National Specifications for Cleanliness in primary medical and dental care
Question and Answer
What are the National Specifications?
The specifications are designed to set out a process which, if adopted, will allow providers of healthcare to demonstrate how they ensure that the premises in which they deliver care are clean and safe, and where the risks which may be posed to the public by infections have been assessed and – where necessary – addressed.
Why are they necessary?
From April 2011 for dentistry, and April 2012 for general practice, providers will need to be registered with the Care Quality Commission for the provision of services. This registration takes place against a range of criteria, one of which is the requirement to ensure that – so far as reasonably practical – service users, staff and anyone else who may be at risk of exposure to infections are protected against the identifiable risks through, amongst other things, the effective operation of systems designed to assess the risk of and to prevent, detect and control the spread of a health care associated infection and the maintenance of appropriate standards of cleanliness and hygiene in relation to premises occupied for the purpose of carrying on the regulated activity and equipment (and reusable medical devices) used for the purpose of carrying on the regulated activity.
How do they work?
Basically, the specifications set out a process – or system – which allows the risks posed by infections to be assessed and the results of that risk assessment to then inform decisions relating to the provision of cleaning services. For example, if through the risk assessment process particular items and/or particular areas of the premises are considered to pose heightened risks, then the decision may be taken to clean these items/areas more frequently.
Are they mandatory?
The requirement to effectively operate systems designed to assess the risk of and to prevent, detect and control the spread of a health care associated infection and the maintenance of appropriate standards of cleanliness and hygiene is mandatory, but there is no single mandatory process for doing so. These specifications have therefore been produced as a guide and have drawn on similar documents which have been available to hospitals and ambulance trusts for some time and which proved helpful. If providers choose not to follow the principles set out in these specifications, they may find they need to create something similar locally.
Do they have the approval of the Care Quality Commission?
The Care Quality Commission are focussed more on outcomes that processes, which is to say they will expect to see clean and hygienic premises, how this is achieved will normally be of lesser importance. However, where they find standards do not meet their expectations then they are likely to require evidence to demonstrate how infection risks have been assessed and met. Having said that, the CQC have been involved in the development of these specifications and their comments incorporated. The same applies to the Department of Health.
How much will it cost to implement the specifications?
There will be a small, one-off cost in terms of staff time to undertake the risk assessments and devise appropriate cleaning frequencies. If existing cleaning services are fully meeting the requirements, then there should be no increase in costs although it may prove necessary to adjust frequencies for specific items/areas – i.e to clean some things more often and others perhaps less frequently. If as a result of undertaking the risk assessment process it is determined that additional cleaning resources are necessary then that is not a function of the specifications, rather it would be a recognition that existing cleaning services are not fully adequate.
What will happen if the specifications are not adopted?
As noted above, decisions relating to registration for delivery of regulated activities lie entirely with the Care Quality Commission. It is likely they may wish to see some form of documentary evidence setting out how providers meet the requirements of the relevant section(s) of the Health and Social Care Act 2008, and the Code of Practice which accompanies it, but they will not limit the ability of providers to determine for themselves what form that evidence should take. Not adopting the principles of these specifications will not, therefore, bring any sanction but as noted it will require providers to devise something locally to meet broadly the same conditions.