Researching Effective Approaches to Cleaning in Hospitals

Hospitals are where people go to get well. Unfortunately, they can also be a place that spreads illness. Insufficient cleaning practices leave behind micro-organisms that cause healthcare-associated infections (HAI’s). Some of which can survive in hospitals for several months.  

Insufficient Cleaning Practices

Improper cleaning practices leave dangerous microbes behind. A meta-analysis published in the Journal of Hospital Infection reveals the risk of pathogen acquisition. The study concludes that “current environmental cleaning practices fail to reduce the risk of acquisition.” The researchers go on to suggests using novel approaches to improve cleaning and implementing new cleaning technologies. 

REACH Study

Evidence-based cleaning can help reduce the risk of HAI’s. A team of researchers in Australia conducted a randomized controlled trial in 11 hospitals to evaluate the impact of researched-based cleaning practices. That study was called the Researching Effective Approaches to Cleaning in Hospitals (REACH) study. Each hospital implemented evidence-based cleaning practices. The practices were presented in “a set of evidence-based practices that when performed collectively and reliably have a proven ability to improve patient outcomes” known as a cleaning bundle. 

5-Part Cleaning Bundle

A cleaning bundle is a set of practices designed to improve health outcomes. There are 5 components to the cleaning bundle.

1. Training – Staff education is a crucial part of implementing an environmental cleaning bundle. Training content needs to be tailored to reflect the hospital’s context and cleaning roles.
2. Technique – Best practice techniques include: developing a defined and consistent cleaning sequence, focusing on high-risk touch-points, using sufficient pressure and movement, and following manufacturer instructions.
3. Product – Disinfectant should be minimally applied for all terminal cleanings and for daily use in high-risk rooms. Also, use point-of-care wipes for medical equipment.
4. Audit – Use ultraviolet marker technology to monitor the effectiveness of techniques and products. Provide regular feedback to environmental services staff members, and summarize audit results for administrators.
5. Communication – Use a team approach to cleaning. There should be daily communication between managers and housekeeping staff. Induct representatives from the cleaning staff into decision-making committees.

Improving Health Outcomes

Using the REACH cleaning bundle resulted in improved thoroughness of cleaning. The results also show the benefit of using a fluorescent gel to assess cleaning. Implementing bundled intervention showed “changes in knowledge, practice, and attitudes in environmental services staff, improvement in the thoroughness of cleaning, and an overall reduction in health-care-associated infections.“

Changes in Knowledge and Attitude

The researchers also gave cleaning staff questionnaires to determine changes in their knowledge and attitudes. Respondents showed an increased understanding of questions relating to hand hygiene, glove use, and personal protective equipment (PPE). 

However, attitudes did not change much. In both the pre- and post-questionnaires, the vast majority of respondents agreed that cleaning matters to patients and families. The study also indicated that housekeeping staff would like feedback on their performance, but most said they did not receive regular feedback. This presents an opportunity for administrators to increase engagement with environmental services staff.

Effective Approaches

In conclusion, implementing an evidence-based cleaning bundle can improve health outcome through better disinfection. The Compendium of Strategies to Prevent Healthcare-Associated Infections synthesizes best research for the most common HAI’s with basic prevention approaches as well as advanced strategies to manage outbreaks.