Policy for the Provision and Management of Cleaning Services

POLICY FOR THE PROVISION

AND MANAGEMENT OF CLEANING SERVICES

15 January 2015

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Policy for the Provision and Management of Cleaning Services

List of Contents

Page
Foreword
Executive Summary / 3
4
SECTION 1 – Introduction and Background / 5
Strategic Context / 6
Aims / 9
Scope / 9
Key Principles / 10
Equality Screening / 12
SECTION 2 – Developments since 2005 Strategy / 13
Impact and Implementation of the Cleanliness Matters Strategy / 14
Other Departmental Initiatives / 14
Recent Developments / 17
NHS Initiatives / 18
Regional Healthcare Hygiene and Cleanliness Audit Tool / 19
SECTION 3 – The Way Forward / 23
Finance and General Management / 24
Audit Approach / 27
Elements to be Assessed / 27
Training / 31
Design and Other Issues / 32
Multi Disciplinary Working / 32
Colour coding Hospital Cleaning Equipment / 32
Sharing Best Practice / 33
Association of Healthcare Cleaning Professionals / 33
SECTION 4 – Appendices / 34
Appendix 1 –Reference List / 35
Appendix 2 – EQIA Screening Template / 37
Appendix 3 – GLOSSARY / 47

Alternative Formats

Consideration will be given to any request to make this document available, in alternative formats - Braille, audio, large print, computer disk or as a PDF document. The Department will consider requests to produce this document in other languages. If the document is required in these or other formats please contact Investment Directorate:

Phone:028 9052 3246

Text Phone:028 9052 7668

Fax:028 9052 2500

Email:

Post:Investment Directorate

DHSSPS

Room D1.4 Castle Buildings

Belfast BT4 3SQ

Foreword

This policy sets out Policy for the Provision and Management of Cleaning Services in the Health and Social Care Sector.

The policy is a reinforcement and clarification of previous policy and entails adopting a risk based approach using National guidelines prepared by the National Patient Safety Agency and a Publicly Available Specification (PAS 5748) issued in 2011 by the British Standards Institution and sponsored by the Department of Health. This reflects discussions with cleaning service providers which suggests that, whilst it is important that Trusts locally produce a cleaning frequency schedule, a single regional version is inappropriate since it cannot meet every organisation’s needs. The precise allocation of resources, and the actual frequency of cleaning, will therefore vary according to locally determined need. The logistics of this are an operational matter for each Trust, but the expectation is that HSC Managers will carry out annual risk assessments and that these will then receive approval at Board level as part of an annual self assessment exercise. This complements and strengthens the main themes of the policy: provision of rigorous programme of auditing to monitor standards of cleanliness; and, corporate governance systems and procedures, to ensure that clear accountability and management arrangements flow down from HSC Trust Boards.

I am aware that PAS 5748 is currently being updated and Departmental officials have been part of the consultation process. Once this has been updated, it will be reviewed and promulgated to HSC bodies in due course.

I would like to acknowledge the contributions made by, and also to thank, the interested groups and individuals who have helped to inform and shape this Policy. It has benefited greatly from the outcomes of the public consultation and I know that there will continue to be ongoing engagement with key stakeholders as the Action Plan is rolled out.

Jim Wells MLA

Minister of Health, Social Services & Public Safety

Executive Summary

This policy sets out the Department’s commitment to maintaining and improving environmental cleanliness in Northern Ireland (NI).

It has been developed with the aim that best management practice, staff training and continued monitoring of performance will lead to services being maintained and improved in a challenging financial climate.

The detail of the policy is presented in the three sections which follow this executive summary.

Section 1 – Introduction and Background.This section sets out the aims, objectives and scope of the policy. It also sets out the key principles which should apply to cleaning services.

Section 2 – Developments since the launch of Cleanliness Matters Strategy in October 2005. This outlines events and progress since 2005 and indicates how these are shaping the proposed strategic direction.

Section 3 – The Way Forward. This section sets out the areas for attention over the coming years.

Section 4 – Appendices.

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Section One

Introduction and Background

Introduction

1.1Cleanliness is an integral part of healthcare services both in terms of safe treatment and quality of the environment. While there have been continuing issues with healthcare associated Infections (HCAIs), recent statistics demonstrate significant reductions in the rates of MRSA and Clostridium difficile infections. It is important to maintain the focus on cleanliness in this context.

1.2The thrust of this policy is: maintaining the momentum of the previous strategy; good management practice, and developing staff. However, the policy also reinforces work carried out by a Regional Hospital Hygiene and Cleanliness Group which developed a new set of standards and a self assessment audit tool for use by the HSC Trusts.

1.3This document is primarily aimed at cleaning in hospitals, but the principles are also relevant to the provision of cleaning services to patients and clients in other health service facilities such as, mental health and community facilities. The policy should be considered in any context where people using the health service receive cleaning services.

Strategic Context

1.4Providing a clean, safe environmentfor healthcare is a key priority for Trusts, and is a core standard in “Standards for better health” (see Appendix 1 for link). Other publications such as “Towards cleaner hospitals and lower rates of infection” (see Appendix 1 for link)and “A Matron’s Charter: An action Plan for Cleaner Hospitals”(see Appendix 1 for link) have further emphasised this, and also recognise the role cleaning has in ensuring that the risk to patients from healthcare associated infections is reduced to a minimum.

1.5In the NHS, the Clean Hospitals Programme (in 2000) led to a series of initiatives which aimed to improve the patient environment and standards of infection prevention and control. Given increasing public awareness and concern about healthcare associated infection (HCAI), cleanliness gained recognition as being a key element in the provision of safe and high quality care, as opposed to a support service.

1.6In Northern Ireland, the requirement to market test support services was abolished in 2001 and there was gradual movement back to in-house provision of services. HSC bodies wished to promote the advantages of integrating domestic services into care teams.

1.7In response to GB initiatives, in October 2005 the DHSSPS issued “Cleanliness Matters - A Regional Strategy for Improving the Standard of Environmental Cleanliness in HSS Trusts 2005-08” (see Appendix 1 for link). The Strategy was developed with a multi-disciplinary Environmental Cleanliness Consultative Reference Group, which was largely drawn from Health & Social Services (HSS) Trusts.

1.8The Strategy was accompanied by the “Cleanliness Matters Toolkit -Practical Guidance for Assessment of Standards of Environmental Cleanliness in HSS Trusts” (The Toolkit), and an Environmental Cleanliness Controls Assurance Standard (see Appendix 1 for link). These two documents reflected the main themes of the Strategy: a rigorous programme of auditing to monitor standards of cleanliness; and, corporate governance systems and procedures to ensure that clear accountability and management arrangements flow down from Trusts’ Boards.

1.9Hospital cleanliness continues to receive a high level of interest from the public; the media and politicians alike. Improving and sustaining levels of environmental cleanliness in hospitals is important if the Health & Social Care sector is to retain public confidence, make a significant impact on reducing HCAIs and improve the overall quality of care and patient experience.

1.10The Regulation and Quality Improvement Authority (RQIA) undertook a programme of unannounced hygiene inspections in hospitals, following the launch on 23 January 2008 of a package of new initiatives aimed at tackling HCAIs.

1.11Significant reductions in MRSA and Clostridium difficile infections were highlighted, and examples of real improvement were provided in the RQIA reports. However, the RQIA reports also recorded areas of poor performance in some Trusts.

1.12In November 2009, further work was undertaken to drive up hygiene and cleanliness standards in hospitals and other healthcare facilities. This was in response to the publication of several reports of unannounced inspections by RQIA which showed significant non-compliance and highlighted the need for improvement.

1.13The Regulation & Quality Improvement Authority (RQIA) conducted an independent review which was commissioned by the Minister for Health, Social Services and Public Safety, following the serious outbreak and tragic deaths of babies from Pseudomonas. The final report was published on 31 May 2012 (see Appendix 1 for link)

1.14The Interim report of the RQIA Independent Review of incidents of Pseudomonas aeruginosa infection in neonatal units in NI, was published on 31 March 2012. The report highlighted learning for all organisations involved and made 15 recommendations for action to the Minister for Health, Social Services and Public Safety. One of the recommendations related to cleaning of sinks and taps. New standard guidance was developed for NI and issued on 31 May 2012 (see Appendix 1 for link).

1.15During the second stage of this review, the governance arrangements and the effectiveness of communications in relation to the pseudomonas incidents were reviewed.

Aims

1.16The aims of the policy are as follows:

  • To ensure high quality cleaning services are provided in a manner which meets all current best practice, regulations and legislation.
  • To ensure that best use is made of available resources.
  • To ensure staff receive training in order to help them perform as effectively as possible and to encourage personal development.
  • To modify the audit arrangements introduced by the Strategy and Toolkit in 2005.
  • To ensure that managers adopt the standards and tool developed by the Regional Hospital Hygiene and Cleanliness Group.
  • To ensure that Trusts’ Boards continue to monitor the quality of provision of cleaning.
  • Environmental cleanliness is a multi-disciplinary responsibility requiring Professionals from all disciplines to work together to achieve the highest standards of cleaning, hygiene, infection prevention / control and auditing. The logistics of this are an optional matter for each Trust.

Scope

1.17This policy applies to all staff. It applies particularly to all staff involved in the provision of services which improve environmental cleanliness, hygiene, infection prevention / control and auditing or with responsibility for providing a clean and safe environment for patients and visitors.

Key Principles

1.18This document sets out the Department’s policy for the future development and delivery of cleaning services. The principles underpinning the development of this policy include:

Quality

1.18.1Trusts must continue to monitor cleanliness through implementation of appropriate audit and reporting procedures. Audit procedures should be reviewed and take account of local circumstances and the Regional Healthcare Hygiene and Cleanliness Tool (see Appendix 1 for link). Standards of environmental cleanliness should be maintained and improved in accordance with the goals and objectives set out in “Quality 2020 – A 10-Year Strategy to protect and improve quality in health and social care in Northern Ireland” (see Appendix 1 for link).

1.18.2Trusts must deliver cleaning services to the standards set out in the Regional Hospital Hygiene and Cleanliness Standards and supporting standards (see Appendix 1 for link).

Training

1.18.3It is recognised that all staff associated with cleaning services must be competent and appropriately trained to a standard commensurate with their role and duties. An example of appropriate training for supervisors and basic grade cleaning staff is the Cleaning Professional Skills Suite (CPSS) of the British Institute of Cleaning Sciences (BICSc).

Efficiency

1.18.4Compliance with agreed standards of cleanliness, hygiene and auditing is an operational matter for each Trust. Trust Managers should implement best professional management practice and review cleaning frequencies, work schedules and budgets; this includes reviewing what is cleaned, how it is cleaned, how often it is cleaned and assessing risk.

1.18.5Trusts must carry out an annual self-assessment of the management of cleaning services including a review of cleaning plans, resources and audit scores.

Multi Disciplinary Working

1.18.6Trust staff from different disciplines must work together to ensure the best possible standards of environmental cleanliness and hygiene.

Governance and Accountability

1.18.7Trusts should ensure that arrangements recommended in Cleanliness Matters, the Regional Healthcare Hygiene and Cleanliness Standards and the DHSSPS Environmental Cleanliness Controls Assurance Standard are maintained. These arrangements include:

  • Definitions of roles, responsibilities and accountability.
  • Reporting to Trusts’ Management Boards on performance.
  • Creation of a multi-disciplinary group within each Trust which is charged with taking forward the local environmental cleanliness strategy.

1.18.8The leading role of Ward Managers / Ward Sisters / Charge Nurses should be recognised, and authority over cleaning services at ward level should be delegated to an appropriate person within each facility who should have the capacity to raise any cleanliness issues with the Cleaning Manager, and responsibility for appropriate escalation / risk management.

Patient, Visitor and Staff Participation

1.18.9Patients, visitors and staff must be involved in the planning, delivery and audit of cleaning services and Trusts must engage with patients, visitors and staff, and use regular surveys on the services provided.

Equality Screening

1.19Section 75 of the NI Act 1998 requires all public bodies in carrying out their functions relating to NI to have due regard to the need to promote equality of opportunity between:

  • Persons of different religious belief, political opinion, racial group, age, marital status or sexual orientation;
  • Men and women generally;
  • Persons with a disability and persons without; and
  • Persons with dependants and persons without.

1.20In addition, without prejudice to the above, public bodies must also in carrying out their functions relating to NI, have regard to the desirability to promote good relations between persons of different religious beliefs, political opinion or racial group.

1.21DHSSPS has carried out an initial screening of this policy and determined that a full Equality Impact Assessment is not required. A summary of the screening is contained in Appendix 2. If you consider that this decision is not correct please let us know why. Please provide details of any action(s) you need including any supporting evidence that you may have.

Section Two

Developments since the issue of the Cleanliness Matters Strategy in October 2005

Impact and Implementation of the Cleanliness Matters Strategy

2.0Cleanliness Matters and the associated controls assurance standard imposed significant new requirements; a rigorous audit regime and corporate governance procedures. Despite initial concerns by Trusts about the workload implications, the benefits were soon recognised. For example:

  • Accountability requirements brought cleanliness to the attention of Trusts’ Boards and highlighted risk and funding issues.
  • Audit processes clarified the respective responsibilities of nursing; estates and domestic services; facilitated cross-disciplinary working, and made it clear that cleanliness was not just a domestic services issue.
  • The scoring process brought about a sharper focus on performance and associated issues, including estate condition.
  • Trusts have reported that including estates conditions in the scoring process has been helpful in the speedier identification and rectification of estates issues.

Other Departmental Initiatives

2.1It is now accepted by Trusts that regular auditing is an essential element of maintaining and improving standards of cleanliness. Similarly, the governance aspects reflected in Cleanliness Matters and the Controls Assurance Standard are now embedded in the culture of health and social care bodies.

2.2After the launch of Cleanliness Matters, the Department commissioned an independent assessment of environmental cleanliness which was carried out by KPMG in early 2006. This produced mixed results. One of the difficulties was that the basis of assessment was (and still) is, public perception of an element, as opposed to how well it has been cleaned. Consequently, in older hospitals, poor scores frequently reflected the age and condition of the estate as opposed to poor cleaning performance. It was also recognised that the design of older buildings may make cleaning more difficult. A follow up audit by KPMG in late 2007 revealed a significant improvement, suggesting that Cleanliness Matters was having a positive impact.

2.3The Ward Sisters’ Charter which was launched in October 2006, encouraged Ward Managers to take responsibility for ensuring that high standards of cleanliness are maintained. This was consistent with the principle in Cleanliness Matters, that cleanliness is everyone’s responsibility, not just the responsibility of the cleaners.

2.4After the restoration of devolved government in 2007, healthcare associated infection (HCAI) became a major issue in healthcare and attracted continued media and MLA attention. While cleaning performance was generally not subject to criticism, the perceived association between HCAI and cleaning ensured that cleanliness standards remained a key issue. The Department produced HCAI action plans in 2006 and 2010 which acknowledged the role of environmental cleanliness but did not introduce significant new requirements on domestic services departments or change any of the principles or elements of Cleanliness Matters.

2.5In particular, there was intensive media coverage of the outbreak of the Clostridium difficile (C diff) infection that occurred in Northern Health and Social Care Trust (NHSCT) hospitals between June 2007 and August 2008. The RQIA carried out an independent review of the outbreak, and in their final report, two of the recommendations (Rec. 7 and 14) are of relevance to this policy:

  • Recommendation 7 -Consideration should be given to undertaking a baseline review of cleaning arrangements against current standards and methodologies.
  • Recommendation 14 -Trusts should review their ward environments to ensure that there is no impediment to safe, cleaner, tidier patient areas.

The Public Inquiry, which was launched in 2009, was asked to establish how many deaths occurred in the Northern Health and Social Care Trust hospitals during the outbreak, for which C difficile was the underlying cause of death, or was a condition contributing to death. It was also asked to report on the experiences of patients and others who were affected directly by the outbreak.