The newNational Standards of Healthcare Cleanliness 2021 harness “the ‘power ofpartnership’”, according to Emma Brookes, Head of Soft FM Strategy andOperations at NHS England and Improvement, for the first time formallymandating a collaborative approach across all relevant departments.
A muchneeded update on hospital cleaning standards was a top priority for Ms Brookeswhen she joined NHS England in 2017, leading her to set up a hugemultidisciplinary working group. Ms Brookes noted: “Cleaning is everyone’sresponsibility, not just the cleaner on the ward, [but] everybody from the CEOdown to the domestic member of staff — everyone needs to take a hand in howthis happens.”
Taking fouryears to complete, the project drew in input from around 50 individuals fromacross the NHS, including people from infection prevention and control,nursing, clinical and microbiological leads, the association of healthcarecleaning professionals (ACHP) and partner organisations such as the HealthEstates and Facilities Management Association (HEFMA), Public Health Wales andthe Health and Safety Executive (HSE).
The newstandards replace the 2007 National specifications for cleanliness in the NHSand the previous Healthcare cleaning manual (2013 revision) to reflect modernmethods of cleaning and infection prevention and control and other changes thathave taken place since 2007. Alongside enhanced collaboration, they have beendesigned to introduce more flexibility, be easier to use and provide efficacy,assurance of cleanliness, transparency of results and quality assurance througha three-stage audit process via a suite of documents: the standards themselves,appendices with attached tools on pest control and a new healthcare cleaningmanual. The new standards will make changes to infection control in NHShospitals such as pseudomonas infection NHS.
Although thenew standards have been criticised in some quarters, amendments have been madeto make them more relevant for primary care, for example.
Themandatory requirements can be summarised as follows:
Functional risk categories:
These havebeen increased from four to six, replacing the previous ‘very high risk’, ‘highrisk’, ‘significant’ and ‘low risk’ categories. The two new ratings have beenadded to provide flexibility across numerous different types of organisationsto address a longstanding criticism that the standards have been too focused onacute risk. Increasing the categories will allow organisations to place rooms,areas, departments and buildings in appropriate categories.
An optionalblended risk category allows an area to be split so that part of it iscategorised as ‘high risk’, while another section of the area is categoriseddifferently. However, an electronic audit system will be essential for keepingtrack of this arrangement.
Functionalrisk (FR)1 replaces the previous ‘very high risk’ category (98%); FR2 replaces‘high risk’ (95%); the new category FR3 equates to 90%; FR4 replaces‘significant risk’ at 85%; FR5 is a new category; while FR6, at 75%, replaces‘low risk’ and also covers a blended approach.
Not all categories will be suitable for all settings, however, in acute settings it is considered good practice to adopt all six functional risk categories.
Organisations are being asked to document how they have allocated categories to different spaces and are required to regularly review these decisions.
Elements, performance, analytical parameters and cleaning frequencies:
Once anorganisation has identified its FR categories it must produce a ‘cleaningspecification’ that includes a list of cleaning elements, performanceparameters and cleaning frequencies.
Elements: The list has increased from 49to 50 and organisations are free to add further elements. Elements that do notexist within an organisation do not have to be scored.
Performance parameters: these arethe expected standard of cleaning for each element, as previously.
Cleaning frequencies: thesehave always been broken down according to FR categories and remain similar towhat people have been used to doing.
Cleaning responsibilities: Thisis about ensuring that not only the staff, but also everyone around them in anorganisation, including patients, understands who is responsible for cleaning.
Emma Brookesexplained: “This has opened up an opportunity to do things differently ...Weknow that anything above ‘hand height’ is ‘hard FM’ and the responsibility ofEstates and Facilities....[Similarly] we have nursing responsibilities,domestic responsibilities and so on [so] let’s put the experts in charge ofcleaning things. We don’t go around putting cannulas into patients so perhapswe shouldn’t ask nurses to go round doing the expert part of the cleaning.[Cleaning’s still] always going to be a part of their job between patients.It’s not about absolving people from responsibility — it’s about putting theexperts in charge of what people should be doing.”
Audit frequency: similarto previously but with some additional frequencies — at two months and threemonths — to help space out audits and introduce flexibility for differentorganisations depending on the risk of any given area.
Star ratings: these areintended to demonstrate what is consistently done well. In fact, Emma Brookesnotes, cleaning scores tend to stay the same — it takes a major event, such asa change of use for a room, to move from a high score pass mark to a very lowone. The chances are that a ward with a four or five star cleaning rating willremain the same, unless a major incident takes place. In some instances thiswill not be an appropriate time to do a cleaning audit if something unusual hashappened, such as flooding.
Ultimately,the star ratings are designed for transparency and will be implemented verygradually. They will also be easier for patients to understand than theprevious percentage scores.
Efficacy audit: thisis a new requirement, which checks the efficacy of the cleaning process at thepoint of service delivery, such as the correct use of colour coding, equipment,materials and methodology. Previously, a technical audit was always followed bya managerial audit, which, essentially, repeated the supervisor audit. Thisdoubling up has now been removed on the basis that there should be confidencethat supervisors and cleaners are well trained enough to carry out a visualaudit.
Commitment to Cleanliness Charter: introducesflexibility. Rather than sticking to a highly specific schedule, need can beresponded to at any time while continuing to demonstrate a commitment tocleanliness and a clean and safe environment from everyone in an organisation,from the top down.
The Charterdisplays who is responsible for any task and the frequency of cleaning thatshould be expected.
Frequency gap analysis: documentswhether cleaning frequencies have increased, decreased or stayed the same.
To find outmore about the new National Standards of Healthcare Cleanliness – download yourfree copy of our Looking Deeper Journal here: https://www.idealspec.co.uk/resources/whitepapers.html