‘how’ or ‘why’ the effectiveness of their cleaning can directly impact patient outcomes. Mindful of the diverse range of experience, skills (including language barriers) and knowledge of participants, one-hour Infection Prevention in Cleaning workshops have been developed and delivered by clinical specialists to meet the specific needs of cleaning staff within the hospital setting.

Topics covered include:

• Why we clean
• HAIs
• Chain of infection & its role in microbial transmission
• High touch surfaces
• Basic infection prevention and cleaning principles
• Correct use of cleaning products
   

Following the workshop, hospital furniture is pre-marked with UV fluorescent gel and all participants are given the opportunity to clean surfaces using the principles learned. Staff can then evaluate the effectiveness of their cleaning using a UV torch and discuss results with the trainer. Small interactive groups of 6-8 provide participants with a safe forum to discuss areas of concern and share thoughts/experiences with each other.

Feedback from both participants and managers has been outstanding, with participants reporting a greater understanding of infection prevention concepts, whilst enjoying and appreciating the opportunity to learn. 98% of staff agreed that the training would improve their personal practice.

Common themes identified by staff during these workshops include:

Clinical

• Mixed messages — Poor communication from clinical staff regarding appropriate precautions and type of clean required for organism.
• Time pressure — “We need the bed now!” Pressure to have rooms cleaned in a short period of time may result in incomplete or ineffective discharge cleans.
• Cleaning staff requested to clean discharge room, but linen not yet removed from bed, or patients still occupying room.

Management

• Confusion over who cleans what. What is classed as clinical or non-clinical equipment? This could result in items such as IV poles or wall mounted equipment not being cleaned at all.
• English as a second language — staff may be unable to read directions on cleaning products, manufacturer’s instructions on equipment or signage in patient rooms.
• Orientation for new starters — trained using a ‘buddy’ system, whereby the new employee works and learns side-by-side with an existing member of staff who may or may not understand current cleaning policy.

Other findings

• Glove use — not changing between rooms, leading to potential cross-contamination.
• Non-standardised chemical use/own cleaning agents. Incorrect re-constitution of chemical cleaning agents e.g. bleach.
• Inappropriate supplies for cleaning method e.g. re-using wipes/cloths/mops in multiple areas.
   

To date GAMA Healthcare Australia have provided 122 one-hour workshop sessions, training 858 staff.

Patients and healthcare workers have a right to a safe and clean environment. Understanding the role of environmental contamination in healthcare settings can have a significant impact on staff attitude, beliefs and enthusiasm for cleaning — and in turn on the effectiveness of their efforts. These workshops and associated feedback reaffirm that knowledge gained through education and support is empowering, enabling staff to apply a rationale to their duties and reinforcing the crucial role they play in reducing HAIs.

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References

1) Weber, D. J., Anderson, D., & Rutala, W, A. (2013) The role of the surface environment in healthcare associated infection. American Journal of Infection Control 26 (5), 338 - 344

2) Dancer, S.J. (2009) The role of hospital cleaning in the control of hospital acquired infection. Journal of Hospital Infection 73 (4), 378 – 385

3) Mitchell, B., Dancer, S.J., Anderson, M., & Dehn, E (2015) Risk of organism acquisition from prior room occupants: a systematic review and meta-analysis. Journal of Hospital Infection (91) 211 – 217

4) Murphy, C.L., Macbeth, D.A., Derrington, P., Gerrard, J., Faloon, J., Kenway, K., Lavender, S., Leonard, S., Orr, A., Tobin, D., & Carling, P. (2011) As assessment of high touch object cleaning thoroughness using a fluorescent marking in two Australian hospitals. Healthcare Infection (16) 4, 156 – 163