Best Practices for Environmental Cleaning

Module 6 - Audit

Learning Objectives

1. To explain the purpose and function of an audit.

2. To describe the audit process.

3. To apply identified tools in a practice setting.

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Why audit?

• Cleaning is an essential part of reducing healthcare acquired infections

• Just because it looks clean, doesn’t mean it is clean

• Objective measurement that can be used as a quality indicator

• If it can’t be measured it can’t be improved (Carling)

• Feedback of results will occur

3

Why audit?

• Transparent process

• Highlights areas of good performance – identifies a job ‘well done’

• Identifies opportunities for improvement

• Identifies deficiencies in building/equipment

• Ensures consistency between staff and areas

4

Types of audit

• Direct observation

Visual assessment

Observation of performance

• Indirect observation

Patient/resident satisfaction surveys

• Measurements of cleanliness

Environmental cultures

ATP bioluminescence

Environmental marking

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You cannot tell by looking…

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You cannot tell by looking…

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Learning Checkpoint

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Learning Checkpoint

• Which of the following are reasons for auditing.

a) Cleaning is an essential part of reducing healthcare associated infections

b) Highlights good performance

c) Just because it looks clean doesn’t mean it is clean

d) Allows staff to receive feedback on cleaning

1) a, c, d

2) a, b, c

3) b, c, d

4) All of the above

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Learning Checkpoint answer

• Correct answer is 4 – All of the above

• Each of these is an important reason for auditing.

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Roles in the audit process

• Self-evaluation

• Environmental Services staff member

• Supervisor

• Coaching to improve practice

• 3rd party auditor – public health

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Roles in the audit process

• Joint ‘walkabouts’ ES staff

ES & Infection Prevention & Control

Other combinations (e.g. clinical personnel)

• Hotel clean vs hospital clean audits – difference in expectations

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The audit process

• Standardized approach

• Checklist will be used

• Done over time – all departments audited

• Feedback will be given to staff on scoring

• Part of quality improvement cycle

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Apply identified tools in a practice setting

• A number of tools are available for auditing

• Visual assessment quantifies whether or not dust, debris or soil are present

Rating is an average of the number of items inspected and those meeting the criteria

Hotel clean – 80% acceptable

Hospital clean – 100%

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Apply identified tools in a practice setting

• Observations of performance utilize a checklist for an objective review

• Advantages are:

Ease of implementation and maintenance

Cost-effective

Results are meaningful

Provides an opportunity for staff involvement

May assist in reducing HAIs over time

• Disadvantages are:

Labour intensive

Might be impacted by Hawthorne effect

15

Apply identified tools in a practice setting

• Patient/Resident/Client Satisfaction Surveys

Indication of how people see the services that are provided

Not indicative of the services that are provided – subjective evaluation

If surveys are used response must: Be measured (i.e. yes/no)

Have a benchmark that is used for comparison

Have a standardized delivery system

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Apply identified tools in a practice setting

• Environmental culture

Not generally recommended

Presence of microorganism does not mean resident/patient infection

If used consider: Do not do random, undirected sampling of air, water and

environmental surfaces

Conduct only as part of an epidemiologic investigation or to assess hazardous environmental conditions

Limit sampling to biological monitoring of sterilization processes, water and dialysate in haemodialysis, or short-term to measure impact of infection prevention measures

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Apply identified tools in a practice setting

• ATP bioluminescence

Requires specialized equipment

Quantitative method

ATP is a chemical substance present in all living cells

Detection indicates that organic material still present

Can be used to provide instant feedback on surface cleanliness, demonstrate deficiencies in cleaning protocols and techniques to staff

May also use in evaluating new cleaning methods (i.e. steam, microfibre cloths)

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Apply identified tools in a practice setting

• Environmental marking

Measures thoroughness of cleaning using a marking system

Involves use of a colourless solution applied to objects in the environment prior to cleaning followed by detection of residual marker after cleaning

Solutions used must be environmentally stable, quick drying, easily removed with cleaning, and invisible in regular room light

Marker should be applied to high-touch surfaces

May be used to assess routine cleaning on a daily basis or vacancy cleaning

Must be quantified by: Calculating percentage of marked object cleaned in the area or

Deriving a cleaning score based on amount of fluorescence

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When you return to your job, what will you do differently as a result of this session?

2020

Thank You!Thank You!

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Image Sources – Module 6

• Microsoft Office Clipart used in slides 7 & 8

• Images in slides 6 & 7 are © PHO 2013