Hospital cleaning feature

Healthcare and infection control

Healthcare facilities play a vital role in society. Injured or sick people who are in need of medical
treatment or surgery are admitted to these facilities as and when the need arises. Given the nature of
such facilities, infection management is a key concern. Consequently, cleanliness and hygiene are a
top priority. African Cleaning Review spoke to Ina Kok, the SHEQ and infection control co-ordinator at
Life Fourways Hospital about the hospital’s cleaning protocols and the various measures that have
been implemented to limit the spread of infection.
Background check
Life Fourways Hospital opened its doors during 2006 with a capacity of 194 beds offering specialised
services such as cardio-thoracic surgery, a renal unit and neurosurgery. In addition a breast health
unit, maternity ward, neonatal and ICU unit are also located at the hospital.
The cleaning of the hospital is outsourced to a leading hospitality services and facilities management
company with approximately 50 cleaners allocated to the facility, performing their duties on a shift
basis. Additional cleaning staff is contracted as and when the need arises. It is a prerequisite that all
cleaners are vaccinated according to legal requirements.
The cleaning company manages practically all Life Fourways Hospital’s cleaning requirements,
including provision of cleaning consumables and laundry, amongst others.
Cleaning prerequisites
The cleaning contractor had to meet a number of requirements to provide a service at Life Fourways
Hospital:
•
Extensive healthcare cleaning experience with a good track record in this regard. The latest cleaning technology and industry standards must also be adhered to at all times Proven company policies and procedures in terms of cleaning wards across the hospital spectrum Access to a cleaning training facility and proof of ongoing training All cleaning equipment is accounted for on a regular basis The company’s service providers are required to supply the correct chemicals and maintain chemical data sheets at all times as well as adhere to proper usage requirements. Protocols which fall under this banner include correct storage and mixing: – For example, chemicals must not be stored too high as this poses a risk to those reaching for them. Chemicals must be stored in locked cupboards; Certain chemicals must not be stored with flammable items such as toilet paper as this poses a fire risk; Chemicals must also be decanted correctly or alternatively be provided in sachet form for ease of mixing and to avoid wastage. Many years ago, at the onset of antibiotic use, infections caused by Staphylococcus aureus were easily treatable. However, over the years, these bacteria have developed resistance to antibiotics. Methicillin (similar to penicillin) is one such antibiotic to which the bacterium is resistant. There are, in fact, a number of different strains of MRSA with varying degrees of resistance. In the UK, Oxford Radcliffe Hospitals have implemented a comprehensive action plan to tackle such infections. For instance, a range of measures regarding the use of intravenous lines and catheters has been introduced. Good hand hygiene practices have also been introduced to prevent the transfer of these superbugs. Life Fourways Hospital has implemented similar in-house measures to complement its cleaning regime and minimise infection. Hand cleaning instruction posters have been placed in all the hospital washrooms. Paper dispensers are utilised throughout and automated alcohol sanitisers have been placed at ward entrances to mitigate infection between visitors and patients. Area specific cleaning
With the spread of disease in mind, Ina says that every sector of the hospital from the reception area
to the ICU ward is populated with cleaners who are purpose trained for that area in an effort to
minimise the spread of disease.
Training is provided by the cleaning service provider on an ongoing basis and is in line with the latest
cleaning standards. For instance, cleaners which staff the ICU and isolation wards have been trained
in the “Top Down” method of cleaning.
The cleaners first remove the curtains of each cubicle which are then sent away for specialised
washing. The walls, floors, bed and related equipment are then washed with a hypochlorite
disinfectant. Cleaners allocated to these areas are supplied with personal protection equipment
(masks, caps, plastic aprons and gloves) to protect them from infection and the cleaning chemicals.
Another area, which receives special cleaning treatment, is the reception area.
This area features a low-maintenance ceramic tile which, although dull to the eye has been purpose
installed with a view to minimising bacteria and labour.
Ina explained: “A ‘maslin’ (dry mop) system is utilised along with an all purpose cleaner to clean the
reception floor. This procedure cancels out the need for buffing and waxing.
“Studies showed that washing, waxing and buffing floors actually attracts organisms and allows germs
to get trapped between the wax and the tile. The maslin system minimises the incidence of germs,
decreases the amount of time spent on cleaning and also boosts safety as the floors are not wet,
which prevents slipping. So although the dull tile may not be perceived to be as clean to the layperson
as the case with a shiny floor, it is in fact a lot more hygienic,” comments Ina.
With this principal in mind, the majority of the hospital has been furnished with a linoleum floor which is
also easy to clean and harbours fewer germs than some of the other floor surfaces.
Prevention better than cure
Specific areas of the hospital are equipped with its own cleaning tools and disinfectants which remain
confined to that area. This cleaning equipment is utilised according to a colour-coded system.
For instance, clean mops are stored in blue buckets, while dirty mops are placed in red buckets. Such
a system prevents the transmission of organisms from one ward to another, says Ina. Spot checks are
carried out to ensure that this system is correctly implemented, she adds.
At Life Fourways Hospital, the traditional spaghetti mop has been replaced with flat micro-fibre mops
as the fibres of spaghetti mops were found to harbour high levels of bacteria. The micro-fibre mop
heads are washed daily at a temperature of 80°C.
Specialised cleaning
One of the few areas of cleaning not managed by the cleaning contractor is the cleaning and
sterilisation of surgical instruments.
After each operating procedure these instruments are taken to a sterilising facility staffed by specially
trained personnel, certified in the handling and cleaning of these instruments. They are cleaned by
means of a steaming process (autoclaving) with several controls in place to ensure that instruments
are sterile. Once sterilised, they are identified as such, and therefore can be verified by each user in
the surgical team.
Specialist approach
Judging from the specialist cleaning techniques and specialised requirements by healthcare facilities it
is clear that cleaning should be carried out by well trained specialists in their field who understand the
dangers of poor infection control and hospital associated infections.
A hot topic
The issue of hospital waste dumping has been aired by the media on a number of occasions
especially as and when instances of illegal dumping have arisen.
There are two types of hospital medical waste – hazardous and non-hazardous. Hazardous waste is
incinerated. Non-hazardous waste is sterilised and disposed of at specifically designated waste
management sites.
Life Fourways Hospital has a comprehensive waste management policy in place and strict procedures
to which its own staff and its contracted external service provider are required to adhere to in terms of
collection, transportation, storage (if necessary) and disposal or destruction of medical waste. This is
to ensure that medical waste is disposed of responsibly and safely, in accordance with legislation, and
does not pose a safety risk to the public and to the environment.
Life Fourways Hospital at all times acts in a responsible and legally compliant manner when carrying
out the disposal of medical waste originating from its facility. To this end, the company has contracted
with an independent service provider which specialises in this field, and which has been granted a
permit by the Department of Environmental Affairs (DEA) to render this type of service, and which has
also been assessed by the Life Healthcare group, of which Life Fourways Hospital is a member.
Factors taken into account in the assessment include whether the service provider is legally permitted
to render this service, the company’s experience in the industry, its capacity to manage the volume of
medical waste generated by the hospital, whether it has its own destruction facilities, and whether it
can provide a “seamless” service.
Strict waste management procedures are followed at Life Fourways Hospital. For example, when the
contracted waste management company collects waste from the hospital, the waste is weighed and
the type of waste (hazardous or non-hazardous) and the weight thereof are noted in the presence of a
hospital representative. Once the contracted company has disposed of the waste in the manner
required by legislation, they give the hospital a disposal/destruction (whichever is relevant) manifest
document which the hospital then checks against the waste that was collected to ensure that all waste
has been accounted for. If any deviations are noted, these are taken up immediately with the
contractor and reported to the group’s head office, who handles the matter with the waste
management company on both a legal and commercial basis.
BOX:
Understanding “superbugs”
“Superbugs” or resistant bacteria are bacteria which have developed several resistance genes to
antibiotics. Antibiotic resistance evolves due to natural causes but can also be engineered through
evolutionary stress (such as that imposed by humans).
In human medicine the major cause of the emergence of resistant bacteria can be attributed to over
prescription of antibiotics by doctors as well as the misuse and overuse by patients.
An excerpt from Wikipedia states the following: “The volume of antibiotic prescribed is the major factor
in increasing rates of bacterial resistance rather than compliance with antibiotics. Inappropriate use of
antibiotics has been attributed to a number of causes including: people who insist on antibiotics;
physicians simply prescribe them as they feel they do not have time to explain why they are not
necessary; physicians who do not know when to prescribe antibiotics or else are overly cautious for
medical legal reasons.”
Poor hand hygiene by hospital staff has also been associated with the spread of resistant organisms.
Arguably one of the most lethal of these superbugs is ‘methicillin-resistant staphylococcus aureus
(MRSA) – a bacterium responsible for several difficult-to-treat infections in humans.
According to Wikipedia, MRSA is, by definition, any strain of Staphylococcus aureus bacteria that has
developed resistance to beta-lactam antibiotics, which include the penicillins (methicillin, dicloxacillin,
nafcillin, oxacillin, etc.) and the cephalosporins. An example of a superbug is Staphylococcus aureus.
MRSA is internationally recognised as being troublesome in hospitals, where patients with open
wounds, invasive devices and weakened immune systems are at greater risk of infection than the
general public.
END BOX

Source: http://ncca.co.za/downloads/Hospital_cleaning_feature.pdf