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Cleaning Policy

Responsible Directorate:

Public Health

Responsible Director:

Dr Judith Hooper

Date Approved:

25 March 2009

Committee:

Governance Committee

NICE GUIDANCE Once NICE guidance is published, health professionals are expected to take it fully into account when exercising their clinical judgment. However, NICE guidance does not override the individual responsibility of health professionals to make appropriate decisions according to the circumstances of the individual patient in consultation with the patient and/or their guardian or carer.


Version Control Current versions of all policies can be found on NHS Kirklees internet and intranet. If printing a document, please check internet/intranet for most up-to-date version. Document Title: Document number: Author: Contributors: Version: Date of Production: Review date: Postholder responsible for revision: Primary Circulation List: Web address: Restrictions:

Cleaning Policy 1 Jenny Scholefield 0.4 March 2009 March 2012 Hotel Services Manager

Standard for Better Health Map Domains: Core Standard Reference: Performance Indicators:

First: Safety and Sixth: Care Environment and Amenities C4a C21 1. Healthcare organizations keep patients, staff and visitors safe by having systems to ensure that the risk of healthcare acquired infection to patients is reduced, with particular emphasis on high standards of hygiene and cleanliness, achieving year on year reductions in Methicillin Resistant Staphylococcus Aureus (MRSA).’ 2. Healthcare services are provided in environments which promote effective care and optimize health outcomes by being well designed and well maintained, with cleanliness levels in clinical and non clinical areas that meet the National Specifications for Clean NHS Premises.

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Contents

Section

Page

1. 2. 3. 4. 5. 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10

Introduction Associated Policies and Procedures Aims and Objectives Scope of the Policy Accountabilities and Responsibilities Risk Assessment Protocols Standards Colour Coding Cleaning Methods Cleaning Response Times Spot Cleaning Spillages Body Fluid Spills Management of Cleaning Contractors Requests For Additional Cleaning Cleaning and evaluation of standards of cleanliness following maintenance, refurbishment, flood, building 7. Equality Impact Assessment 8. Training Needs Analysis 9. Monitoring Compliance with this Policy 10. References 11. Appendices Appendices A

B C D E F G H I J

Summary of relevant legislation and guidance documents for Managing Cleanliness in Healthcare Premises Key Stakeholders Consulted/involved in the development of the policy Equality Impact Assessment Tool Element Standards Cleaning Procedures Guidance Cleaning Frequencies Performance Parameters for managing Cleaning Contractors National Specification for Cleanliness Audit Tools Response Times and Rectification Definitions

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4 5 5 5 6 14 16 17 17 17 17 17 18 19 19 20 20 20 21 22

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27 29 28 34 35 39 40 40 41


Policy Statement NHS Kirklees will set out a structured and effective approach for NHS Kirklees to deliver a clean and safe environment for everyone using healthcare facilities by: a) b)

Contributing to and supporting the Trust Health Care Associated Infections (HCAI) control mechanisms; Implementing a whole system approach that includes all healthcare and associated professionals.

1. Introduction Trusts need to be able to demonstrate that healthcare premises are clean and that risks from inadequate or inappropriate cleaning have been minimized. All cleaning related risks should be identified and managed on a consistent long term basis, irrespective of where the responsibility for providing cleaning services lies, and if necessary logged onto the risk register. Current statutory and mandatory documents regarding cleanliness in healthcare premises include: - Code of Practice for the Prevention and Control of Healthcare Associated Infections 2008 - National Patient Safety Agency 2007 The National Specifications for Cleanliness in Healthcare Premises - Department of Health (2007) Improving Cleanliness and Infection Control - Health Act 2006 - Department of Health (2006) Saving Lives: a delivery programme to reduce healthcare associated infections including MRSA - Department of Health (2004) Standards for Better Health - Department of Health (2004) Towards Cleaner Hospitals and Lower Rates of Infection, including Matrons’ Charter - NHS Estates (2004) Revised Guidance on Contracting for Cleaning - Department of Health PFU and PPP Forum Code of Best Practice for Benchmarking and Market Testing in NHS PFI Projects - Workplace Health Safety and Welfare Regulations - The Management of Health and Safety at Work Regulations 1992 - Food Safety Act 1990 - Health and Safety Act 1974 Appendix A includes summaries of relevant legislation and guidance documents, which form the national framework within which standards of cleanliness must be managed in NHS premises. Where required, these documents have been tailored for use in NHS Kirklees, and incorporated into this policy to enable the Trust to demonstrate how it will meet National and Statutory obligations.

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2. Associated policies & procedures This policy should be read in accordance with the following Trust policies, procedures and guidance: • • • • • • •

Infection Control Policy Waste Management Guideline Dress Code Policy for Clinical Staff Decontamination, Disinfectants and Antiseptics Universal precautions Policy for Maintenance Hand Decontamination Policy

All equipment requires cleaning, some equipment also needs decontaminating: this policy must be used in conjunction with the Decontamination of Reusable Medical Devices Policy where appropriate. 3. Aims and objectives The Cleaning Policy will: - Clearly define specific roles and responsibilities for cleaning - Outline clear, agreed cleaning routines; - Reference to consultation process with Infection Control Team particularly when internal or external contracts are being prepared; - Incorporate the NPSA National Specification for Cleanliness and associated documents, including NHS Estates revised guidance for contracting for cleaning, NHS Healthcare Cleaning Manual, National Colour Coding of cleaning materials and equipment; - Detail how requests for additional cleaning, both urgently and routinely should be scheduled/organised;

4. Scope of the policy This policy must be followed by all NHS Kirklees employees and Independent Contractors who use NHS Kirklees Premises, where the contracts for cleaning are managed by NHS Kirklees. It must be followed by all staff who work for NHS Kirklees, including those on temporary or honorary contracts, bank staff and students. Breaches of this policy may lead to disciplinary action being taken against the individual. Independent Contractors are responsible for the development and management of their own procedural documents and for ensuring compliance with relevant legislation and best practice guidelines. Independent Contractors are encouraged to seek advice and support as required.

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5.

Accountabilities and Responsibilities

5.1 Accountabilities Chief Executive and Director of Public Health Final accountability for all aspects of cleanliness lies with the Chief Executive and the Trust Board. The nominated board member responsible for reporting to the Trust Board on cleanliness and infection prevention and control: that proper systems and processes are in place to achieve high standards of cleanliness for NHS Kirklees Trust, is the Director of Public Health. The Director of Public Health and the Assistant Director of Estates will ensure sufficient resources are dedicated to keeping premises clean, and that all Trust employees understand their responsibilities for keeping premises clean. The Director of Public Health will designate lead managers for cleaning and decontamination of equipment used for treatment (Health Act 2006). The Board, in addition to the Director of Public Health, will ensure high standards of cleanliness are in place through designated officers within the Trust, these are: Infection Prevention and Control Team (IPCT) Will ensure that clinical and non clinical staff, undertake annual mandatory infection control training, ensuring staff understand their responsibilities for cleaning and decontamination to ensure that items such as ward based equipment do not ‘fall through the gaps’. Ensure that cleaning and decontamination training for healthcare workers is provided, sufficient and appropriate. The IPCT and the Estates and Facilities team will liaise and undertake joint audits to ensure appropriate facilities and standards of cleanliness are provided for Healthcare Services to be provided by the Trust. Assistant Director of Estates and Facilities Responsible for ensuring high standards of cleaning services and facilities are provided to the Trust: these services are delivered through external contractors and Service Level Agreements, ensuring that robust monitoring arrangements are in place. The Assistant Director of Estates and Facilities will also ensure that national guidance on cleanliness and environment issues are interpreted and implemented in conjunction with the Director of Public Health.

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Hotel Services Manager The Hotel Services Manager is responsible for ensuring that appropriate standards of cleanliness are achieved and maintained across the Trust premises: that domestic/ housekeeping / caretaking service are delivered in accordance with specifications and contracts. Lead the NHS Kirklees’ National Standards of Cleanliness Group which will ensure cleaning related risks are identified and managed on a consistent long term basis, and ensure that nurses and infection control teams are involved in drawing up cleaning contracts/specifications. Contract Managers (for Facilities Services Contracts) The Contract Managers will ensure that domestic/housekeeping/ caretaking services are delivered in accordance with the specifications, using suitably trained, adequately resourced and safely equipped staff. The Contract Managers will be responsible for their monitoring teams who will carry out regular audits of their areas in accordance with the National Specifications for Cleanliness in NHS Premises. The Contract Managers will ensure that cleaning routines are clear, agreed and well publicized (Health Act 2006). Estates Manager The Estates Manager working with the Assistant Director of Estates and Facilities, Hotel Services Manager and Infection Control team, will ensure that environmental standards are maintained to the required level and fit for purpose, and that action is taken to rectify issues that arise from Patient Environmental Action Team (PEAT) inspections and technical cleaning audits. Modern Matrons / Heads of Service Matrons/ Heads of Service will establish a cleanliness culture across their units, recognize the important work which their cleaning staff do and make sure they feel part of the ward/service team. Modern Matrons / Heads of Service will take the overall lead for all cleaning related issues within their service areas, will work closely with the Hotel Services Manager and/ or their service provider/contractor and be involved in the drawing up of cleaning contracts. Matrons/ Heads of Service should monitor service provision and be able to provide sufficient information, when appropriate, to withhold payment (Matron’s Charter 2004 DOH). Domestic Supervisors (including those employed by external contractors) Domestic Services Supervisors will be responsible for the day-to-day supervision of staff and the local delivery of services. They will make daily contact with the nominated site contacts to ensure that service issues are resolved in a timely

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fashion. Supervisors will also undertake regular audits in addition to the monitoring team, and will be responsible for taking remedial action that arises from technical monitoring and PEAT inspections. Domestic Services staff Domestic Services staff are responsible for carrying out cleaning and housekeeping tasks to the highest possible standards in accordance with agreed specifications and the Service Provider’s Cleaning Manual, a copy of which should be available at each site. Domestic Services staff will liaise with nominated site contacts on a day to day basis to report difficulties that may arise and to be aware of any issues that may affect the carrying out of their duties. It is important to see the Domestic staff as part of the site’s team. All employees and independent contractors using NHS Kirklees premises Keeping the NHS clean is everybody’s responsibility. All employees of NHS Kirklees, have responsibility for cleaning designated pieces of equipment, furniture and furnishings, these range from equipment for which they are responsible e.g. computers, printers, to equipment required for direct patient care, and a shared responsibility for the total environment, e.g. cleaning spillages as they occur and reporting problems. Patients Patients will have a part to play in monitoring and reporting on standards of cleanliness.

5.2

Clear allocation of responsibility for cleaning all areas of, and Items within the Trust’s premises

The table below outlines a schedule of cleaning responsibility: which focuses on clarifying responsibility for cleaning items / fixtures/ fittings which are usually outside the scope of domestic services and/or where responsibility is not clear. The table has been adapted for NHS Kirklees from Appendix 6 of the NPSA National Specifications for Cleanliness (2007). In considering, amending, agreeing and completing this framework, the Trust should have regard to the Microbiology Advisory Committee manual which provides advice and guidance on what level of decontamination is required, for example, cleaning or disinfection. This framework should also not replace local infection control policy. For example, in the case of specific infections, a higher level of decontamination may be required. What is suggested in the table does not replace manufacturers’ instructions where applicable.

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Table 1 Responsibility matrix for cleaning all areas and items within Trust premises (Adapted from Appendix 6 of the National Specifications for Cleanliness) Total cleaning responsibility framework (i.e. Cleaning not covered by domestic services) Comments Staff group Items Frequency Method (see responsible procedures AU = after (H/C means any Appendix E) use healthcare or D = daily clinical staff as W = appropriate) weekly Patient equipment (medical) IV stand W Detergent wipes IV pumps /syringe drivers Cardiac monitors

H/C staff

W

Detergent wipes

H/C staff

D and AU

Detergent wipes

H/C staff

Blood gas machines

W

Alcohol wipes

H/C staff

Dressings trolleys Linen trolleys Tea trolleys

W

Detergent wipes

H/C staff

W and AU

Detergent wipes

H/C staff

W and AU

Detergent wipes

H/C staff

W

Detergent wipes

H/C staff

W

Detergent wipes

H/C staff

W and AU

Detergent wipes

H/C staff

D and AU

Alcohol wipes

H/C staff

Notes trolleys Drugs trolleys Sharps bin trolleys Blood pressure cuffs

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Include wheels Cleaned by med phys after repair Cleaned by med phys after repair Cleaned by med phys after repair Include wheels Include wheels Include wheels Include wheels Include wheels Include wheels Cleaned by med phys after repair


Cleaning responsibility framework Items

Frequency

Method (see procedures Appendix E)

Comments Staff group responsible (H/C means any healthcare or clinical staff as appropriate)

Det/water/bowl/di sposable cloths Det/water/bowl/di sposable cloths Det/water/bowl/ disposable cloths Det/water/bowl/ disposable cloths Det/water/bowl/ disposable cloths Det/water/bowl/ disposable cloths Detergent wipes Detergent wipes

H/C staff

Det/water/bowl/ disposable cloths Det/water/bowl/ disposable cloths

Domestic (TBC)

Det/water/bowl/ disposable cloths Det/water/bowl/ disposable cloths Det/water/bowl/ disposable cloths Detergent wipes Det/water/bowl/ disposable cloths Detergent wipes

H/C staff

Detergent wipes Det/water/bowl/ disposable cloths Detergent wipes

H/C staff

AU = after use D = daily W = weekly Patient equipment (medical) Pillows

AU

Mattresses

AU

Cotsides

AU

Wheelchairs

W

Public wheelchairs Commodes

W

Cushions Oxygen sat probes Wash bowls

AU AU

D

AU

Pressure relieving mattress Hoists

AU

Pat slides

AU

Easy slides

AU

Hoist slings Stands aids

AU D

Handling belts Resuscitatio n trolleys

AU

Larying handles

D

D

D and AU

10

H/C staff H/C staff H/C staff H/C staff H/C staff H/C staff H/C staff

H/C staff

H/C staff H/C staff H/C staff Domestic (TBC) H/C staff

H/C staff


Cleaning responsibility framework Frequency Method (see AU = after procedures use Appendix E) D = daily W = weekly Patient equipment (medical) continued

Staff group responsible (H/C means healthcare or clinical staff as appropriate)

Comments

Oxygen/suction D and AU equipment

Detergent wipes

H/C staff

Oxygen/suction W equipment (portable) Wall AU humidifiers

Detergent wipes

H/C staff

Detergent wipes

H/C staff

Cleaned by medical phys after repair Cleaned by medical phys after repair Cleaned by medical phys after repair Cleaned by medical phys after repair Cleaned by medical phys after repair

Items

Portable nebulisers

W and AU

Detergent wipes

H/C staff

Ventilator equipment

D and AU

Detergent wipes

H/C staff

Catheter stands Bed pans/holders Slipper pans

W and AU

H/C staff

AU

Urine bottles

AU

Urine jugs

AU

Raised toilet seats

D

Scanners

D and AU

Washer disinfector Washer disinfector Washer disinfector Washer disinfector Washer disinfector Det/water/bowl/ Disposable cloths Detergent wipes

Scales

W and AU

H/C staff

Gas cylinder holders

AU

Det/water/bowl/ Disposable cloths Detergent wipes

AU

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H/C staff H/C staff H/C staff H/C staff Domestic (TBC)

H/C staff

Porters (TBC)

Medical physics


Cleaning responsibility framework Method (see Frequency AU = after procedures use Appendix E) D = daily W = weekly Patient equipment (medical) continued

Staff group responsible (H/C means healthcare or clinical staff )

Tower W balconies Traction D and AU beams Thomas AU splints Monkey poles AU Weights AU Braun frames AU General / media equipment

Det/water/bowl/ Disposable cloths Det/water/bowl/ Disposable cloths Detergent wipes

Estates

Detergent wipes Detergent wipes Detergent wipes

H/C staff H/C staff H/C staff

TVs

W

Domestic

Hi-Fis Telephones Computer/key boards Printers Fax Audio/visual systems Photo-copiers Screens CCTV equipment OHPs Flip charts Accessories ie. Staplers, in trays, hole punchers Loan equipment: ie heaters Hand cleaning holders

W D W

Det/water/bowl/ Disposable cloths Detergent wipes Detergent wipes Detergent wipes

Domestic Domestic Users

W W D

Detergent wipes Detergent wipes Detergent wipes

Users Users Users

M W M

Detergent wipes Detergent wipes Detergent wipes

Users Domestic Users

M M M

Detergent wipes Detergent wipes Detergent wipes

Domestic Domestic Users

AU

Detergent wipes

Estates

D

Detergent wipes

Healthcare staff

Items

12

Comments

Domestic (TBC) H/C staff

Alcohol rub/hibiscrub


Cleaning responsibility framework Method (see Items Frequency AU = after procedures use Appendix E) D = daily W = weekly Ward / staff equipment Pest control W Detergent wipes devices Recycling W Detergent wipes bins Drugs W Detergent wipes cupboards Drugs fridges W Det/water/bowl/ Disposable cloths Bed pan W Det/water/bowl/ washer Disposable cloths Macerators W Det/water/bowl/ Disposable cloths Isolation D Alcohol wipes trolleys Fridges/ W Det/water/bowl/ freezers Disposable cloths Cookers W Det/water/bowl/ Disposable cloths Microwaves W Det/water/bowl/ Disposable cloths Toasters W Detergent wipes Ice machines

W

Kettles Kitchen cupboards Milk fridges

W D

Crockery

AU

Det/water/bowl/ Disposable cloths Detergent wipes Det/water/bowl/ Disposable cloths Det/water/bowl/ Disposable cloths Dishwasher

Cutlery

AU

Dishwasher

Water boilers

W

Water coolers

W

Dishwashers

W

Det/water/bowl/ Disposable cloths Det/water/bowl/ Disposable cloths Det/water/bowl/ Disposable cloths

W

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Staff group responsible (H/C means healthcare or clinical staff )

Comments

Contractor Domestic H/C staff H/C staff H/C staff H/C staff H/C staff

Include wheels Domestic (exc Users to catering areas) clean Domestic (exc spillages as catering areas) they occur. Domestic (exc catering areas) Catering Domestic (exc staff for catering areas) catering areas. H/C staff Refer to Domestic Domestic (exc cleaning catering areas) manuals. Domestic (exc catering areas) Catering staff Users in staff areas Catering staff Users in staff areas Domestic (exc Catering catering areas) staff for catering Domestic areas Catering staff


6.1 RISK ASSESSMENT PROTOCOLS

6.1.1 Risks Associated with Cleanliness Unclear or inadequately identified local cleaning standards and policies could result in: - Poor infection prevention and control; - Risk to the health and safety of patients, visitors and staff through poor or poorly applied cleaning protocols and processes; - Poor public image; - Lack of public confidence; - Clinical governance issues; - Litigation. - Poor value for money; 6.1.2 Identifying risk categories All healthcare environments should pose minimal risk to patients, staff and visitors. However, different functional areas represent different degrees of risk and, therefore, require different cleaning frequencies and different levels of monitoring and auditing. High risk areas: High risk functional areas may include general wards, public thoroughfares and public toilets. Outcomes should be maintained by regular and frequent cleaning with ‘spot cleaning’ in between. Other areas adjoining high risk functional areas should receive the same level of cleaning. Within a period of one month all rooms within a high risk functional area should be audited. Significant risk areas: Significant risk functional areas may include out patients departments, other areas adjoining significant risk functional areas should receive the same intensive levels of cleaning. In these areas high levels of cleanliness are required for both hygiene and aesthetic reasons. Both informal and formal monitoring should take place continuously. Over a period of 3 months all rooms within a significant risk functional area should be audited at least once Low risk areas: Low risk functional areas may include administrative areas, non sterile supply areas, record storage and archives. Over a period of 12 month all rooms within a low risk functional area should be audited at least once 6.1.3 Confirmation of how Risk Categories to be applied to all NHS Kirklees premises The Hotel Services Manager and Deputy Director for Infection Prevention and Control have reviewed the National Specifications for Cleanliness Risk categories and cleaning frequencies and concluded that patient and treatment areas, and adjacent rooms should be classified as Significant Risk. Where there are clearly separated blocks of administration, meeting, training rooms, these will be classed as low risk. The table below details how this has categorised all NHS Kirklees premises

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Table 2. RISK CATEGORIES FOR EACH OF THE TRUST’S PREMISES Location

Post code

Almondbury Clinic

HD5 8UU

Batley HC

WF17 8DQ

Beckside Court Broughton House Cleckheaton HC

WF17 5PW WF17 5QT BD19 5AN

Dewsbury HC Eddercliffe IC Fartown

WF13 1HY WF15 6LP HD2 2QA

Golcar Clinic

HD7 4AR

Holme Valley memorial Hospital Keldergate Liversedge Health Centre Marsden HC Mill Hill ComHC

HD2 1LE WF15 6DF HD7 6DF HD5 9TS

Moorfield Clinic DRAM Safe Haven (Mouldgreen) New Brewery Lane Princess Royal Com HC

HD4 5RX HD5 9BU

Ravensthorpe HC Ringway Comm Store Saviletown Shaw Cross Clinic Skelmanthorpe HC Slaithwaite Thornton Lodge Clinic

WF13 3JY HD1 5JU WF12 9JR WF12 7HP HD8 9DA HD7 5AB HD4 5RQ

Whitehouse Clinic Woodkirk House walk in centre

HD1 5JU WF13 4HS

WF12 9DZ

National Specifications for Cleanliness 2007 Risk category Significant risk Ground floor: Low risk Significant risk Top floor low risk Low risk Significant risk Significant risk Admin 1st low risk Significant risk Significant risk Significant risk 1st floor low risk Significant risk 1st floor low risk High risk, significant and low risk areas Significant risk Significant risk Significant risk Significant 1st floor low risk Significant risk Closing Significant risk Significant risk admin: low risk Significant risk Low risk Significant risk NA Significant risk Significant risk Significant risk 1st floor low risk Significant risk Significant risk

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6.2 STANDARDS 6.2.1 The Standards to be achieved The National Specifications for Cleanliness focus on outcomes rather than the method by which they are achieved, since the responsibility for day to day arrangements rests entirely with the Trust. The National Specifications for Cleanliness were updated in 2007. The Project Co agreement for the PFI buildings is based on the National Standards for Cleanliness 2004, the standards to be achieved/ outcomes for cleaning are similar to those detailed in 2007. Appendix 1 of the National Specifications for Cleanliness includes a range of 49 elements listed under broad headings which, taken together, will cover the entirety of items and areas to be cleaned in the Trust’s premises, these have been detailed in: Appendix D Element standards: cleaning standards guarantee. Appendix F Definition of terms from (Appendix 8 NSC) 6.2.2 Cleaning Schedules and frequencies It is important that the Trust has locally determined frequencies to meet the requirements of the Code of Practice and to identify the resources needed to keep the facilities clean, and therefore demonstrate to the Healthcare Commission that sufficient resources are being allocated. The precise allocation of resources and the actual frequency of cleaning varies according to locally determined need. The existing minimum requirements as detailed in the National Specifications for Cleanliness are outlined in Appendix F, which should be read in conjunction with the risk categories for the specific areas as listed in 6.1.3. Cleaning schedules should be publically displayed to ensure compliance with the Health Code 2008 6.2.3 Performance Parameters The Performance Parameters in Appendix H are taken from the NHS Facilities Management Standard Service Specification – Cleaning Services, and detail how cleaning contracts will be monitored and managed. This is similar to the framework detailed for Project Co PFI units in North Kirklees. 6.2.4 The systems to be used to measure outcomes The National Specifications for Cleanliness audit tools which are used for managing cleanliness in NHS Kirklees are included in Appendix I. The benchmark which the Trust uses to establish whether an acceptable standard of cleanliness has been achieved is a minimum score of 85% for each consulting/ treatment room, and an overall score of 85% for the building/unit.

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6.3 Colour coding NHS Kirklees has adopted the colour code below for all cleaning materials. All cleaning items, for example cloths (re-usable and disposable), mops, buckets, aprons and gloves should be colour coded. This also includes those items used to clean catering departments.

Red

Bathrooms, washrooms, showers, toilets, basins and bathroom floors

Blue

General areas including wards, departments, offices and basins in public areas Green Catering departments, ward kitchen areas and patient food service at ward level Yellow Isolation areas

6.4 Cleaning methods The NPSA website links to the NHS Cleaning manual which details methods of work for undertaking cleaning tasks for items detailed in the National Specifications 007. Cleaning Contractors will be required to use these recommended methods for cleaning.

6.5 Cleaning response Times The cleaning response times are detailed in Appendix J.

6.6 Spot Cleaning Spillages In the event of untoward/ accidental spillages, the person who had the accident (or a person nominated by them) must take immediate steps to clean up as much of the spillage as possible to prevent staining and encouraging insects. Following which the contractors should be notified. Failure to undertake remedial cleaning may result in staining and/or pest infestations, for which additional costs may be incurred, and re-charged if necessary to return areas to an acceptable standard.

6.7 Bodily fluid spills The containment, collection, and disposal of body fluids and subsequent decontamination of the area is the responsibility of those clinical staff responsible for the patient, in the area where the spillage occurs. Once the spillage kit has been used, the body fluids removed and the area decontaminated, then the cleaning staff should be notified, i.e. Initial or MITIE, who will arrange a thorough cleaning of the area as required, e.g. carpet / upholstery clean, floor mopping.

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Where incidents arise in shared/public areas where it is not possible to identify who is responsible for the patient or visitor, then MITIE or Initial will deal with the spillage. Since this is a reactive cleaning service, Initial and MITIE will not have staff based at each site to deal with such incidents immediately they occur, Whoever is first notified of the issue or first notices it, must identify who is on site and has received appropriate training to use the spillage kits to contain the fluids and make the area safe until Initial or MITIE can send someone to assist. Whilst reactive cleaning should be available at all sites, the cleaning staff are scheduled to clean out of hours, i.e. early morning or evenings, so the response would usually be provided by the managers on duty in the area, and the geographical spread of sites means they may take up to 2 hours to locate suitably trained staff and arrange for them to visit the site: during which time the area must be made safe by staff on site. 6.8 Management of cleaning contractors NHS Kirklees organizes its cleaning services via Service Level Agreements and contracts. The PFI contract has a clearly defined specification, and Performance Parameters. The contract with Initial Services (who clean the premises within the former Huddersfield Central and South PCTs) has been revised to meet the requirements of the National Specifications for Cleanliness 2007. All the accommodation at Holme Valley Memorial Hospital is cleaned under Service Level Agreements with Calderdale and Huddersfield Foundation Trust, which needs updating and additional resources to make it compliant with the National Specifications for Cleanliness 2007. NHS Kirklees Estates and Facilities Team manage standards of cleanliness for NHS Kirklees and NHS Calderdale; current proposals are to extend to NHS Wakefield. A scoping exercise is currently being undertaken to establish how the 50+ premises which this will cover could have all the Facilities Services, including cleaning, brought together under one contract to ensure consistent standards are achieved Trust wide. The Health Act 2006, National Specifications for Cleanliness 2007, NHS Estates revised Guidance on Contracting for Cleaning NHS Healthcare Premises 2004, Healthcare Cleaning manual and associated documents will be utilized. The Infection Prevention and Control Team will be included in developing the Service Specifications. Contracts will be evaluated and awarded to the economically most advantageous tender, to take account of quality of service assurance as well as price. The NHS Facilities Management Standard Service Level Specification for Cleaning Services will be used as a basis for new cleaning contracts.

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6.9 Requests for additional cleaning The cleaning service contractors for all NHS Kirklees sites (excluding Holme Valley Memorial Hospital) are based on output contracts requiring them to clean to the standards detailed in Appendix D. Should additional cleans be required to meet these standards, the cleaning supervisor should be contacted; if this does not resolve the issue, the Hotel Services Manager should be notified on 01924 351680. 6.10

Cleaning and evaluation of standards of cleanliness following maintenance, repairs, refurbishment, floods, building work etc

Contractors are responsible for cleaning up after themselves, removing their equipment and leaving sites safe each day when working in NHS Kirklees premises. The cleaning contracts provide for each room to receive an appropriate clean each day, which ensure appropriate standards of cleanliness are achieved. Should work be undertaken in clinical rooms after they have received their daily clean, whoever is organising the work, must ensure that appropriate arrangements have been made for rooms to be cleaned as necessary prior to them being used for clinical services. Depending on the extent of the work (as categorised below) the standards of cleanliness should be audited using methods outlined below to ensure appropriate standards of cleanliness are maintained.

1. Minor repairs to loose equipment, services and furnishings • Ensure scheduled daily clean is sufficient to restore appropriate standards of cleanliness 2. Repairs to building fabric, for example, repair minor leaks, damaged woodwork, paintwork, flooring: • Clean area in line with identified risk category and to the standard of the National Specification for Cleanliness 2007 and undertake audit. 3. Major repair (requiring closure of facility) for example: structural damage of walls, floors, ceiling; flooding or leak requiring repair to fabric; minor alterations to building fabric • Builders clean followed by full clean of area, • Visual audit using NSC audit tool or equivalent • Environmental air sampling of clinical areas 4. New builds or refurbishment to facilitate alteration to room use, from non clinical use to clinical use, requiring major alteration or disturbance to fabric • Builders clean followed by deep clean • Visual audit using NSC audit tool or equivalent • Environmental air sampling

Major incidents will be addressed by individual assessment.

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7.

Equality Impact Assessment

This Policy was found to be compliant with this philosophy (see appendix C). 8. Training Needs Analysis In order to ensure that policies, guidelines and protocols are introduced and work effectively, there is a need to provide adequate training and instruction. As a result, the author(s) of this document have carried out a training needs analysis which has identified the staff who require training, the methodology of training delivery and the frequency that the training will be provided. The policy author must ensure that the details of this training is passed to the Training and Education Team and where necessary, this will then be included in the Trust Training Prospectus. The Trust will ensure that clinical and non clinical staff attend training provided by the Infection Prevention and Control Team, to ensure all staff understand their responsibilities for cleaning and decontamination of equipment: to ensure that items such as ward/department based equipment is cleaned in accordance with manufacturers instructions and the Trust Decontamination of Re-usable Medical Devices Policy. Line managers are responsible for ensuring that their staff attend appropriate training and achieve appropriate standards of cleanliness for the items which they have been allocated responsibility for cleaning, as outlined in table 1. Cleaning contractors will ensure their staff are trained in accordance with the cleaning manual attached to the National Specifications of Cleanliness 2007. 9. Monitoring Compliance with this policy The monthly updates for the Board Report and Statement of Internal Control require those with delegated responsibility to demonstrate actions taken to meet the requirements of how the Trust is complying with: 1. National Specifications for Cleanliness in the NHS (NPSA 2007) 2. Health Act 2006 and Associated Codes of Practice2008 3. Revised Guidance on Contracting for Cleaning NHS Estates (DOH2004) 4. A Matrons Charter (DOH 2004)

10. References - National Specifications for Cleanliness (NPSA 2007 - Health Act 2006 - Code of Practice for the Prevention and Control of Healthcare Associated Infections (DOH 2006 & 2008), - A Matrons’ Charter(DOH 2004),

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- Revised Guidance on Contract Cleaning NHS Estates (DOH 2004) - Benchmarking and Market Testing in NHS PFI projects Code of Best Practice (DOH PFU & PPP Forum). - NPSA Colour coding guidance

11.

Appendices

A.

SUMMARY OF RELEVANT LEGISLATION AND GUIDANCE DOCUMENTS FOR MANAGING CLEANLINESS IN HEALTHCARE PREMISES

A1

Standards for Better Health: Department of Health

Since April 2005, a performance framework for the NHS and social care has been driven by Standards for Better Health, which set out the level of quality all

21


organizations providing NHS care will be expected to meet or aspire to across the NHS in England. The Standards are detailed in full in the Department of Health publication. The core standards do not of themselves set out new expectations of the NHS, but are based on a number of standards or requirements that already exist. They describe a level of service which is acceptable and which must be universal. Meeting the core standards is not optional. Health care organizations must comply with them. The two core standards which relate to cleanliness are: 1. Standard C4(a) ‘Healthcare organizations keep patients, staff and visitors safe by having systems to ensure that the risk of healthcare acquired infection to patients is reduced, with particular emphasis on high standards of hygiene and cleanliness, achieving year on year reductions in Methicillin Resistant Staphylococcus Aureus (MRSA).’ 2. Standard C21 ‘ Healthcare services are provided in environments which promote effective care and optimize health outcomes by being well designed and well maintained, with cleanliness levels in clinical and non clinical areas that meet the national specifications for clean NHS premises.

A2 Towards cleaner hospitals and lower rates of infection (DOH 2004) Published by the DOH in July 2004, this report highlights the importance of cleanliness to patients and notes that: ‘a clean environment provides the right setting for good patient care practice and good infection control. It is important for efficient and effective healthcare.’

A3 A Matron’s Charter: an Action Plan for Cleaner Hospitals Building on the undertaking in Towards Cleaner Hospitals and Lower rates of Infection. The Matrons’ Charter aims to give matrons and nurses at ward/departmental level the practical advice and power to ensure high standards are maintained. Core Standard 21 guidance stated: The Healthcare organization should have adopted the commitments of the Matron’s Charter A matron’s charter and action plan for cleaner hospitals (DOH 2004) The 10 broad commitments of A Matron’s Charter are as follows: 1. Keeping the NHS clean is everybody’s responsibility 2. The patient environment will be well maintained, clean and safe 3. Matrons will establish a cleanliness culture across their units 4. Cleaning staff will be publicised for the important work they do. Matrons will make sure they feel part of the ward team; 5. Specific roles and responsibilities for cleaning will be clear;

22


6. Cleaning routines will be clear, agreed and well publicized 7. Patients will have a part to play in monitoring and reporting on standards of cleanliness 8. All staff working in healthcare will receive education in infection control 9. Nurses and infection control teams will be involved in drawing up cleaning contracts, and matrons have authority and power to withhold payment; sufficient resources will be dedicated to keeping hospitals clean

A4

Saving Lives: a delivery programme to reduce healthcare associated infection including MRSA Building on previous policy and guidance, Saving Lives sets out nine challenges in the form of a self assessment and planning tool including: Challenge 8 requires organizations to review the status of the built environment and the effectiveness of facilities management services, including cleaning, in order to provide a safe and clean environment for patient care. Specific assurance was required for: - compliance with legislation; - compliance with specifications; - assessment of quality; - availability of cleaning when it was required

A5

Health Act 2006 Codes of Practice for Prevention and Control of Healthcare Associated Infections (DOH 2006 & 2008) The Codes of Practice for the Prevention and Control of Healthcare Associated Infections places further aims and responsibilities on NHS Trusts to ensure that local provision of cleaning services is adequately resourced, clearly defined through a strategic cleaning plan and clear cleaning schedules and frequencies, and arranged to ensure that patients, the public and staff know what they can expect.

Duty 4. Duty to provide and maintain a clean and appropriate environment for Healthcare An NHS body must, with a view to minimizing the risk of HCAI’s ensure that: a. There are policies for the environment that make provision for liaison between the members of any infection control team(ICT) and the persons with overall responsibility for facilities management; b. It designates lead managers for cleaning and decontamination of equipment used for treatment (a single individual may be designated for both areas)

23


c.

d.

e. f. g.

h.

All parts of the premises in which it provides healthcare is suitable for the purpose, kept clean and maintained in good physical repair and condition; The cleaning arrangements detail the standards of cleanliness required in each part of its premises and that a schedule of cleaning frequencies is publicly available; There is adequate provision of suitable hand washing facilities and antibacterial hand rubs; There are effective arrangements for the appropriate decontamination of instruments and other equipment; The supply and provision of linen and laundry supplies reflect Health Service Guidance (HSG)(95)18 Hospital Laundry Arrangements for Used and Infected Linen, as revised from time to time; and Uniform and work wear policy to ensure that clothing worn by staff when carrying out their duties is clean and fit for purpose.

The ‘environment’ means the totality of a patient’s surroundings when in NHS premises. This includes the fabric of the building and related fixtures, fittings and services such as air and water supplies.

A6 Revised Guidance on Contracting for Cleaning (NHS Estates 2004) When ‘Towards Cleaner Hospitals and Lower rates of Infection’ was published in 2004, the Secretary of State undertook to produce guidance for the NHS to ensure that in future contracts for cleaning were driven by quality rather than price. The Revised Guidance on Contracting for Cleaning takes the first step in meeting that undertaking. It provides: - A best practice guide on evaluating and awarding contracts so that quality is considered alongside price; - Revised National Specifications for Cleanliness (formerly the National Standards of Cleanliness, these have since been updated as detailed below in 2.8.1) which set out clearly the standards which healthcare premises should have as a minimum; - The recommended minimum cleaning frequencies; - A revised Healthcare Facilities Cleaning Manual. Further work has been undertaken to supplement the guidance, including: - A ‘ward based cleaning management system’ which allows Matrons to be in charge of what and how often things get cleaned, set quality standards, make judgments about performance and be able to quickly put right anything that might be wrong; - Guidance on setting performance parameters which allow penalties for under performance in the delivery of cleaning services to more closely reflect the issues which are of importance to patients;

24


-

Guidance on ensuring contract specifications enables contracts to be terminated as swiftly as possible in the event of serious under performance.

Ministers have made it clear that it is their expectation that the guidance in this and subsequent documents will be followed by NHS Trusts, and that trusts will ensure adequate resources are provided to meet costs.

A7

Benchmarking and Market Testing in NHS PFI projects Code of Best Practice (DOH PFU &PPP Forum) This Code of Best Practice provides Guidance and advice on good practice to NHS Trusts, Project Companies and Service Providers about to embark on benchmarking and market testing in a PFI scheme, and is intended as a supplement to contract provisions and current guidance. Whilst this Code predominantly concerns operational schemes, it will assist parties in handling schemes in the procurement phase in conjunction with SF3 Schedule 17 and HSG(97)5.

A8 National Specifications for Cleanliness in the NHS (NPSA 2007) The National Specifications for Cleanliness in the NHS: a framework for setting and measuring performance outcomes April 2007 update the National Standards of Cleanliness first published by NHS Estates in 2001 and revised in August 2003 and December 2004 (in Revised Guidance on Contracting for Cleaning as the National Specifications for Cleanliness). They provide a comparative framework within which hospitals and trusts in England can set out details for providing cleaning services and assessing ‘technical’ cleanliness. The national specifications have been reviewed and revised to: - ensure they take account of changes occurring since the date of the last review, specifically, but not restricted to Towards Cleaner Hospitals and Lower Rates of Infection, A Matron’s Charter, The Healthcare Commission’s Standards for Better Health and the Code of Practice for the Prevention and Control of Healthcare Associated Infections (introduced under the Health Act 2006); - incorporate the recommended Minimum cleaning frequencies (first published separately in December 2004 in Revised Guidance on Contracting for Cleaning); - include a specimen strategic cleaning plan, an operational cleaning plan and a cleaning responsibility framework. The National Specifications for Cleanliness should be applied regardless of the manner in which cleaning services are provided. Compliance with the specifications, and the monitoring and auditing processes should be written into contracts with cleaning service providers.

25


These Specifications focus on outcomes rather than the method by which they are achieved, since the responsibility for day to day arrangements rests entirely with individual NHS Trusts. They can be used as: - a basis for developing specifications for service level agreements; - a standard against which services can be benchmarked; - an aid to establishing the right staffing levels; - part of an ongoing performance management process; - a framework for auditing; - a benchmark in the drive to reduce healthcare associated infections; - a useful tool in improving patient and visitor satisfaction levels. The National Specifications for Cleanliness outline that high levels of cleanliness can only be achieved through: - clear specifications; - the proper training of staff; - documented lines of accountability; - involving patients; - all staff recognizing their responsibilities; - a meaningful framework for measurement; - NHS trust management board support, the appointment of a board nominee to represent cleaning and related issues at board level and board ownership to embed cleanliness as part of the Trust’s strategy; - Modern matrons taking the lead; - Direct links between NHS directors of infection prevention and control, and local infection control teams and policies;

A9

Patient Environment Action Team assessments and the National Specifications for Cleanliness From 2007, the results of Patient Environment Action Team (PEAT) assessments will be calculated against these specifications and the auditing process which accompanies them. It is, therefore, vital that all healthcare premises follow the auditing process and provide their annual score through the Estates Returns and Information Collection (ERIC) process. NHS trusts are reminded that providing this score through ERIC is a mandatory return. The Healthcare organization should be able to demonstrate that wards and departments are clean and kept clean. The organization should have in place clear local policies which include cleaning methods and frequencies, risk protocols and local service agreements for each functional area.

B. KEY STAKEHOLDERS CONSULTED / INVOLVED IN THE DEVELOPMENT OF THIS POLICY

26


Stakeholders name and designation Joan Booth, Head of Localities Keith Geldard, Estates Manager David Henwood, Assistant Director, Estates and Facilities Pam Lumb, Head of Therapies Bryan Machin, Director of Finance Jane O’Donnell, Deputy Director Infection Control Pat Patrice, Head of Corporate Governance and Services Jenny Scholefield, Hotel Services Manager Julia Calcraft, Locality Manager, HVMH Policy Development Group

27

Key Participant Yes/No Yes Yes

Feedback requested Yes/No Yes Yes

Yes

Yes

Yes Yes Yes

Yes Yes Yes

Yes

Yes

Yes Yes

Yes Yes Yes

Feedback accepted Yes/No

Yes


C. EQUALITY IMPACT ASSESSMENT TOOL To be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval. Insert Name of Policy / Procedure Yes/No 1.

Does the policy/guidance affect one group less or more favourably than another on the basis of: • Race

NO

• Ethnic origins (including gypsies and

NO

travellers) • Nationality

NO

• Gender

NO

• Culture

NO

• Religion or belief

NO

• Sexual orientation including lesbian, gay

NO

and bisexual people • Age

NO

• Disability - learning disabilities, physical

disability, sensory impairment mental health problems

and

NO

2.

Is there any evidence that some groups are affected differently?

NO

3.

If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable?

NA

4.

Is the impact of the policy/guidance likely to be negative?

NA

5.

If so can the impact be avoided?

NA

6.

What alternatives are there to achieving the policy/guidance without the impact?

NA

7.

Can we reduce the impact by taking different action?

NA

Comments


D. ELEMENT STANDARDS Requirements specified in Appendix 1 of the National Specifications for Cleanliness 2007. See Appendix J for definitions ENVIRONMENT Patient equipment: Direct contact Element Standard All parts including underneath should be visibly 1. Commodes clean with no blood and body substances, dust, dirt, debris or spillages. As above 2. Bathroom hoists As above 3. Weighing scales, manual handling equipment As above 4. Drip stands All parts including underneath should be visibly 5. Other medical clean with no blood and body substances, dust, equipment NOT dirt, debris or spillages. connected to a patient, e.g. intravenous infusion pumps drip stands and pulse oximeters All parts including underneath should be visibly 6. Medical equipment clean with no blood and body substances, dust, connected to a patient, e.g. intravenous infusion dirt, debris or spillages. pumps drip stand and pulse oximeters All parts including underneath should be visibly 7. Patient washbowls clean with no blood and body substances, dust, dirt, debris or spillages. Patient washbowls should be decontaminated appropriately between patients and should be stored clean, dry and inverted. Badly scratched bowls should be replaced. 8. Medical gas equipment All parts including underneath should be visibly clean with no blood and body substances, dust, dirt, debris or spillages. All parts including the blades/fins and the 9. Patient fans underside should be visibly clean with no blood and body substances, dust, dirt, debris or spillages.


Element Standards Close contact Element 10. Bedside alcohol hand wash container, clipboards and notice boards

11. Notes and drugs trolley 12. Patient personal items eg. cards and suitcase

13. Linen trolley

Fixed assets Element 14. Switches, sockets and data points

15. Walls

16. Ceiling

17. All doors

18. All internal glazing including partitions

19. All external glazing

Standard All parts including holder of the bedside alcohol hand wash container should be visibly clean with no blood and body substances, dust, dirt, debris or spillages. Hand wash dispenser should be free of product build up around the nozzle. Splashes on the wall, floor, bed or furniture should not be present. All parts including underneath and inside of the notes trolley should be visibly clean with no blood and body substances, dust, dirt, debris or spillages All parts of the patients’ items should be visibly clean with no blood and body substances, dust, dirt, debris or spillages. Loose items such as clothing should be stored away either in the locker or bag. All parts including underneath of the linen trolley should be visibly clean with no blood and body substances, dust, dirt, debris or spillages

Standard All wall fixtures eg. switches, sockets and data points should be visibly clean with no blood and body substances, dust, dirt, debris, adhesive tape or spillages All wall surfaces including skirting should be visibly clean with no blood and body substances, dust, dirt, debris, adhesive tape or spillages All ceiling surfaces should be visibly clean with no blood and body substances, dust, dirt, debris, adhesive tape or spillages All parts of the door structure should be visibly clean so that all door surfaces, vents, frames and jambs have no blood and body substances, dust, dirt, debris, adhesive tape or spillages All internal glazed surfaces should be visibly clean and smear-free with no blood and body substances, dust, dirt, debris, adhesive tape or spillages. All external glazed surfaces should be clean.

30


Element Standards 20. Mirrors

21. Bedside patient TV including earpiece for bedside entertainment system 22. Radiators

23. Ventilation grilles extract and inlets

Hard floors Element 24. Floor-polished

25. Floor – non slip

Soft floors Element 26. Soft floor

Mirrors should be visibly clean and smear free with no blood and body substances, dust, dirt, debris, adhesive tape or spillages All parts of the bedside TV should be visibly clean with no blood and body substances, dust, dirt, debris, adhesive tape or spillages. All parts of the radiator (including between panels) should be visibly clean with no blood and body substances, dust, dirt, debris, adhesive tape or spillages. The external part of the ventilation grille should be visibly clean with no blood and body substances, dust, dirt, debris or cobwebs.

Standard The complete floor including all edges, corners and main floor spaces should have a uniform shine and be visibly clean with no blood and body substances, dust, dirt, debris, spillages or scuff marks. The complete floor including all edges, corners and main floor space should have uniform finish or shine and be visibly clean with no blood and body substances, dirt, debris or spillages.

Standard The complete floor including all edges, corners should be visibly clean with no blood and body substances, dust, dirt, debris, spillages or scuff marks. Floors should have a uniform appearance and an even colour with no stains or watermarks.

31


Element Standards FIXTURES Electrical fixtures and appliances Element Standard The pest control device should be free from dead 27. Pest control devices insects, animals or birds and be visibly clean. The casing of electrical items should be visibly 28. Electrical items clean with no blood and body substances, dust, dirt, debris or adhesive tape. Cleaning equipment should be visibly clean with no 29. Cleaning equipment blood and body substances, dust, dirt, debris or moisture. Furnishings and fixtures Element 30. Low surfaces

31. High surfaces

32. Chairs

33. Beds

34. Lockers

35. Tables

Standard All surfaces should be visibly clean with no blood and body substances, dust dirt, debris, adhesive tape or spillages. All surfaces should be visibly clean with no blood and body substances, dust dirt, debris, adhesive tape or spillages. All parts of the furniture should be visibly clean with no blood and body substances, dust dirt, debris, adhesive tape or spillages. All parts of the bed (including mattress, bed frame, wheels and castors) should be visibly clean with no blood and body substances, dust dirt, debris, adhesive tape or spillages. All parts of the locker (including wheels, castors and inside) should be visibly clean with no blood and body substances, dust dirt, debris, adhesive tape or spillages. All parts of the table (including wheels, castors and underneath) should be visibly clean with no blood and body substances, dust dirt, debris, adhesive tape or spillages.

32


Element Standards Furnishings and fixtures continued Element Standard 36. Hand wash containers All parts and surfaces of hand soap and paper towel containers should be visibly clean with no blood and body substances, dust dirt, debris, adhesive tape or spillages. Dispensers should be kept stocked. 37. Hand hygiene alcohol All parts and surfaces of the hand hygiene alcohol rub dispensers should be visibly clean with no rub dispensers blood and body substances, dust dirt, debris, adhesive tape or spillages. Dispensers should be kept stocked. The waste receptacle should be visibly clean 38. Waste receptacles including lid and pedal with no blood and body substances, dust dirt, debris, adhesive tape or spillages. Receptacles should be emptied frequently and not allowed to overflow. Curtains/blinds should be visibly clean with no 39. Curtains and blinds blood and body substances, dust, dirt, debris, stains or spillages.

Kitchen fixtures and appliances Element Standard Dishwashers should be visibly clean with no blood 40. Dishwashers and body substances, dust dirt, debris, stains, spillages or food debris. Fridges and freezers should be visibly clean with 41. Fridges and freezers no blood and body substances, dust dirt, debris, spillages, food debris or build up of ice. 42. Ice machines and hot Ice machines and hot water boilers should be visibly clean with no blood and body substances, water boilers dust, dirt, debris, or spillages. Kitchen cupboards should be visibly clean with no 43. Kitchen cupboards blood and body substances, dust dirt, debris, stains, spillages or food debris. All microwave surfaces should be visibly clean with 44. Microwaves no blood and body substances, dust dirt, debris, spillages or food debris.

33


Element Standards Toilets, sinks, wash hand basins and bathroom fixtures Element Standard The shower, wall attached shower chairs should be 45. Showers visibly clean with no blood and body substances, scum, dust, lime scale, stains, deposit or smears. The toilet and bidet should be visibly clean with no 46. Toilets and bidets blood and body substances, scum, dust, lime scale, stains, deposit or smears. There should be plenty of all consumables and 47. Replenishment soap. The sink and wall attached dispensers should be 48. Sinks visibly clean with no blood and body substances, dust, dirt, debris, lime scale, stains or spillages. Plug hole and overflow should be free from build up. The bath should be visibly clean with no blood and 49. Baths body substances, dust, dirt, debris, lime scale, stains or spillages. Plug hole and overflow should be free from build up.

E. CLEANING PROCEDURE GUIDANCE Adapted from Appendix 7 of the National Specifications for Cleanliness Refer to manufacturers’ cleaning instructions. Wear personal protective equipment, i.e. gloves, aprons and/or as appropriate. - Wipe all surfaces including underneath, paying special attention to ‘contact’ points. - Apply colour coding policy. - Use specified product, for example: - Detergent wipes; - Alcohol wipes; - Detergent and disposable cloths. - Always comply with health and safety policies: - COSHH (refer to data/ assessment sheets); - Electrical equipment (switch off appliances and unplug); - Manual handling (lift in pairs, empty contents wherever possible). - Always comply with infection control policies and procedures: - Good personal hygiene; - Safer disposal of clinical waste; - Adherence to standard infection control precautions; - Adherence to decontamination policy; - Seek specialist advice for cleaning of fabric finishes.

-

34


F. CLEANING FREQUENCIES Source: National Specifications for Cleanliness in the NHS (NPSA April 2007) Element 1

Commodes, weighing scales, manual handling equipment;

2 3

Bathroom hoists Weighing scales, manual handling equipment Drip stands Other medical equipment eg. Intravenous infusion pumps, pulse oximeters etc NOT CONNECTED TO PATIENT Other medical equipment eg. Intravenous infusion pumps, pulse oximeters etc CONNECTED TO PATIENT Patient washbowls Medical gas equipment Patient fans

4 5

6

7 8 9

10 Bedside alcohol hand wash container, clipboards & noticeboards 11 Notes and drug trolley 12 Patient personal items eg cards, suitcase

Minimum cleaning frequencies High risk Significant risk Low risk Clean contact points after each NA use One full clean daily Clean contact points after each use

NA

NA

One full clean daily and between patient use

One full clean daily Case daily. One full Full clean clean daily and between quarterly. patient use. Quarterly full clean. One full clean daily and between patient use

One full clean weekly One full clean daily

35

NA


Cleaning Frequencies Minimum cleaning frequencies Element High risk Significant risk 1 Linen trolley Contact points clean daily 3 One full clean weekly 1 Switches, sockets One full clean daily 4 & data points 1 Walls One check clean Check clean 5 daily weekly Full clean weekly Dust (dust only) monthly Full wash yearly 1 6

Ceiling

1 7 1 8 1 9 2 0 2 1 2 2 2 3 2 4

All doors All internal glazing inc. partitions All external glazing Mirrors Bedside patient TV Radiators Ventilation grilles extract and inlets Floor-polished

Low risk

One full clean weekly Check clean weekly

Washing every 3yrs One full clean monthly (dust only) 1 check dust monthly One full washing yearly Washing 3 yearly One full clean daily One full clean weekly One check clean daily One full clean weekly One full clean weekly One full clean every 3 months One full clean daily One full clean daily

One full clean weekly Dust removal one full clean daily + 1 check clean daily Wet mop one full clean daily + 1 check clean daily Machine scrub clean weekly

One full clean monthly One full clean monthly Dust removal daily Wet mop daily

Machine scrub clean monthly Strip & reseal yearly

36

One full clean weekly NA

Dust removal 1 full clean weekly + 1 check clean weekly Wet mop 1 full clean weekly + one check clean weekly Machine clean quarterly Strip & reseal twice yearly


Cleaning Frequencies Element Minimum cleaning frequencies High risk Significant risk Dust 2 Floor non-slip Dust removal one removal 5 full clean daily + 1 daily check clean daily Wet mop one full clean daily + one check clean daily Machine clean weekly 2 6

Soft floor

2 7 2 8

Pest control devices Electrical items

2 9 3 0 3 1

Cleaning equipment Low surfaces

3 2 3 3

Chairs

3 4 3 5 3 6 3 7

Lockers

High surfaces

Beds

Tables Hand wash containers Hand hygiene/alcohol rub dispensers

Wet mop daily

Machine clean monthly 1 full clean daily + 1 1 full clean check clean daily daily

Low risk Dust removal 1 full clean weekly + 1 check clean weekly Wet mop one full clean weekly + 1 check clean weekly Machine clean quarterly

1 full clean weekly + 1 check clean weekly Shampoo 6 Shampoo 12 Shampoo twice monthly monthly yearly Dust removal one full clean daily Full clean monthly Dust removal 1 full clean daily Dust removal 1 full clean weekly Full clean monthly Full clean quarterly Full clean after each use 1 full clean daily +1 1 full clean 1 full clean weekly check clean daily 1 full clean weekly 1 full clean weekly + 1 check clean weekly 1 full clean daily + 1 1 full clean 1 full clean weekly check clean daily daily Frame daily NA Under weekly Whole on discharge 1 full clean daily + 1 1 full clean NA daily check clean daily 1 full clean daily + 2 1 full clean weekly check cleans daily Daily NA

37


Cleaning Frequencies Minimum cleaning frequencies Element High risk Significant Low risk risk 3 Waste 1 full clean daily & 1 full clean daily 8 receptacles 1 check clean daily One deep clean weekly 3 Curtains and Clean, change or replace yearly or Clean, change or 9 blinds as soiled replace twice yearly Bed curtain change Bed curtains 6 monthly replace 12 monthly 4 Dishwasher 1 full clean daily + 2 1 full clean daily 0 check cleans daily 4 Fridges and 3 check cleans daily 1 check clean daily 1 freezer 1 full clean weekly (remove all contents to clean) Defrost monthly 4 Ice machines and 1 daily check clean NA 2 hot water boilers 1 full clean weekly 4 Kitchen 1 full clean weekly 1 full clean 1 full clean quarterly 3 cupboards monthly 1 full clean daily 4 Microwaves 1 full clean daily 4 and 2 check cleans daily 4 Showers 1 full clean daily & 5 1 check clean 4 Toilets and bidets 2 full cleans daily & 6 1 check clean daily 4 Replenishment 3 times daily Once daily 7 1 full clean daily 4 Sinks 2 full cleans daily & 8 1 check clean daily 4 Baths 1 full clean daily + 1 9 check clean daily

38


G. PERFORMANCE PARAMETERS Ref Parameter SP01a Comprehensive cleaning schedules have been produced in agreement with the Trust’s Representative and are available for inspection at all times. SP01a Scheduled cleaning in Moderate Risk Functional Areas has been completed and all Elements meet the Service Standards SP01b Scheduled cleaning in Low risk Functional Areas has been completed and all Elements meet the Service Standards SP01c Scheduled cleaning in Minimal Risk Functional Areas has been completed and all Elements meet the Service Standards (Appendix D) SP01d All cleaning practices comply with the Trust’s Control of Infection Policy and Procedures. SP01e Cleaning Services undertaken within Access Times except where expressly permitted by the Trust’s Representative. Reactive Cleaning is undertaken at frequencies agreed and stated in SP02 Table 2 (see Appendix F) Planned cleaning is undertaken at frequencies agreed and stated in Table SP03 2 SP04a All equipment used in the provision of the Cleaning Service is maintained, cleaned and stored in accordance with Trust policy SP04b All equipment and materials used in the provision of the Cleaning Service is compliant with NHS colour coding to indicate specific areas of use. SP04c All equipment used within sensitive areas of the Sites are appropriately noise restricted and fitted with high quality and HEPPA standard dust filters. SP04d All equipment is compliant with all relevant legislation and holds a portable appliance certificate where appropriate SP05 All equipment and materials used in the provision of the Cleaning Service are approved, procured, maintained, cleaned and stored in accordance with Trust Policy, agreed stock levels and COSHH requirements. SP05a All equipment and materials used in the provision of the cleaning service are agreed with the Trust’s Representative SP05b All feminine hygiene services are supplied, emptied and replenished in accordance with the agreed schedule SP05c An ordering system for nominated Trust staff is fully operational at all times. All evidence of pests and pest excreta are promptly reported to the SP06 Helpdesk, all pest contaminated areas cleaned and disinfected as agreed. Waste is collected, bagged and stored in accordance with the Waste SP07 Management Service Level Specification. Deep clean of rooms is performed as scheduled in agreement with the SP08 Trust All internal and external windows are cleaned in accordance with agreed SP09 schedules and standards in Appendix A, D and F.

39


H. NATIONAL SPECIFICATION FOR CLEANLINESS AUDIT TOOLS The National Patient Safety Agency developed an audit tool for auditing standards of cleanliness in accordance with the National Specifications for Cleanliness 2007. This audit tool or equivalent will be used by the Trust and Cleaning Service Providers to audit standards of cleanliness across Trust Premises. I. RESPONSE TIMES AND RECTIFICATIONS Table 3: Functional Area Categorisation Category Operational Status Functional Areas included in Category 1 High Risk In Patient Areas 2

Significant Risk

3

Low Risk

4

Minimal Risk

Treatment rooms Consulting rooms Clean and Dirty Utility Rooms Public thoroughfares WCs Kitchens Administrative Areas Reception Store Rooms Plant rooms External surrounds

Table 4: Response Requirements Response Category EMERGENCY

URGENT

ROUTINE

Response time during normal hours 40 minutes (Dewsbury 10 minutes) 40 minutes (Dewsbury 10 minutes 4 hours

40

Rectification Time

Response time outside normal hours 2 hours

12 hours

2 hours

24 hours

4 hours

36 hours


J. DEFINITIONS As detailed in Appendix 8 of the National Specifications for Cleanliness 2007 A range of terms are used in the National Specifications for cleanliness, and these have particular relevance to the way that cleanliness is achieved in healthcare premises. Definitions are not exhaustive. Dust includes dust, lint, powder, fluff and cobwebs. Dirt includes mud smudges, soil, graffiti, mould, fingerprints, ingrained dirt and scum. Debris includes crisp packets, drinks cans and bottles, chewing gum, rubbish, cigarette butts, litter, adhesive tape, grit, lime scale. Spillage includes any liquid, tea stains, sticky substances. Room types are a subset of functional areas. For example, on a ward these could be bedded bays and sanitary areas. This allows cleaning managers the opportunity to more closely audit and manage standards in specific parts of functional areas. Inputs are the resources used to produce and deliver outputs. Inputs may include staff, equipment or materials. Outcomes are the effect or consequences of the output, for example, cleaning (output) produces a clean and safe environment for patient care (outcome). Outputs are the actual product or service, for example, cleaning. Processes are the procedures, methods and activities that turn the inputs into outputs, for example, mopping a floor. Quality systems refer to integration of organisational structure, integrated procedures, resources, and responsibilities required to implement quality management. Taken together these provide for the development of a comprehensive and consistent service.

41

http://www.kirklees.nhs.uk/fileadmin/documents/New/Your_health/Infection_prevention___control/Polici  

http://www.kirklees.nhs.uk/fileadmin/documents/New/Your_health/Infection_prevention___control/Policies/Cleaning_policy.pdf

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