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Last Updated: Wednesday, 13 July, 2005, 18:07 GMT 19:07 UK
Cleaning Standards

cleaner mopping a floor
photo: Mark Stephens/AP
In July 2004, the government published a new set of national standards for healthcare in the NHS. There are 24 core standards which set out 'the minimum level of service patients and service users have a right to expect'.

These standards matter to hospitals, because in September 2006, each trust's performance against them will be published by the healthcare commission. On this basis, in place of the current system of star ratings, the public will learn how each trust rates on a four point scale ranging from weak to excellent.

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Cleanliness is included in these standards. Standard C21 states that health care services should be provided in environments which 'promote effective care and optimise health outcomes by being well designed and well maintained'. A dirty hospital, where hospital-acquired infections are prevalent, is clearly not one which would meet this standard.

The level of cleanliness which the government requires in this standard is set out in the 'National specifications for Cleanliness'. These are incorporated into the seventy-eight page document "Revised guidance on contracting for cleaning" which was published in December 2004.

The full document is available on the department of health site:

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Contract cleaning in the NHS is a competitive market which embraces a host of multinational companies like 'Initial Hospital Services' who employed our reporter Shabnam Grewal to work in Birmingham Heartlands. These companies are able to bid against in-house teams for contracts.

The area should be tidy, ordered and uncluttered with only appropriate, cleanable, well-maintained furniture used. Any presence of blood or body substances is unacceptable
From 'Revised Guidance for Contract Cleaning'
The declared purpose of this document is to ensure that throughout the NHS future contracts for cleaning "are driven by quality rather than price." By insisting that Hospital managers are responsible for standards of cleanliness and setting those standards out, the government hopes that managers will begin to scrutinise more thoroughly the work of the cleaning agencies who they award contracts to and not just opt for the cheapest. When the contract comes up for renewal, there should not just be an effort to force down costs but also to work to deliver higher standards.

Not all areas in a hospital should be cleaned in the same way. It is clear that an operating theatre requires more frequent and intense cleaning than a general ward might and that a general ward needs to be cleaner than an office which stores patient files. There are standards for how quickly problems should be rectified which depends on the level of risk in each area.

Appendix One of this document goes on to specify the standard that each 'element' in a hospital should be cleaned to: from beds to light switches. There are 49 elements in all.

In terms of overall appearance, for example, it states "The area should be tidy, ordered and uncluttered with only appropriate, cleanable, well-maintained furniture used. Any presence of blood or body substances is unacceptable".

Surfaces, beds (including mattresses, frame and castors), chairs and curtains 'should be visibly clean with no bloody or body substances, dust, dirt, debris, adhesive tape and spillages.' Sinks, baths and toilets should meet that standard and be free of 'lime scale, stains and spillages. Plugholes and overflow should be free from build-up.'

In chapter 2 it goes on to set out how frequently each of these elements need cleaned in order to meet the standards. (See the table at 2.10) For example, even a patient's personal items such as suitcase, cards or toys should be given a full clean daily and be cleaned between patient use (that is when passed from one patient to another). A bed frame should be cleaned daily, the underside of the bed weekly and the whole bed when a patient has been discharged.

In the final part of this document, Hospital managers are additionally asked that when they award cleaning contracts they look at the training and recruitment of cleaning staff, the management of the contractor, the plans the contractor has to inspect and ensure quality, the equipment and product the contractor plans to use and of course the price, which remains the single largest determinant of who gets the contract.

On training it states that "cleaning personnel receiving continuous training are more likely to show greater motivation and commitment to the industry." However this is an issue which would be handled at a local level between the contractor and the trust's management. Unlike the 'Specifications for cleanliness' contained in chapter 1, it does not feed into the criteria on which a hospital will be rated by the Healthcare Commission.

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