2007 national spec for cleanliness in the nhs

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The national specifications for cleanliness in the NHS:

a framework for setting and measuringperformance outcomes

April 2007


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The national specifications for cleanliness

in the NHS

Preface

National Patient Safety Agency

April 2007

PrefaceThese specifications update the National standards of cleanliness firstpublished by NHS Estates in 2001 and revised in August 2003 andDecember 2004 (in Revised Guidance on Contracting for Cleaningas The National Specifications for Cleanliness). They provide acomparative framework within which hospitals and trusts in Englandcan set out details for providing cleaning services and assessingtechnical cleanliness.

The national specifications have been reviewed and revised to:

ensure they take account of changes occurring since the date of thelast review, specifically, but not restricted to Towards Cleaner Hospitalsand Lower Rates of Infection,A Matrons Charter, The HealthcareCommissions Standards for Better Health and the Code of Practicefor the Prevention and Control of Healthcare Associated Infections(introduced under the Health Act 2006);

incorporate the recommended Minimum cleaning frequencies (firstpublished 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.

These specifications are not a cleaning manual: rather theyprovide an assurance framework to support compliance with thecore cleanliness standard and the code of practice. For furtherinformation on providing cleaning services, see The NHS healthcarecleaning manual.

Neither do these specifications seek to provide advice on preciselyhow cleaning services should be provided, for example, by directemployment or contracting out. These matters are for localdetermination. Ultimately, local managers are accountable for theeffectiveness of cleaning services, and these specifications provideclear advice and guidance on: what is required; how trusts candemonstrate the way(s) in which cleaning services will meet theserequirements; and how to assess performance.

Throughout this document reference is made to hospital cleaning.It is, however, recognised that delivery of healthcare takes place ina variety of settings. This document applies chiefly to traditionalhospitals whether in the acute, mental health or primary care trustcommunities but the principles contained apply equally to othersettings and expressions such as hospital and hospital cleaningshould be interpreted accordingly.


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Preface


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The specifications should be applied regardless of the mannerin which cleaning services are provided. Compliance with thespecifications, and the monitoring and auditing processes should bewritten into contracts with cleaning service providers.

Cleaning service managers and providers should read this documentthoroughly and ensure that all staff are aware of its contents. Allthose involved in the provision of hospital cleaning services shouldbe working towards the common and shared goal of high qualitycleaning services that meet the needs and expectations of patients,the public and other hospital staff.

Patient Environment Action Team assessments and


From 2007, the results of Patient Environment Action Team (PEAT)assessments will be calculated against these specifications and theauditing process which accompanies them.

It is, therefore, vital that all hospitals follow the auditing processand provide their annual score through the Estates Returns and

Information Collection (ERIC) process. NHS trusts are reminded thatproviding this score through ERIC is a mandatory return.


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Contents


April 2007

Contents

Foreword 4

Service delivery 9

Principles and objectives

Operational delivery

Auditing and monitoring information 6

Auditing 7Audit principles 19Frequency 19Personnel 19Methodology 20Sampling 20

Identifying risk categories 4Very high-risk functional areas 24High-risk functional areas 25Significant-risk functional areas 25Low-risk functional areas 26Action 26

Appendix Element standards 7

Appendix Sample cleaning audit score sheet

Appendix Template cleaning audit score sheet 4

Appendix 4 External audit score sheet 5

Appendix 5 Specimen cleaning frequencies 7

Appendix 6 Specimen cleaning responsibility framework 4

Appendix 7 Cleaning procedure guidance 47

Appendix 8 Definition of terms 48Appendix 9 References and useful

sources of information 49

Appendix 0 Code of practice for the prevention andcontrol of healthcare associated infections[separate document]

Appendix Specimen operational plan[separate document]

Appendix Specimen strategic cleaning plan[separate document]


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ForewordProviding a clean and safe environment for healthcare is a keypriority for the NHS and is a core standard in Standards for betterhealth. Other publications such as Towards cleaner hospitals andlower rates of infection andA Matrons Charter: An Action Plan forCleaner Hospitals have further emphasised this, and also recognisethe role cleaning has in ensuring that the risk to patients fromhealthcare associated infections is reduced to a minimum. The

code of practice to the hygiene bill(for the prevention and controlof healthcare associated infections) will place further onus andresponsibility on NHS trusts to ensure that local provision of cleaningservices is adequately resourced; clearly defined through a strategiccleaning plan, and clear cleaning schedules and frequencies; andarranged to ensure that patients, the public and staff know whatthey can expect. Further information relating to each of thesepublications is detailed below.

This key priority, coupled with increasing public concern abouthealthcare associated infections, means hospitals need to not only

be clean but able to demonstrate how and to what standard they arekept clean.

The national specifications for cleanliness in the NHSwere launchedin April 2001 as The national standards of cleanliness. In December2004, the word standards was replaced with specifications toavoid confusion with the Healthcare Commissions Standards forbetter health.

What is ultimately most important is that hospitals are clean, andthat must remain the focus of hospital cleaning services. Whilst theability to demonstrate the levels of cleanliness being achieved is

important, this should not be at the expense of service delivery.

The specifications have been designed to provide a simple, easy-to-apply methodology within which hospitals in England can assess theeffectiveness of their cleaning services. Since their first publication,NHS managers have welcomed the opportunity both to measureperformance in a uniform way and benchmark performance againstsimilar healthcare environments. The specifications are now in dailyuse in most healthcare establishments.

High levels of cleanliness can only be achieved through:

clear specifications; the proper training of staff;

documented lines of accountability;

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Foreword


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involving patients;

all staff recognising their responsibilities;

a meaningful framework for measurement;

NHS trust management board support, the appointment of a boardnominee to represent cleaning-related issues at board level and boardownership to embed cleanliness as part of the trusts strategy;

modern matrons taking the lead;

direct links between NHS trusts directors of infection prevention andcontrol, and local infection control teams and policies.

The involvement of the board nominee has a significant influence oncombatting healthcare associated infections. More closely involvingmatrons and patients in the setting and monitoring of standards iscrucial to delivering consistently high levels of service.

NHS trusts now have greater freedom to decide how to organisetheir resources and the use of these specifications is a matter onwhich local managers must take a view. However Standards for

better health require healthcare premises to be cleaned to nationalspecifications. Applying both the standards and the monitoringand auditing processes set out in this document can help NHStrusts demonstrate their compliance with the standard relating tocleanliness. Additionally, they help reduce the risks associated withpoor cleanliness, demonstrate due diligence, and promote a moreconsistent and high quality output that patients and the public willnotice and appreciate.

The changing environment for clean hospitals

Much has changed in hospital cleaning since the publication ofthe NHS Plan, which brought a renewed emphasis on this areaof hospital activity and led directly to the introduction of thesenational specifications.

Through the establishment of clear standards, and monitoring andauditing procedures, hospital cleanliness has significantly improvedsince 2000. However, patients and the general public expect there tobe continuous improvements.

This expectation is reflected in a number of publications andactivities since these national specifications were last reviewed which

impact on the provision of cleaning services.

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Foreword


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Towards cleaner hospitals and lower rates

of infection

Published by the Department of Health in July 2004, this reporthighlights the importance of cleanliness to patients and notes that:A clean environment provides the right setting for good patientcare practice and good infection control. It is important for efficientand effective healthcare.

A Matrons Charter: An Action Plan for

Cleaner Hospitals

Building on the undertaking in Towards cleaner hospitals and lowerrates of infection to give matrons and nurses at ward level thepractical advice and power to ensure high standards are maintained,A Matrons Charter: An Action Plan for Cleaner Hospitals has10 commitments:

1 Keeping the NHS clean is everybodys 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 recognised for the important work they do.Matrons will make sure cleaning staff feel part of the ward team.

5 Specific roles and responsibilities for cleaning will be clear.

6 Cleaning routines will be clear, agreed and well-publicised.

7 Patients will have a part to play in monitoring and reporting onstandards 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 upcleaning contracts, and matrons have authority and power towithhold payment.

10 Sufficient resources will be dedicated to keeping hospitals clean.

Standards for better health

Introduced in 2006 to replace the star-ratings system, these are thestandards against which all NHS trusts will need to report and, where

appropriate, provide evidence to the Healthcare Commission tosupport their statements.


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Foreword


April 2007

There are two standards which relate to cleanliness:

1 Standard C4 (a): Healthcare organisations keep patients, staff andvisitors safe by having systems to ensure that the risk of healthcareacquired infection to patients is reduced, with particular emphasison high standards of hygiene and cleanliness, achieving year-on-yearreductions in Methicillin Resistant Staphylococcus Aureus (MRSA).

2 Standard C21: Healthcare services are provided in environmentswhich promote effective care and optimise health outcomes by being

well-designed and well-maintained with cleanliness levels in clinicaland non-clinical areas that meet the national specifications for cleanNHS premises.

Applying the standards and processes set out in this documentwill provide NHS trusts with valuable information which they maywish to provide to the Healthcare Commission in support ofthese standards.

Health Act 2006: The code of practice for the

prevention and control of healthcare associated

infectionsThe code of practice includes a duty to provide and maintain a cleanand appropriate environment and specific provisions include theappointment of a lead manager for cleaning and publicly availablecleaning arrangements. There is also a duty to provide all staff withtraining on infection prevention and control. A copy of the code ofpractice is in Appendix 10.

Saving Lives: a delivery programme to reduce

healthcare associated infections including MRSA

Building on previous policy and guidance, Saving Lives set out ninechallenges in the form of a self-assessment and planning tool,including:

Challenge 6 requires organisations to ensure that all employeeshave a programme of education and training on the prevention andcontrol of infection in order to understand their responsibility forinfection control and the actions they must personally take.This made specific reference to induction and on-going training forall staff.

Challenge 8 requires organisations to review the status of the builtenvironment and the effectiveness of facilities management services,including cleaning, in order to provide a safe and clean environmentfor patient care.


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Foreword


April 2007

Specific assurance was required for:

compliance with legislation;

compliance with specifications;

assessment of quality;

availability of cleaning when it was required.


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Service delivery


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Service deliveryThese specifications were originally developed by a group ofexperienced cleaning services managers from both the NHS andprivate sector companies, along with members of the InfectionControl Nurses Association. They drew on work already undertakenby the State of Victoria in Australia. The National Patient SafetyAgency (NPSA) is grateful to both the Australian authorities andother organisations and individuals who have assisted in reviewing

and revising the specifications to ensure they are based on currentand accepted best practice.

NHS trusts need to be able to demonstrate that the hospitals undertheir authority are clean, and that risks to patient safety frominadequate or inappropriate cleaning have been minimised.

These specifications aim to provide a common understanding ofwhat it means to be a clean healthcare setting. The aim is to improvethe quality of health service by ensuring that all cleaning-relatedrisks are identified and managed on a consistent, long-term basis,irrespective of where the responsibility for providing cleaning

services lies.

These specifications focus on outcomes rather than the methodby which they are achieved, since the responsibility for day-to-dayarrangements rests entirely with individual NHS trusts. They canbe 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 (see also Appendix 5 oncleaning frequencies);

part of an ongoing performance management process;

a framework for auditing;

a benchmark in the drive to reduce healthcare associated infections;

a useful support tool in improving patient and visitor satisfaction levels.


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Service delivery


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Infection control

The chief executive of each NHS trust is responsible for ensuring thatthere are effective arrangements for infection control throughoutthe trust. A director of infection prevention and control has beenappointed in every NHS trust to help their healthcare setting meetthis requirement.

These specifications support local risk management plans byassessing the effectiveness of cleaning programmes. The director

of infection prevention and control and the local infection controlcommittee, infection control teams and nurses must be involved intheir use and regularly appraised of the results of assessment, andmonitoring and audit findings.

Crucial to the success of cleaning services is that the issues ofpersonal responsibility and accountability are addressed. Keypersonnel should have reflected in their objectives the deliverableoutcomes for cleanliness to ensure that it is incorporated into thetrusts core business through performance frameworks and thatthey are held to account for their elements of it.


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Principles and objectives


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Principles and objectivesThe delivery of a high quality cleaning service is complex, demandingand should not be underestimated. However, at all times it should bekept in mind that the single most important factor is the outcome ofthe service how clean the hospital is.

Key attributes of service delivery are that it:

is patient and customer-focused;

provides clarity for all staff responsible for ensuring a hospital is cleanand safe;

enhances quality assurance systems;

addresses governance and risk assessment;

is consistent with infection control standards and requirements;

meets the requirements of core standard C21;

set clear outcome statements, which can be used as benchmarks andoutput indicators;

has clear objectives that provide a foundation for serviceimprovements;

allows scope for precise arrangements to be determined locally in thelight of circumstances and priorities;

provides for a culture of continuous improvement.


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Strategic operational cleaning plans, schedules and

frequencies, and cleaning responsibility frameworks

Setting out clear local policies and arrangements as detailed above isbest achieved through the production of a board-approved strategiccleaning plan and the development of an operational cleaning plan.These will also help NHS trusts meet the Healthcare Commissions

requirements in terms of documentary evidence around theprovision of cleaning services, and the legislative requirements ofThe code of practice for the prevention and control of healthcareassociated infections.

There is no national standard for a strategic or operational cleaningplan, and it is for each NHS trust to produce their own. However,there is an example of each in Appendices 11 and 12 that can actas guides.

In order to ensure timely and effective action, local standards andpolicies should clearly set out the range and scope of work to be

undertaken. These should stipulate:

the standards to be achieved;

clear and measurable outcomes sought;

clear allocation of responsibility for cleaning all areas of, and itemswithin, the hospital;

the cleaning lead manager;

cleaning schedules and frequencies;

the systems to be used to measure outcomes;

the reports required and the managers who should receive them;

operational and training policies and procedures, including how theNHS trust will ensure all staff receive appropriate training prior tobeing allocated to specific cleaning tasks;

the risk assessment protocols;

the service level agreements for each functional area;

how cleaning services operations and controls dovetail witharrangements for infection control, including training for all cleaningservice staff in infection control policies and procedures;

how cleaning training for nursing staff (and others as appropriate) willbe delivered.


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These are important since unclear or inadequately identified localcleaning standards and policies could result in:

risk to the health and safety of patients, visitors and staff through pooror poorly applied cleaning protocols and processes;

poor public image;

lack of public confidence;

clinical governance issues;

poor value for money;

poor infection prevention and control;

litigation.

Recommended minimum cleaning frequencies

Revised Guidance on Contracting for Cleaning published the firstset of recommended minimum cleaning frequencies to ensure aminimum standard of cleanliness.

Discussions with NHS cleaning service providers suggests that,whilst it is important that NHS trusts locally produce a cleaningfrequency schedule, a single national version is inappropriate sinceit cannot meet every NHS organisations needs. It would also stifletrusts ability to allocate cleaning resources where they are mostneeded. It would also frustrate the requirement to give more controlto matrons and senior nurses in terms of deciding where availablecleaning resources are best deployed. It is also the case that few, ifany, NHS trusts have applied these exactly, rather their use has beenconcerned with identifying the precise cleaning resource needed tokeep hospitals clean.

Nonetheless, it is important that NHS trusts have locally determinedfrequencies to meet the requirements of the code of practice andto identify the resources needed to keep the hospital clean, andtherefore demonstrate to the Healthcare Commission that sufficientresources are being allocated. The precise allocation of resources,and the actual frequency of cleaning, varies according to locallydetermined need.

The existing minimum recommended frequencies are thereforereproduced in Appendix 5 to help NHS trusts produce their ownfrequencies specific to their own needs.


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Cleaning responsibility framework

Hospitals have varying shapes, sizes and ranges of equipment, bothclinical and non-clinical, which require cleaning. Responsibilityfor cleaning can also vary and will include, at least, domesticcleaning services providers, nursing and other ward staff (includinghousekeepers) and estates staff. There are also items, such as windowsand carpets, that require less frequent cleaning and may be cleaned bycontractors.

Ensuring all items which require cleaning are cleaned is a significant butimportant task. Experience suggests that the opportunities for itemssuch as ward-based equipment to fall through the gapsis considerable.

The specification in Appendix 1 includes a range of 49 elements listedunder broad headings which, taken together, will cover the entirety ofitems and areas to be cleaned. However, within these broad headings,there are a much greater range of specific items for which a national listcould not be produced with any reliable degree of accuracy.

It is recommended that NHS trusts produce a schedule of cleaningresponsibility, specifically for each hospital, and list either:

all items to be cleaned; or

all items not covered by domestic cleaning services.

The schedule should identify who is responsible for cleaning each item.NHS trusts may also find it helpful to include a locally agreed cleaningfrequency schedule within this document.

Appendix 6 has a specimen cleaning responsibility framework withsuggested cleaning frequencies.

Management of staff

All levels of the cleaning team should be clear about their roles andresponsibilities. Each member of staff should have:

a clear understanding of their specialised responsibility, in a form of awork schedule;

detailed and appropriate training and continued refresher training withthe opportunity to gain qualifications;

a clear career ladder available should they wish;

an appraisal in line with agenda for change and their Knowledge andSkills Framework;

the attendance management policy freely available and appliedappropriately.


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Cleaning equipment

The cleaning equipment that is regularly used should be fit forpurpose, easy-to-use and well-maintained. It is imperative that eachtrust regularly reviews its cleaning equipment to ensure that it isfit for purpose and, importantly, can demonstrate that it has clearinfection control benefits.

The NPSA issued a safer practice notice that set out a NationalColour Coding System. Each trust must make sure that its

equipment conforms to this notice.

IT

In the modern, changing healthcare environment, patient-centredservice that needs to be flexible is highly difficult to achieve. Sometrusts have found the need to modernise their administrative systemby using appropriate IT software packages. There are many availableand they must be able to:

adjust cleaning specification according to need;

produce service level agreements and work schedules; allocate and manage staff against the agreed specifications;

data compute audit information and produce results;

analyse service performance and trends.


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Auditing and monitoring information


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Auditing and monitoring informationThis section explains how to establish the cleanliness of equipment,fixtures and fittings, and buildings so that a whole hospital scorecan be calculated by collecting area-specific scores. Results canbe established for the same equipment across a whole hospitalsite, parts of buildings, all wards or departments, or groupings ofwards. This allows any variations in quality across similar areas to beidentified, and the causes of any unclean areas to be addressed.

The specification operates according to risk categories throughwhich each cleanable area of the hospital (known as functionalareas, and covering both clinical and non-clinical) is allocated a riskfactor on a scale from very high to low. This is a crucial first step inapplying the specifications since the level of monitoring and auditis directly linked to the identified risk factor. The specificationsinclude advice on which areas might be allocated within eachfunctional area, but ultimately this is a decision to be made locallyin consultation with the NHS trusts director of infection preventionand control, and the local infection control committee.

Quality standards are set out according to the 49 elements(equipment, fixtures, fittings and buildings (or part thereof)) which,taken together, comprise the broad range of items commonly foundin hospitals. However, as noted earlier, it is not possible to list everyitem which may be present in a hospital. NHS trusts should ensurethat all items in their hospital are included through, for example, acleaning responsibility framework (see Appendix 6).

The appendices provide a range of information relating to theelements, sample scoring sheets, cleaning frequencies and otheruseful information.

To accompany these specifications, an Excel spreadsheet withframeworks for gathering, reviewing and reporting auditinformation is available from: www.npsa.nhs.uk/health/currentprojects/cleaningandnutrition

Timeframe for rectifying problems

The table overleaf can be used to measure the importance ofcleaning each element in any particular functional area. For example,a toilet in an operating theatre and a toilet in a waiting room shouldbe equally clean. However, the floor of a plant room requires less

attention than the floor in an ITU/ICU.

Elements in every room should be assigned one of the three levels ofpriority described overleaf.


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Priority Timeframe for rectifying problems

A - Constant

Cleaning critical (very high-risk and high-risk functional areas).

Immediately or as soon as is practicallypossible. Cleaning should be recognised asa team responsibility. If domestic or cleaningstaff are not on duty, cleaning should be theresponsibility of other ward or departmentpersonnel. These responsibilities should beclearly set out and understood.

B - Frequent

Cleaning important and requiresmaintaining (significant risk functionalareas).

03 hours for patient areas (to be rectified bydaily scheduled cleaning service fornon-patient areas).

C - Regular

On a less frequent scheduled basis, andas required in-between cleans (low-riskfunctional areas).

048 hours.

AuditingThe audit process should encourage quality improvements andshould not be punitive. Two levels of audit should be employed:

technical;

managerial.

The precise arrangements for undertaking technical and managerialaudits may vary according to local arrangements (for example wherea contracted cleaning services provider undertakes the technicalaudits with trust hotel services departments (or similar) undertaking

managerial style audits). Such arrangements are acceptable providedthey deliver the same or a broadly similar level of audit to that setout above.

NHS trusts may wish to consider a third, external level of audit andreach an agreement with another local NHS trust to provide this on areciprocal basis. Alternatively, they could consider asking their localpatient and public involvement or other patient group to carry outan independent audit.

There are no national targets within these specifications, however,good practice would suggest that individual hospitals/trusts settheir own aims. These should be realistic, achievable, challengingand regularly reviewed to ensure they contribute to an ethos ofcontinuing improvement.


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To assist trusts in determining their own targets, the following areprovided as indicative aims for each of the four risk categories:

Very high 98 per cent

High 95 per cent

Significant 85 per cent

Low 75 per cent

Once hospitals have determined their target scores by risk category,an overall target score can be calculated by determining the per centof the hospital which falls into each risk category and applying thefollowing formula:

98x0 + 95x70 + 85x0 +75x0

00 = 9.0 per cent

An overall trust target rate can be calculated by applying theaggregation process described on page 21 using bed numbers toensure the varying size of hospital is accurately reflected.

Technical audits

These are regular audits by appropriately qualified staff which form acontinuous and inseparable part of the day-to-day management andsupervision of cleaning services.

Technical audits should be conducted as a joint exercise between thestaff responsible for cleanliness, infection control teams and matronsas well as service users.

Managerial audits

These ad hoc audits should verify cleaning outcomes of technicalaudits and identify areas for improvement. The audit team shouldconsist of senior NHS trust management, and nurses and modernmatrons with responsibility for cleaning and infection control. Inaddition there should be a board representative, preferably theperson with board-level responsibility for cleaning services, and apatient or service user representative.

Managerial audits should be conducted as a joint exercise betweenthe staff responsible for cleanliness and service users.

External audits

External audits are not an intrinsic part of the auditing processbut are recommended as good practice since they provide an


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independent view of cleanliness and validate the NHS trusts owninternally awarded scores.

Collaborating with neighbouring facilities or NHS trusts is oftenthe easiest way to get appropriately qualified staff or managers totake part in an external audit process. It also minimises travel costs andexpenses.

However, there can also be value in reciprocal arrangements betweenfacilities and NHS trusts where managers do not know each other

and some distance separates them. Such situations may provide moreopportunities to share best practice.

Audit principles

Issues to be considered when designing and implementing an auditprocess include:

frequency;

personnel;

methodology;

sampling;

scoring;

action.

Frequency

In healthcare premises where standards are deemed acceptable, thefollowing frequencies of audit are recommended:

technical in accordance with the relevant risk category;

managerial quarterly (usually best undertaken as a rolling programmeso that all aspects are reviewed in a 12 month period);

external annually (often undertaken on a reciprocal basis with aneighbouring NHS trust), taking more than one day to complete.

External audit frequencies should be increased where these scores differnoticeably from scores derived from audits undertaken by the NHS trust.

Personnel

Audits (particularly technical audits) should not be the sole responsibility

of the cleaning services department. The task should be shared amongstall of the relevant stakeholders in the healthcare facility.

Managers and staff involved with audits should:

have a detailed knowledge of healthcare establishments and procedures;


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be professionally competent to judge what is acceptable in terms ofcleanliness and infection prevention and control;

be able to make discriminating judgements on risk in relation to theareas being cleaned;

be able to make informed judgements on the extent to which existingcleaning frequencies may be insufficient.

Patients and patient representatives would not be expected tohave a detailed knowledge of the healthcare establishment orits procedures.

Methodology

Audits should involve three interrelated levels of score:

room score;

functional area score;

overall score.

The following methodology is recommended in establishing scores

for these levels:

auditors assign a score to each individual room in the functional area(the room score);

the room scores in any functional area are averaged to establish thescore for the functional area itself (the functional area score);

the scores of all the functional areas are averaged to give theoverall score.

There are a number of commercially-available computer packagesthat can aid the monitoring and auditing process and NHS trusts maywish to explore these and their applicability.

Sampling

Technical audits

Technical audits should be ongoing. The regularity of reviews offunctional areas and rooms should be undertaken in accordance withthe relevant risk category. Each quarter, the functional area scoresshould be collated and averaged to form the quarterly summaryscore.

This may require some room and/or functional area scores tobe brought forward if they are not scheduled for audit in thecorresponding review period.

The healthcare facilitys overall score is the most recent quarterlysummary score.


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Calculating NHS trust scores

Where an overall NHS trust score is required, or there is a need togroup facilities within an NHS trust, an aggregated score can be usedto form the overall score for cleanliness. However, account must betaken of the relative size of each of the healthcare facilities beingaggregated.

Example

Within an NHS trust, Facility A has 200 beds and a score of 86 percent, Facility B has 1000 beds and a score of 42 per cent. The overallscore must be calculated by weighting the individual scores by thebed numbers:

(86 per cent x 00) + (4 per cent x ,000)

.00 = 49 per cent

Managerial audits

The managerial audit review team should validate a sample of auditinformation arising from the technical audits on a quarterly basis.

For example, each quarter, the managerial audit team may decide toreview each quarter:

some elements across all functional areas;

some room types; or

one or more functional areas.

The decision should be based on:

the standards already being achieved; where local NHS trust managers feel emphasis should be placed;

randomly chosen elements, rooms or functional areas.

The frequency of reviews, what to sample and the sample sizeshould be appropriate to the risk category. For example, high-riskareas should be audited more frequently and comprehensively thanlow-risk areas.

Where there are particular problems, the sample size should beincreased to better inform the audit process.


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External audits

Where employed, external audits should be undertaken at least oncea year to:

validate the results generated by the host facility or NHS trust;

provide peer review and opportunities for the sharing of best practice.

The external audit review team should be looking to see if the mostrecent quarterly summary score provided by the NHS trust matches

with the general standards seen on the day of the external review.

Where the score provided by the facility differs to that provided bythe external audit team, assessment feedback should be provided toNHS trust managers.

External auditors should be given the opportunity to determine whatthey wish to review, and the extent to which it should be reviewed.To be effective, external auditors will need to access the outcomesfrom the past four quarterly summary score calculations andoutcome information from the technical audits.

A sample format for an external audit is given in Appendix 4.

Scoring

The auditor must decide the cleanliness of each element in aroom using the element standard criteria, acceptable (score 1) orunacceptable (score 0).

Elements are categorised under eight headings and comprise 49element standards (as set out in Appendix 1).

Each room must first be reviewed for those elements not presentand these should be discounted on the audit score sheet asnot applicable.

An example of a completed audit score sheet for use in scoringrooms in functional areas is set out in Appendix 2. Appendix 3 is ablank format.

An audit score sheet and 13-week format for monitoringfunctional areas over a quarter period are available fromwww.npsa.nhs.uk/health/currentprojects/cleaningandnutrition


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The score sheet provides the opportunity to assign generalresponsibility for elements within a functional area to cleaning,nursing or estates services. This is achieved by entering C (cleaning),N (nursing) or E (estates) in the line marked responsibility.

The electronic version of the score sheet will calculate thepercentage score achieved for each of the departments in additionto the functional area overall percentage score.

The score sheet allows for calculations to be made horizontally

(outcome per room) and vertically (outcome per element) along withthe totals referred to above.

Thereafter, each element should be scored in accordance with theprinciples set out in the section headed Methodology

Where an element is assigned a score of 0 (unacceptable) then thereason for failure and an appropriate time for remedial action tobe taken (see page 17) should be entered in the record. This recordsheet forms the second page of the cleaning audit score sheet (seeAppendix 4).

Once all elements in the room have been scored, the total number ofacceptable scores should be expressed as a percentage of the totalpossible number of acceptable scores in that room. For example,if the sanitary area had a maximum of 12 elements, and 10 wereacceptable, the overall percentage would be calculated as 10/12 or83 per cent.

The functional area score is calculated by taking an average of theindividual room scores as follows:

Ward

Bay A 70%

Bay D 80%

Sanitary area 2 90%

Ward office 100%

Side room 6 90%

70 + 80 + 90 + 00 + 90

5 = 86 per cent

Overall functional area score is 86 per cent.


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Auditors need to exercise discretion in judging the acceptability ofany element. For example, one or two scuff marks on a floor or anisolated smudge on a window should not indicate that the elementshould necessarily be scored as unacceptable.

Identifying risk categories

All healthcare environments should pose minimal risk to patients,staff and visitors. However, different functional areas representdifferent degrees of risk and, therefore, require different cleaning

frequencies and different levels of monitoring and auditing.Consequently, all functional areas should be assigned one of fourrisk categories: very high, high, significant and low. These categoriesare explained below.

Risk categories are used to set SLAs and outcome auditing levels. Toensure that auditing processes are continuous and equal they shouldtake place within the timeframes outlined below.

Informal monitoring should take place in areas where standardsare considered poor or where routine monitoring reveals

consistent weaknesses.Very high-risk functional areas

Required service level

Consistently high cleaning standards must be maintained.Required outcomes will only be achieved through intensive andfrequent cleaning.

Both informal monitoring and formal auditing of standards shouldtake place continuously. Areas and rooms allocated a very high-risk category should be audited at least once a week until the leadcleaning manager and infection control team are satisfied thatconsistently high standards are being achieved, after which the auditfrequency may be reduced to no less than monthly.

Functional areas

Very high-risk functional areas may include operating theatres,ICUs, SCBUs, accident and emergency (A&E) departments, and otherdepartments where invasive procedures are performed or whereimmuno-compromised patients are receiving care.

Additional internal areasBathrooms, toilets, staff lounges, offices and other areas adjoiningvery high-risk functional areas should be treated as having the samerisk category, and receive the same intensive levels of cleaning.


26/52


in the NHS



April 2007

High-risk functional areas


Outcomes should be maintained by regular and frequent cleaningwith spot cleaning in-between.

Both informal monitoring and formal auditing of standards shouldtake place continuously. Rooms in a high-risk functional area shouldbe audited at least once a month until the lead cleaning manager

and infection control team are satisfied that consistently highstandards are being achieved, after which the audit frequency maybe reduced to no less than twice-monthly.

Functional areas

High-risk functional areas may include general wards (acute, non-acute and mental health), sterile supplies, public thoroughfares andpublic toilets.

Additional internal areas

Bathrooms, toilets, staff lounges, offices and other areas adjoininghigh-risk functional areas should be treated as having the same riskcategory and receive the same regular levels of cleaning.

Significant-risk functional areas


In these areas, high standards are required for both hygiene andaesthetic reasons. Outcomes should be maintained by regular andfrequent cleaning with spot cleaning in-between.

Both informal monitoring and formal auditing of standards shouldtake place continuously. Rooms in a significant-risk functional areashould be audited at least once every three months.

Functional areas

Significant-risk functional areas may include pathology, outpatientdepartments, laboratories and mortuaries.

Additional internal areas

Bathrooms, toilets, staff lounges, offices and any other areasadjoining significant-risk functional areas should be treated ashaving the same risk category and receive the same regular levelsof cleaning.


27/52


28/52


in the NHS

Appendix 1


April 2007

Appendix Element standardsSee Appendix 8 for definitions.

Cleaning standards guarantee

Environment

Patient equipment

Direct contact

Element Standard

. CommodesAll parts including underneath should be visiblyclean with no blood and body substances,dust, dirt, debris or spillages.

. Bathroom hoists As above

. Weighing scales, manualhandling equipment

As above

4. Drip stands As above

5. Other medical equipment NOTconnected to a patient, e.g.intravenous infusion pumps andpulse oximeters

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

6. Medical equipment connectedto a patient, e.g. intravenousinfusion pumps drip stand andpulse oximeters


7. Patient washbowls


Patient washbowls should be decontaminated

appropriately between patients and should bestored clean, dry and inverted. Badly scratchedbowls should be replaced.

8. Medical gas equipmentAll parts including underneath should be visiblyclean with no blood and body substances,dust, dirt, debris or spillages.

9. Patient fans

All parts including the blades/fins and theunderside should be visibly clean with noblood and body substances, dust, dirt, debrisor spillages.


29/52


in the NHS

Appendix 1


April 2007

Close contact

Element Standard

0. Bedside alcoholhand washcontainer,clipboards andnotice boards

All parts including holder of the bedside alcohol hand washcontainer should be visibly clean with no blood and bodysubstances, dust, dirt, debris or spillages.

Hand wash dispenser should be free of product build-uparound the nozzle. Splashes on the wall, floor, bed or furnitureshould not be present.

. Notes and drugstrolley

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.

. Patient personalitems e.g. cardsand suitcase

All parts of the patients items should be visibly clean with noblood and body substances, dust, dirt, debris or spillages.

Loose items such as clothing should be stored away either inthe locker or bag.

. Linen trolleyAll parts including underneath of the linen trolley should bevisibly clean with no blood and body substances, dust, dirt,debris or spillages.

Fixed assets

Element Standard

4. Switches, socketsand data points

All wall fixtures e.g. switches, sockets and data points shouldbe visibly clean with no blood and body substances, dust, dirt,debris, adhesive tape or spillages.

5. WallsAll wall surfaces including skirting should be visibly clean withno blood and body substances, dust, dirt, debris, adhesivetape or spillages.

6. CeilingAll ceiling surfaces should be visibly clean with no blood andbody substances, dust, dirt, debris, adhesive tape or spillages.

7. All doorsAll parts of the door structure should be visibly clean so that alldoor surfaces, vents, frames and jambs have no blood or bodysubstances, dust, dirt, debris, adhesive tape or spillages.

8. All internalglazing includingpartitions

All internal glazed surfaces should be visibly clean andsmear-free with no blood and body substances, dust, dirt,debris, adhesive tape or spillages. They should have a uniformshine appearance.

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

0. MirrorsMirrors should be visibly clean and smear-free with no bloodand body substances, dust, dirt, debris, adhesive tapeor spillages.

. Bedside patient TVincluding earpiecefor bedsideentertainmentsystem

All part of the bedside patient TV should be visibly clean withno blood and body substances, dust, dirt, debris, adhesivetape or stains.

. RadiatorsAll part of the radiator (including between panels) should bevisibly clean with no blood and body substances, dust, dirt,debris, adhesive tape or spillages.

. Ventilation grillesextract and inlets

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


30/52


31/52


in the NHS

Appendix 1


April 2007

Furnishings and fixtures

Element Standard

0. Low surfacesAll surfaces should be visibly clean with no blood and bodysubstances, dust, dirt, debris, adhesive tape or spillages.

. High surfacesAll surfaces should be visibly clean with no blood and bodysubstances, dust, dirt, debris, adhesive tape or spillages.

. ChairsAll parts of the furniture should be visibly clean with noblood and body substances, dust, dirt, debris, adhesive tape,stains or spillages.

. BedsAll parts of the bed (including mattress, bed frame, wheelsand castors) should be visibly clean with no blood and bodysubstances, dust, dirt, debris, adhesive tape or spillages.

4. LockersAll parts of the locker (including wheels, castors and inside)should be visibly clean with no blood and body substances,dust, dirt, debris, adhesive tape, stains or spillages.

5. Tables

All parts of the table (including wheels, castors andunderneath) should be visibly clean with no blood andbody substances, dust, dirt, debris, adhesive tape, stainsor spillages.

6. Hand washcontainers

All part of the surfaces of hand soap, paper towel containersshould be visibly clean with no blood and body substances,dust, dirt, debris, adhesive tape or spillages.

7. Hand hygienealcohol rubdispensers

All part of the surfaces of hand hygiene alcohol rub dispensers

should be visibly clean with no blood and body substances,dust, dirt, debris, adhesive tape or spillages. Dispensers shouldbe kept stocked.

8. Waste receptacles

The waste receptacle should be visibly clean including lid andpedal with no blood and body substances, dust, dirt, debris,stains or spillages. Receptacles should be emptied frequentlyand not allowed to overflow.

9. Curtains andblinds

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

Kitchen fixtures and appliances

Element Standard

40. DishwashersDishwashers should be visibly clean with no blood and bodysubstances, dust, dirt, debris, stains, spillages or food debris.

4. Fridges andfreezers

Fridges and freezers should be visibly clean with no blood andbody substances, dust, dirt, debris, spillages, food debris orbuild up of ice.

4. Ice machines andhot water boilers

Ice machines and hot water boilers should be visibly clean withno blood and body substances, dust, dirt, debris or spillages.

4. Kitchen cupboardsKitchen cupboards should be visibly clean with no bloodand body substances, dust, dirt, debris, stains, spillages orfood debris.

44. Microwaves

All microwave surfaces should be visibly clean with no

blood and body substances, dust, dirt, debris, spillages orfood debris.


32/52


in the NHS

Appendix 1


April 2007

Toilets, sinks, wash hand basins and bathroom

fixtures

Element Standard

45. ShowersThe shower, wall-attached shower chairs should be visiblyclean with no blood and body substances, scum, dust, limescale, stains, deposit or smears.

46. Toilets and bidetsThe toilet and bidet should be visibly clean with no blood andbody substances, scum, dust, lime scale, stains, deposit orsmears.

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

48. Sinks

The sink and wall-attached dispensers should be visibly cleanwith no blood and body substances, dust, dirt, debris, limescale, stains or spillages. Plugholes and overflow should befree from build-up.

49. BathsThe bath should be visibly clean with no blood and bodysubstances, dust, dirt, debris, lime scale, stains or spillages.Plugholes and overflow should be free from build-up.


33/52

Appen

dixSampleclean

ingauditscoreshee

t

CLEANINGAUDITSC

ORESHEET

Functionalarea:

Auditors:

Auditdate:

Responsibility

Roomname

1.Commodes

2.Bathroomhoists

3.Weighingscales,manualhandlingequipment

4.Dripstands

5.Othermedicalequipmente.g.intravenousinfusionpumps,pulseoximeters,etc.NOTCONNECTEDTOPATIENT

6.Medicalequipmente.g.intravenousinfusionpumpsdripstand,pulseoximeters,etc.CONNECTEDTOPATIENT

7.Patientwashbowls

8.Medicalgasequipment

9.Patientfans

10.Bedsidealcoholhandwashcontainer,clipboards&noticeboards

11.Notes&drugstrolley

12.Patientpersonalitemse.g.cards,suitcase

13.Linentrolley

14.Switches,sockets&datapoints

15.Walls

16.Ceiling

17.Alldoors

18.Allinternalglazingincludingpartitions

19.Allexternalglazing

20.Mirrors

21.BedsidepatientTVincludingearpieceforbedsideentertainmentsystem

22.Radiators

23.Ventilationgrillesextractandinlets

24.Floorpolished

25.Floornonslip

26.Floorsoftfloor

27.Pestcontroldevices

28.Electricalitems

29.Cleaningequipment

30.Lowsurfaces

31.Highsurfaces

32.Chairs

33.Beds

34.Lockers

35.Tables

36.Handwashcontainers

37.Handhygiene/alcoholrubdispensers

38.Wastereceptacles

39.Curtains&blinds

40.Dishwashers

41.Fridges&freezers

42.Icemachinesandhotwaterboilers

43.Kitchencupboards

44.Microwaves

45.Showers

46.Toilets&bidets

47.Replenishment

48.Sinks

49.Baths

Actualscore

Percentageattained

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

Achievable

score

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

Totalscore

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

Percentagescoreachieved

Cleaningservice

########

Nursing

########

Estates

########

Functinalarea

Overallpercentagescore

#DIV/0!


34/52

CLEANINGAUDITSCORESHEET

Functionalarea:Area1

Auditors:

ANOther

Auditdate:01:12:04

Responsibility:

Roomname

1.Commodes

2.Bathroomhoists


4.Dripstands

5.Othermedicalequipmente.g.intravenousinfusionpumps,pulseoximeters,etc.NOTCONNECTEDTOPATIENT

6.Medicalequipmente.g.intravenousinfusionpumpsdripstand,pulseoximeters,etc.CONNECTEDTOPATIENT

7.Patientwashbowls


9.Patientfans

10.Bedsidealcoholhandwashcontainer,clipboards&noticeboards

11.Notes&drugstrolley

12.Patientpersonalitemse.g.cards,suitcase

13.Linentrolley


15.Walls

16.Ceiling

17.Alldoors

18.Allinternalglazingincludingpartitions

19.Allexternalglazing

20.Mirrors

21.BedsidepatientTVincludingearpieceforbedsideentertainmentsystem

22.Radiators

23.Ventilationgrillesextractandinlets

24.Floorpolished

25.Floornonslip

26.Floorsoftfloor

27.Pestcontroldevices

28.Electricalitems

29.Cleaningequipment

30.Lowsurfaces

31.Highsurfaces

32.Chairs

33.Beds

34.Lockers

35.Tables

36.Handwashcontainers

37.Handhygiene/alcoholrubdispensers

38.Wastereceptacles

39.Curtains&blinds

40.Dishwashers

41.Fridges&freezers

42.Icemachinesandhotwaterboilers

43.Kitchencupboards

44.Microwaves

45.Showers

46.Toilets&bidets

47.Replenishment

48.Sinks

49.Baths

Actualscore

Percentageattained

Room

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

0

1

1

1

1

1

1

1

1

1

1

11

1

1

1

0

1

47

96

Room

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

11

0

0

0

1

0

45

9

Room

1

0

1

0

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

0

0

0

0

0

0

0

00

0

0

0

1

0

4

69

Room4

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

x

1

0

1

0

1

1

1

1

1

1

1

1

1

0

1

1

1

1

1

0

1

1

1

1

1

x

xx

x

x

0

1

0

7

86

Room5

1

0

1

0

1

1

1

1

1

1

1

1

1

1

1

x

x

1

x

1

1

1

1

1

0

0

1

1

1

x

1

1

0

1

x

1

1

1

0

1

1

1

11

1

x

0

1

0

5

8

Room6

1

0

1

1

1

1

1

1

1

1

1

1

1

1

x

1

x

1

1

1

1

1

x

1

1

1

1

x

0

1

1

1

1

1

1

1

1

1

1

0

1

1

11

x

x

0

1

0

8

88

Room7

1

0

0

0

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

x

1

1

1

1

1

1

1

1

1

1

1

1

1

1

0

1

0

1

1

1

11

1

1

0

1

0

4

85

Room8

1

0

0

1

0

1

1

1

1

1

1

1

1

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

x

0

1

1

0

0

1

1

1

1

1

1

1

11

1

1

0

1

0

5

5

Room9

1

0

x

x

1

1

1

1

1

1

1

1

1

1

1

1

x

1

1

1

1

1

1

1

1

1

1

1

1

1

0

1

1

1

1

1

1

x

1

0

1

1

11

1

1

0

1

0

9

89

Room0

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1

11

1

1

0

1

0

47

96

Achievable

score

9

0

9

9

0

0

00000

000

9

8

7

0

9

009

9

0000

9

0

8

000

0

9

00

9

000

9

99

8

7

000465

Totalscore

9

4

7

6

9

0

00000

000

8

7

6

8

8

8

9

8

8

9

8

8

9

8

8

7

8

9

9

9

8

8

8

8

7

7

9

8

88

6

5

9

88

Percentagescoreachieved

Cleaningservice

########

Nursing

########

Estates

########

Functionalarea

Overallpercentagescore

#DIV/0!


35/52


in the NHS

Appendix 3


April 2007

Appendix Template cleaning auditscore sheet

NATIONAL CLEANING STANDARDS COMMENTS

RECORD

Functional area :

Audited by:

Date:

Room specific:

Problem:

To nursing/estates:

To other action:

Required:

Action:

Taken:


36/52


in the NHS

Appendix 4


April 2007

Appendix 4 External audit score sheetThis form may be used by the external audit team to structure theirreview/report.

In order to validate an overall score of a facility, one score sheetshould be completed. When reviewing an overall score for amulti-site trust, one score sheet should be completed for the trustas a whole. However, this score sheet should demonstrate howrepresentative the audit has been at all of the facilities concerned.

A copy of the completed form(s) should be left with the facility/trustunder review by the team leader

Name of trust:

Name(s) of facilities in the trust covered by this review:

Lead trust director:

External audit team names, role, positions and employing trust:

Date of audit:

Name of lead external auditor:

External audit scores

Insert scores arising from the review of functional areas chosen atrandom for inclusion in the sample.

Functional area name:

Risk category percentage:

Attained:


37/52


in the NHS

Appendix 4


April 2007

Quarterly percentage scores provided by the trust

Most recent quarterly summary score (quarter ending) per cent.

Comments by the external audit team, to be

completed if required

On the basis of the functional areas reviewed in this external auditand the information provided by the trust, we do (or do not) agreewith the either:

1. The most recent quarter score

and/or

2. The trusts overall score

We feel that ____ per cent reflects the standards currently beingachieved.

To be completed by lead auditor

Name:

Auditor:

Date:


38/52

7

Append

ix5Specimencleaningfrequencie

s

Element

Minimumcleaningfrequency

Veryhigh-risk

High-risk

S

ignificant-risk

Low-risk

1.Commodes,w

eighingscales,manualhandlingequipment

Cleancontactpointsaftereachuse


C

leancontactpointsaftereachuse

N/A

Onefullcleandaily

Onefullcleandaily

O

nefullcleandaily

2.Bathroomhoists



C





C


N/A

4.Dripstands



C


N/A

5.O

thermedicalequipmente.g.intravenousinfusionpumps,

pulseoximeters,e

tc.N

OTCONNECTEDTOPATIENT

Onefullcleandailyandbetweenpatient

use

Onefullcleandailyandbetween

patientuse

O

nefullcleandailyandbetweenpatientuse

N/A

6.Medicalequip

mente.g.intravenousinfusionpumpsdrip

stand,pulseoximeters,e

tc.C

ONNECTEDTOPATIENT


use


patientuse

O


7.Patientwashb

owls


use


patientuse

O



Onefullcleandaily

Onefullcleandaily

O

nefullcleandaily

9.Patientfans


use


patientuse

C

asedaily

Onefullcleanweekly

Onefullcleanmonthly

O

nefullcleanquarterly

10.Bedsidealcoholhandwashcontainer,clipboards&notice

boards.

Casedailyandbetweenpatientuse


patientuse

O


11.Notes&drug

strolley

Onefullcleanweekly

Onefullcleanweekly

O

nefullcleanweekly

12.Patientperso

nalitemse.g.cards,suitcase

Onefullcleandaily

Onefullcleandaily

O

nefullcleandaily

N/A

13.L

inentrolley

Contactpointsdaily

Contactpointcleandaily

C

ontactpointsdaily

Onefullcleanweekly

Onefullcleanweekly

O

nefullcleanweekly


Onefullcleandaily

Onefullcleandaily

O

nefullcleanweekly

15.Walls

CheckCleandaily

Onecheckcleandaily

C

heckcleanweekly

Checkclean

weekly

Dustweekly

Onefullcleanweekly(dustonly)

D

ustmonthly

Washingyearly

Onefullwashingyearly

W

ashingyearly

Washingonce

everythreeyears


39/52

8

Element

Minimumcleaningfrequ

ency

Veryhigh-risk

High-risk

Significant-risk

Low-risk

16.

Ceiling

Dustmonthly

Onefullcleanmonthly(dustonly)

Dustmonthly

Onecheckdustmonthly

Washingyearly

Onefullwashingyearly

Washingyearly

Washingthree-yearly

17.

Alldoors

Onefullcleandaily

Onefullcleandaily

Onefullcleandaily

Onefullcleanweekly

18.A

llinterna

lglazing

includingpartitions

Onefullcleandaily

Onecheckcleandaily

Onecheckcleandaily

Onefullcleanweekly

Onefullcleanweekly

Onefullcleanweekly

19.A

llexterna

lglazing

Onefullcleaneverythree

months


months


months

N/A

20.

Mirrors

Onefullcleandaily

Onefullcleandaily

Onefullcleandaily

Onefullcleanweekly

21.Bedsidepa

tientTV

incl.earpiecefor

bedsideen

t.system

Onefullcleandaily

Onefullcleandaily

Onefullcleandaily

N/A

22.

Radiators

Onefullcleandaily

Onefullcleandaily

Onefullcleandaily

Onefullcleanmonthly

23.

Ventilatio

ngrilles

extractan

dinlets.

Onefullcleanweekly

Onefullcleanweekly

Onefullcleanmonthly

Onefullcleanmonthly

24.

Floor-po

lished

Dustremovaltwofullclea

ns

daily

Dustremovalonefullclean

daily+onecheckcleandaily

Dustremovaldaily


weekly+onecheckcleanweekly

Wetmoptwofullcleansd

aily

Wetmoponefullcleandaily+

onecheckcleandaily

Wetmopdaily

Wetmoponefullcleanweekly

+onecheckcleanweekly

Machinecleanweekly

Machinecleanweekly

Machinecleanmonthly

Machinecleanquarterly

Strip&resealyearly

Strip&resealyearly

Stripyearly

Strip&resealtwice-yearly

25.

Floornon-slip

Dustremovaltwofullclea

ns

daily


daily+onecheckcleandaily

Dustremovaldaily


weekly+onecheckcleanweekly

Wetmoptwofullcleansd

aily

Wetmoponefullcleandaily+

onecheckcleandaily

Wetmopdaily

Wetmoponefullcleanweekly

+onecheckcleanweekly

Machinecleanweekly

Machinecleanweekly

Machinecleanmonthly

Machinecleanquarterly

26.

Softfloor

Twofullcleansdaily

Onefullcleandaily+one

checkcleandaily

Onefullcleandaily

Onefullcleanweekly+one

checkcleanweekly

Shampoosix-monthly

Shampoosix-monthly

Shampoo12-monthly

Shampootwice-yearly

27.

Pestcontrol

devices

Dustremovalonefullclea

n

daily


daily


daily


daily

Fullcleanmonthly

Fullcleanmonthly

Fullcleanmonthly

Fullcleanmonthly


40/52

Element


Veryhigh-risk

High-risk

Significant-risk

Low-risk

28.E

lectricalitems


daily


daily


daily


weekly

Fullcleanmonthly

Fullcleanmonthly

Fullcleanmonthly

Fullcleanquarterly

29.C

leaning

equipmen

t

Fullcleanaftereachuse




30.Lowsurfaces

Twicedaily

Onefullcleandailyandone

checkcleandaily

Onefullcleandaily

Onefullcleanweekly

31.H

ighsurfa

ces

Twiceweekly

Onefullcleanweeklyandone

checkcleanweekly

Onefullcleanweekly

Onefullcleanweekly

32.C

hairs

Dailyandonecheckclean


checkcleandaily

Onefullcleandaily

Onefullcleanweekly

33.Beds

Framedaily

Framedaily

Framedaily

N/A

Underweekly

Underweekly

Underweekly

Wholeondischarge

Wholeondischarge

Wholeondischarge

34.Lockers

Twicedaily


checkcleandaily

Onefullcleandaily

N/A

35.Tables

Twicedaily

Onefullcleandailyandtwo

checkcleandaily

Onefullcleandaily

Onefullcleanweekly

36.Handwash

containers

Daily

Daily

Daily

N/A

37.Handhygie

ne/

alcoholrub

dispensers

Daily

Daily

Daily

N/A

38.Wasterece

ptacles

Dailyandonecheckclean


checkcleandaily

Onefullcleandaily

Onefullcleandaily

Deepcleanweekly

Deepcleanweekly

Onedeepcleanweekly

Onedeepcleanweekly

39.Curtainsan

dblinds

Clean,c

hangeorreplaceyearly

Cleaned,changedor

replacedyearly

Cleanchangeorreplaceyearly

Cleanchangeorreplacetwice

yearly

Bedcurtainschangefour-

monthly

Bedcurtainschangesix-monthly

Bedcurtainsreplace12-monthly

40.D

ishwashe

r

Onefullandtwocheckclean

daily


checkcleandaily

Onefullcleandaily

Onefullcleandaily

9


41/52

Element


Veryhigh-risk

High-risk

Significant-risk

Low-risk

41.Fridges&f

reezers

Threecheckcleansdaily



Onecheckcleandaily

Onefullcleanweekly

Onefullcleanweekly(removea

ll

contenttoclean)

Onefullcleanweekly

Onefullcleanweekly

Defrostmonthly

Defrostfreezermonthly

Defrostmonthly

Defrostmonthly

42.Icemachin

esand

hotwaterboilers

Dailycheckclean

Onedailycheckclean

Onecheckcleandaily

N/A

Onefullcleanweekly

Onefullcleanweekly

Onefullcleanweekly

43.K

itchencu

pboards

Onefullcleanweekly

Onefullcleanweekly

Onefullcleanmonthly

Onefullcleanquarterly

44.M

icrowaves

Onefullandtwocheckclea

n

daily


checkcleansdaily

Onefullcleandaily

Onefullcleandaily

45.S

howers

Onefullandonecheckclea

n

daily


checkcleandaily

Onefullcleandaily

Onefullcleandaily

46.Toilets&b

idets

Threefullcleansdaily

Twofullcleansdailyandone

checkcleandaily

Onefullcleandaily

Onefullcleandaily

47.Replenishm

ent

Threetimesdaily

Threetimesdaily

Oncedaily

Onetimesdaily

48.S

inks

Threefullcleansdaily

Twofullcleansdailyandone

checkcleandaily

Onefullcleandaily

Onefullcleandaily

49.Baths

Onefullandonecheckclea

n

daily


checkcleandaily

Onefullcleandaily

Onefullcleandaily

40


42/52


in the NHS

Appendix 6


April 2007

Appendix 6 Specimen cleaningresponsibility frameworkThe table overleaf contains a specimen cleaning responsibilityframework which will assist trusts in ensuring all items which requirecleaning are cleaned, regardless of whether they are included indomestic services schedules and regardless of who has responsibilityfor cleaning them.

All frequencies, methods, responsibilities and comments areexamples only and should not be interpreted as requirementsor recommendations.

In completing this framework, trusts should have regard to theMicrobiology Advisory Committee manual which provides adviceand guidance on what level of decontamination is required, forexample, cleaning or disinfection.

What is suggested in the table does not replace manufacturersinstructions where applicable.

This framework should also not replace local infection control policy.For example, in the case of specific infections, a higher level ofdecontamination may be required.


43/52


in the NHS

Appendix 6


April 2007

Totalcleanin

gresponsibilityframework(i.e.clea

ningnotcoveredbydomesticservic

es)

Items

Time

(mins)

(estd)

Frequen

cy

e.g.daily/

weekly

Method(seeprocedures)

Staffgroup

responsible(ward

staffmeansany

healthcareorclinical

staffasappropriate)

Comm

ents

Frequency

(forlocal

determination

-seeappendix5

forguidance)

Wardpatientequipment

(medical)

IVstand

W

Detergentwipes

Wardstaff

Includ

ewheels

IVpumps/syrin

gedrivers

W

Detergentwipes

Wardstaff

Clean

edbymed

physa

fterrepair

Cardiacmonit

ors

DandAU

Detergentwipes

Wardstaff

Clean

edbymed

physa

fterrepair

Bloodgasmac

hines

W

Alcoholwipes

Wardstaff

Clean

edbymed

physa

fterrepair

Dressingtrolle

ys

W

Detergentwipes

Wardstaff

Includ

ewheels

Linentrolleys

Wa

ndA

U

Detergentwipes

Wardstaff

Includ

ewheels

Teatrolleys

Wa

ndA

U

Detergentwipes

Wardstaff

Includ

ewheels

Notestrolleys

W

Detergentwipes

Wardstaff

Includ

ewheels

Drugstrolleys

W

Detergentwipes

Wardstaff

Includ

ewheels

Sharpsbintrolleys

Wa

ndA

U

Detergentwipes

Wardstaff

Includ

ewheels

Bloodpressurecuffs

DandAU

Alcoholwipes

Wardstaff

Clean

edbymed

physa

fterrepair

Pillows

AU

Det/water/bowl/disposable

cloths

Wardstaff

Mattresses

AU


cloths

Wardstaff

AU=Afteruse

D=Daily

W=

Weekly


44/52


in the NHS

Appendix 6


April 2007

Items

Time

(mins)

(estd)

Frequen

cy

e.g.daily/

weekly

Method(seeprocedures)

Staffgroup

responsible

Comm

ents

Frequency

Cotsides

AU


cloths

Wardstaff

Wheelchairs

W


cloths

Wardstaff

Coinopwheelchairs

W


cloths

Mobility?

Commodes

D


cloths

Domestic(TBC)

Cushions

AU

Detergentwipes

Wardstaff

Oxygensatprobes

AU

Detergentwipes

Wardstaff

Clean

edbymedical

Physa

fterrepair

Washbowls

AU


cloths

Wardstaff

Invert

todry

Pressurereliev

ingmattress

CVRS

AU


cloths

Wardstaff

Hoists

D


cloths

Domestic(TBC)

Patslides

2007 national spec for cleanliness in the nhs

Documents