document

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: Cleaning Policy Document number: 1 Author: Jenny Scholefield Contributors: Version: 0.4 Date of Production: March 2009 Review date: March 2012 Postholder responsible for revision:

Hotel Services Manager

Primary Circulation List: Web address: Restrictions: Standard for Better Health Map Domains: First: Safety and

Sixth: Care Environment and Amenities Core Standard Reference: C4a C21 Performance Indicators: 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. Introduction 4 2. Associated Policies and Procedures 5 3. Aims and Objectives 5 4. Scope of the Policy 5 5. Accountabilities and Responsibilities 6 6.1 Risk Assessment Protocols 14 6.2 Standards 16 6.3 Colour Coding 17 6.4 Cleaning Methods 17 6.5 Cleaning Response Times 17 6.6 Spot Cleaning Spillages 17 6.7 Body Fluid Spills 17 6.8 Management of Cleaning Contractors 18 6.9 Requests For Additional Cleaning 19

6.10 Cleaning and evaluation of standards of cleanliness following maintenance, refurbishment, flood, building

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7. Equality Impact Assessment 20 8. Training Needs Analysis 20 9. Monitoring Compliance with this Policy 20 10. References 21 11. Appendices 22

Appendices

A Summary of relevant legislation and guidance documents for Managing Cleanliness in Healthcare Premises

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B Key Stakeholders Consulted/involved in the development of the policy

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C Equality Impact Assessment Tool 29 D Element Standards 28 E Cleaning Procedures Guidance 34 F Cleaning Frequencies 35 G Performance Parameters for managing Cleaning

Contractors 39

H National Specification for Cleanliness Audit Tools 40 I Response Times and Rectification 40 J Definitions 41

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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) Contributing to and supporting the Trust Health Care Associated Infections (HCAI) control mechanisms; b) 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 Re-usable 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) Items Frequency

AU = after use D = daily W = weekly

Method (see procedures Appendix E)

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

Comments

Patient equipment (medical) IV stand W Detergent wipes H/C staff Include

wheels IV pumps /syringe drivers

W Detergent wipes H/C staff Cleaned by med phys after repair

Cardiac monitors

D and AU Detergent wipes H/C staff Cleaned by med phys after repair

Blood gas machines

W Alcohol wipes H/C staff Cleaned by med phys after repair

Dressings trolleys

W Detergent wipes H/C staff Include wheels

Linen trolleys

W and AU Detergent wipes H/C staff Include wheels

Tea trolleys W and AU Detergent wipes H/C staff Include wheels

Notes trolleys


Drugs trolleys


Sharps bin trolleys

W and AU Detergent wipes H/C staff Include wheels

Blood pressure cuffs

D and AU Alcohol wipes H/C staff Cleaned by med phys after repair

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Cleaning responsibility framework Items Frequency



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

Comments

Patient equipment (medical) Pillows AU Det/water/bowl/di

sposable cloths H/C staff

Mattresses AU Det/water/bowl/disposable cloths

H/C staff

Cotsides AU Det/water/bowl/ disposable cloths

H/C staff

Wheelchairs W Det/water/bowl/ disposable cloths

H/C staff

Public wheelchairs

W Det/water/bowl/ disposable cloths

H/C staff

Commodes D Det/water/bowl/ disposable cloths

H/C staff

Cushions AU Detergent wipes H/C staff Oxygen sat probes

AU Detergent wipes H/C staff

Wash bowls AU Det/water/bowl/ disposable cloths

Domestic (TBC)

Pressure relieving mattress

AU Det/water/bowl/ disposable cloths

H/C staff

Hoists D Det/water/bowl/ disposable cloths

H/C staff

Pat slides AU Det/water/bowl/ disposable cloths

H/C staff

Easy slides AU Det/water/bowl/ disposable cloths

H/C staff

Hoist slings AU Detergent wipes H/C staff Stands aids D Det/water/bowl/

disposable cloths Domestic (TBC)

Handling belts


Resuscitation trolleys

D Detergent wipes Det/water/bowl/ disposable cloths

H/C staff

Larying handles

D and AU Detergent wipes H/C staff

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

Comments

Patient equipment (medical) continued Oxygen/suction equipment

D and AU Detergent wipes H/C staff Cleaned by medical phys after repair

Oxygen/suction equipment (portable)

W Detergent wipes H/C staff Cleaned by medical phys after repair

Wall humidifiers

AU Detergent wipes H/C staff Cleaned by medical phys after repair

Portable nebulisers

W and AU Detergent wipes H/C staff Cleaned by medical phys after repair

Ventilator equipment

D and AU Detergent wipes H/C staff Cleaned by medical phys after repair

Catheter stands

W and AU Washer disinfector

H/C staff

Bed pans/holders

AU Washer disinfector

H/C staff

Slipper pans AU Washer disinfector

H/C staff

Urine bottles AU Washer disinfector

H/C staff

Urine jugs AU Washer disinfector

H/C staff

Raised toilet seats

D Det/water/bowl/ Disposable cloths

Domestic (TBC)

Scanners D and AU Detergent wipes H/C staff Medical physics

Scales W and AU Det/water/bowl/ Disposable cloths

H/C staff

Gas cylinder holders

AU Detergent wipes Porters (TBC)

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

Comments

Patient equipment (medical) continued Tower balconies

W Det/water/bowl/ Disposable cloths

Estates

Traction beams

D and AU Det/water/bowl/ Disposable cloths

Domestic (TBC)

Thomas splints


Monkey poles AU Detergent wipes H/C staff Weights AU Detergent wipes H/C staff Braun frames AU Detergent wipes H/C staff General / media equipment TVs W Det/water/bowl/

Disposable cloths Domestic

Hi-Fis W Detergent wipes Domestic Telephones D Detergent wipes Domestic Computer/keyboards

W Detergent wipes Users

Printers W Detergent wipes Users Fax W Detergent wipes Users Audio/visual systems

D Detergent wipes Users

Photo-copiers M Detergent wipes Users Screens W Detergent wipes Domestic CCTV equipment

M Detergent wipes Users

OHPs M Detergent wipes Domestic Flip charts M Detergent wipes Domestic Accessories ie. Staplers, in trays, hole punchers

M Detergent wipes Users

Loan equipment: ie heaters

AU Detergent wipes Estates

Hand cleaning holders

D Detergent wipes Healthcare staff

Alcohol rub/hibiscrub

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

Comments

Ward / staff equipment Pest control devices

W Detergent wipes Contractor

Recycling bins

W Detergent wipes Domestic

Drugs cupboards

W Detergent wipes H/C staff

Drugs fridges W Det/water/bowl/ Disposable cloths

H/C staff

Bed pan washer


H/C staff

Macerators W Det/water/bowl/ Disposable cloths

H/C staff

Isolation trolleys

D Alcohol wipes H/C staff Include wheels

Fridges/ freezers


Domestic (exc catering areas)

Cookers W Det/water/bowl/ Disposable cloths


Microwaves W Det/water/bowl/ Disposable cloths


Toasters W Detergent wipes Domestic (exc catering areas)

Ice machines W Det/water/bowl/ Disposable cloths

H/C staff

Kettles W Detergent wipes Domestic Kitchen cupboards

D Det/water/bowl/ Disposable cloths


Milk fridges W Det/water/bowl/ Disposable cloths


Users to clean spillages as they occur. Catering staff for catering areas. Refer to cleaning manuals.

Crockery AU Dishwasher Catering staff Users in staff areas

Cutlery AU Dishwasher Catering staff Users in staff areas

Water boilers W Det/water/bowl/ Disposable cloths


Water coolers W Det/water/bowl/ Disposable cloths

Domestic

Dishwashers W Det/water/bowl/ Disposable cloths

Catering staff

Catering staff for catering areas

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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 National

Specifications for Cleanliness 2007 Risk category

Almondbury Clinic HD5 8UU Significant risk Ground floor: Low risk

Batley HC WF17 8DQ Significant risk Top floor low risk

Beckside Court WF17 5PW Low risk Broughton House WF17 5QT Significant risk Cleckheaton HC BD19 5AN Significant risk

Admin 1st low risk Dewsbury HC WF13 1HY Significant risk Eddercliffe IC WF15 6LP Significant risk Fartown HD2 2QA Significant risk

1st floor low risk Golcar Clinic HD7 4AR Significant risk

1st floor low risk Holme Valley memorial Hospital

High risk, significant and low risk areas

Keldergate HD2 1LE Significant risk Liversedge Health Centre WF15 6DF Significant risk Marsden HC HD7 6DF Significant risk Mill Hill ComHC HD5 9TS Significant

1st floor low risk Moorfield Clinic HD4 5RX Significant risk DRAM Safe Haven (Mouldgreen)

HD5 9BU Closing

New Brewery Lane WF12 9DZ Significant risk Princess Royal Com HC Significant risk

admin: low risk Ravensthorpe HC WF13 3JY Significant risk Ringway Comm Store HD1 5JU Low risk Saviletown WF12 9JR Significant risk Shaw Cross Clinic WF12 7HP NA Skelmanthorpe HC HD8 9DA Significant risk Slaithwaite HD7 5AB Significant risk Thornton Lodge Clinic HD4 5RQ Significant risk

1st floor low risk Whitehouse Clinic HD1 5JU Significant risk Woodkirk House walk in centre

WF13 4HS 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

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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;

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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)

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c. 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;

d. 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;

e. There is adequate provision of suitable hand washing facilities and antibacterial hand rubs;

f. There are effective arrangements for the appropriate decontamination of instruments and other equipment;

g. 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

h. 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;

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- 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.

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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

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27

Stakeholders name and designation Key

Participant Yes/No

Feedback requested

Yes/No

Feedback accepted Yes/No

Joan Booth, Head of Localities Yes Yes Keith Geldard, Estates Manager Yes Yes David Henwood, Assistant Director, Estates and Facilities Yes Yes

Pam Lumb, Head of Therapies Yes Yes Bryan Machin, Director of Finance Yes Yes Jane O’Donnell, Deputy Director Infection Control Yes Yes Pat Patrice, Head of Corporate Governance and Services Yes Yes

Jenny Scholefield, Hotel Services Manager Yes Yes Julia Calcraft, Locality Manager, HVMH Yes Yes Policy Development Group Yes 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 Comments

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 travellers)

NO

• Nationality NO

• Gender NO

• Culture NO

• Religion or belief NO

• Sexual orientation including lesbian, gay and bisexual people

NO

• Age NO

• Disability - learning disabilities, physical disability, sensory impairment and mental health problems

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

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 1. Commodes All parts including underneath should be visibly

clean with no blood and body substances, dust, dirt, debris or spillages.

2. Bathroom hoists As above 3. Weighing scales, manual handling equipment

As above

4. Drip stands As above 5. Other medical equipment NOT connected to a patient, e.g. intravenous infusion pumps drip stands and pulse oximeters

All parts including underneath should be visibly clean with no blood and body substances, dust, dirt, debris or spillages.

6. Medical equipment connected to a patient, e.g. intravenous infusion pumps drip stand and pulse oximeters

All parts including underneath should be visibly clean with no blood and body substances, dust, dirt, debris or spillages.

7. Patient washbowls All parts including underneath should be visibly 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.

9. Patient fans All parts including the blades/fins and the underside should be visibly clean with no blood and body substances, dust, dirt, debris or spillages.

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

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.

11. Notes and drugs trolley

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

12. Patient personal items eg. cards and suitcase

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.

13. Linen trolley All parts including underneath of the linen trolley should be visibly clean with no blood and body substances, dust, dirt, debris or spillages

Fixed assets Element Standard 14. Switches, sockets and data points

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

15. Walls All wall surfaces including skirting should be visibly clean with no blood and body substances, dust, dirt, debris, adhesive tape or spillages

16. Ceiling All ceiling surfaces should be visibly clean with no blood and body substances, dust, dirt, debris, adhesive tape or spillages

17. All doors 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

18. All internal glazing including partitions

All internal glazed surfaces should be visibly clean and smear-free with no blood and body substances, dust, dirt, debris, adhesive tape or spillages.

19. All external glazing All external glazed surfaces should be clean.

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Element Standards 20. Mirrors Mirrors should be visibly clean and smear free with

no blood and body substances, dust, dirt, debris, adhesive tape or spillages

21. Bedside patient TV including earpiece for bedside entertainment system

All parts of the bedside TV should be visibly clean with no blood and body substances, dust, dirt, debris, adhesive tape or spillages.

22. Radiators 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.

23. Ventilation grilles extract and inlets

The external part of the ventilation grille should be visibly clean with no blood and body substances, dust, dirt, debris or cobwebs.

Hard floors Element Standard 24. Floor-polished

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.

25. Floor – non slip 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.

Soft floors Element Standard 26. Soft floor 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.

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Element Standards FIXTURES

Electrical fixtures and appliances Element Standard 27. Pest control devices The pest control device should be free from dead

insects, animals or birds and be visibly clean. 28. Electrical items The casing of electrical items should be visibly

clean with no blood and body substances, dust, dirt, debris or adhesive tape.

29. Cleaning equipment Cleaning equipment should be visibly clean with no blood and body substances, dust, dirt, debris or moisture.

Furnishings and fixtures Element Standard 30. Low surfaces All surfaces should be visibly clean with no blood

and body substances, dust dirt, debris, adhesive tape or spillages.

31. High surfaces All surfaces should be visibly clean with no blood and body substances, dust dirt, debris, adhesive tape or spillages.

32. Chairs All parts of the furniture should be visibly clean with no blood and body substances, dust dirt, debris, adhesive tape or spillages.

33. Beds 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.

34. Lockers 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.

35. Tables 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.

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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 rub dispensers

All parts and surfaces of the hand hygiene alcohol rub dispensers should be visibly clean with no blood and body substances, dust dirt, debris, adhesive tape or spillages. Dispensers should be kept stocked.

38. Waste receptacles The waste receptacle should be visibly clean 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.

39. Curtains and blinds Curtains/blinds should be visibly clean with no blood and body substances, dust, dirt, debris, stains or spillages.

Kitchen fixtures and appliances Element Standard 40. Dishwashers Dishwashers should be visibly clean with no blood

and body substances, dust dirt, debris, stains, spillages or food debris.

41. Fridges and freezers Fridges and freezers should be visibly clean with no blood and body substances, dust dirt, debris, spillages, food debris or build up of ice.

42. Ice machines and hot water boilers

Ice machines and hot water boilers should be visibly clean with no blood and body substances, dust, dirt, debris, or spillages.

43. Kitchen cupboards Kitchen cupboards should be visibly clean with no blood and body substances, dust dirt, debris, stains, spillages or food debris.

44. Microwaves All microwave surfaces should be visibly clean with no blood and body substances, dust dirt, debris, spillages or food debris.

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Element Standards Toilets, sinks, wash hand basins and bathroom fixtures Element Standard 45. Showers The shower, wall attached shower chairs should be

visibly clean with no blood and body substances, scum, dust, lime scale, stains, deposit or smears.

46. Toilets and bidets The toilet and bidet should be visibly clean with no blood and body substances, scum, dust, lime scale, stains, deposit or smears.

47. Replenishment There should be plenty of all consumables and soap.

48. Sinks The sink and wall attached dispensers should be 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.

49. Baths The bath should be 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.

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.

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

Minimum cleaning frequencies Element High risk Significant risk Low risk Clean contact points after each

use 1 Commodes, weighing

scales, manual handling equipment; One full clean daily

NA

2 Bathroom hoists 3 Weighing scales,

manual handling equipment

NA

4 Drip stands

Clean contact points after each use

NA 5 Other medical

equipment eg. Intravenous infusion pumps, pulse oximeters etc NOT CONNECTED TO PATIENT

6 Other medical equipment eg. Intravenous infusion pumps, pulse oximeters etc CONNECTED TO PATIENT

7 Patient washbowls

One full clean daily and between patient use

8 Medical gas

equipment One full clean daily

9 Patient fans One full clean daily and between patient use. Quarterly full clean.

Case daily. Full clean quarterly.

10 Bedside alcohol hand wash container, clipboards & noticeboards

One full clean daily and between patient use

11 Notes and drug trolley One full clean weekly 12 Patient personal

items eg cards, suitcase

One full clean daily NA

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Cleaning Frequencies Minimum cleaning frequencies Element

High risk Significant risk

Low risk

13

Linen trolley Contact points clean daily One full clean weekly

14

Switches, sockets & data points

One full clean daily One full clean weekly

One check clean daily

Check clean weekly

Full clean weekly (dust only)

Dust monthly

Check clean weekly

15

Walls

Full wash yearly Washing every 3yrs

One full clean monthly (dust only) 1 check dust monthly

16

Ceiling

One full washing yearly Washing 3 yearly 17

All doors One full clean daily One full clean weekly

One check clean daily 18

All internal glazing inc. partitions One full clean weekly

One full clean weekly

19

All external glazing

One full clean every 3 months

20

Mirrors One full clean daily One full clean weekly

21

Bedside patient TV

NA

22

Radiators

One full clean daily

One full clean monthly

23

Ventilation grilles extract and inlets

One full clean weekly

One full clean monthly

Dust removal one full clean daily + 1 check clean daily

Dust removal daily

Dust removal 1 full clean weekly + 1 check clean weekly

Wet mop one full clean daily + 1 check clean daily

Wet mop daily

Wet mop 1 full clean weekly + one check clean weekly

Machine scrub clean weekly

Machine scrub clean monthly

Machine clean quarterly

24

Floor-polished

Strip & reseal yearly Strip & reseal twice yearly

36

Cleaning Frequencies Element Minimum cleaning frequencies High risk Significant

risk Low risk

Dust removal one full clean daily + 1 check clean daily

Dust removal daily

Dust removal 1 full clean weekly + 1 check clean weekly

Wet mop one full clean daily + one check clean daily

Wet mop daily

Wet mop one full clean weekly + 1 check clean weekly

25

Floor non-slip

Machine clean weekly

Machine clean monthly

Machine clean quarterly

1 full clean daily + 1 check clean daily

1 full clean daily

1 full clean weekly + 1 check clean weekly

26

Soft floor

Shampoo 6 monthly

Shampoo 12 monthly

Shampoo twice yearly

Dust removal one full clean daily 27

Pest control devices Full clean monthly

Dust removal 1 full clean daily Dust removal 1 full clean weekly

28

Electrical items

Full clean monthly Full clean quarterly29

Cleaning equipment

Full clean after each use

30

Low surfaces 1 full clean daily +1 check clean

1 full clean daily

1 full clean weekly

31

High surfaces 1 full clean weekly + 1 check clean weekly

1 full clean weekly

32

Chairs 1 full clean daily + 1 check clean daily

1 full clean daily

1 full clean weekly

Frame daily Under weekly

33

Beds

Whole on discharge

NA

34

Lockers 1 full clean daily + 1 check clean daily

NA

35

Tables 1 full clean daily + 2 check cleans daily

1 full clean daily

1 full clean weekly

36

Hand wash containers

37

Hand hygiene/alcohol rub dispensers

Daily NA

37

Cleaning Frequencies Minimum cleaning frequencies Element High risk Significant

risk Low risk

1 full clean daily & 1 check clean daily

1 full clean daily 38

Waste receptacles

One deep clean weekly Clean, change or replace yearly or

as soiled 39

Curtains and blinds

Bed curtain change 6 monthly

Bed curtains replace 12 monthly

Clean, change or replace twice yearly

40

Dishwasher 1 full clean daily + 2 check cleans daily

1 full clean daily

3 check cleans daily 1 check clean daily 1 full clean weekly (remove all contents to clean)

41

Fridges and freezer

Defrost monthly 1 daily check clean 4

2 Ice machines and hot water boilers 1 full clean weekly

NA

43

Kitchen cupboards

1 full clean weekly 1 full clean monthly

1 full clean quarterly

44

Microwaves 1 full clean daily and 2 check cleans daily

45

Showers 1 full clean daily & 1 check clean

46

Toilets and bidets 2 full cleans daily & 1 check clean daily

1 full clean daily

47

Replenishment 3 times daily Once daily

48

Sinks 2 full cleans daily & 1 check clean daily

49

Baths 1 full clean daily + 1 check clean daily

1 full clean daily

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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.

SP02 Reactive Cleaning is undertaken at frequencies agreed and stated in Table 2 (see Appendix F)

SP03 Planned cleaning is undertaken at frequencies agreed and stated in Table 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.

SP06 All evidence of pests and pest excreta are promptly reported to the Helpdesk, all pest contaminated areas cleaned and disinfected as agreed.

SP07 Waste is collected, bagged and stored in accordance with the Waste Management Service Level Specification.

SP08 Deep clean of rooms is performed as scheduled in agreement with the Trust

SP09 All internal and external windows are cleaned in accordance with agreed schedules and standards in Appendix A, D and F.

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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 Treatment rooms Consulting rooms Clean and Dirty Utility Rooms Public thoroughfares WCs Kitchens

3 Low Risk Administrative Areas Reception

4 Minimal Risk Store Rooms Plant rooms External surrounds

Table 4: Response Requirements Response Category

Response time during normal hours

Response time outside normal hours

Rectification Time

EMERGENCY 40 minutes (Dewsbury 10 minutes)

2 hours 12 hours

URGENT 40 minutes (Dewsbury 10 minutes

2 hours 24 hours

ROUTINE 4 hours 4 hours 36 hours

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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.

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document

Documents

cleaning methods

additional cleaning

cleaning response times

e cleaning procedures

f cleaning frequencies

spot cleaning spillages

health outcomes

policy statement nhs