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It is a well known fact that a systematic approach to cleaning in a medical environment helps to control infection and ensure patient well being. Individual practices in the medical, dental and even veterinary sectors benefit from Shields systematic approach.
We worked tirelessly throughout the COVID 19 Pandemic, in partnership with many NHS surgeries to ensure that they remained open and fit for purpose. Our services included COVID deep cleans, contactless fogging, hygiene cleaning, touch point cleaning and much more.
By a combination of accurate costing and adoption of best practice our clients now include Private Clinics, NHS Surgeries and Laboratories.
We are also familiar with the demands imposed by the Care Quality Commission (CQC) and have designed a methodology with our clients in the public health sector to maintain standards and achieve the required scores.
We have been cleaning medical contracts for over 20 years and we are proud of the part that we have played ensuring that our clients have passed their CQC Audits and been compliant with the previous National specifications for cleanliness in the NHS 2007 standards.
We can only be responsible for the cleaning and auditing of the elements that we are contracted to clean. We are dedicating our knowledge and expertise to our clients to help achieve the required standards through our blended responsibilities, with the joint aim of achieving the appropriate audit results. This should enable the desired star ratings to be scored as set out by the NHS Healthcare and Cleanliness Standard.
1. Auditing
We have developed our procedures to enable us to do the technical audits to the new standards, for the elements that we are responsible for cleaning. We will provide you with regular audit results which have been scored in line with the new standards, the practice will be able to use this information along with their own audits to produce the overall scorings. This process must be a collaborative approach due to many of the cleaning elements included in the audit process not being the responsibility of Shield staff to maintain and clean.
We will carry out an annual Efficacy audit to enable us to monitor and review the processes and procedures we have in place.
2. Detailed Cleaning Task Schedule
The ‘commitment to cleanliness charter’ requires specific tasks to be carried out routinely and evidenced. Our daily cleaning task schedule tick sheet will help with this and can be adapted to be site specific.
Due to the arrangements for cleaning that are in place between Shield Cleaning Services and our clients we can only be responsible for category F3 – F6. We are contracted to visit the premises once per day to carry out the areas we are responsible for cleaning, we would not be able to provide F1 or F2 response to cleaning in the time we have available. We would be happy to provide quotations for additional cleaning requirements or increased frequencies should our clients’ needs change.
3. Medical Sector Experience
We continue to deliver a high standard of cleaning to many medical contracts and have done for 20 years. We have a valued understanding of the specific requirements for cleaning medical sites.
We adhere to strict infection control, cross contamination measures, hazardous waste handling and disposal, with the appropriate training in place for our staff.
We have been completing daily task schedule check sheets for many years and have been providing site specific specifications which have been compliant to CQC standards throughout the years. Our Service Manager and Regional Manager have current certificates in level 2 courses in Infection Control and are working with our clients to meet the requirements of the cleanliness charter and responsibility framework.
Introduction to The National Standards of Healthcare Cleanliness 2021
All those involved in providing healthcare cleaning services should work towards high quality, safe cleaning services that meet the needs and expectations of patients, the staff and public, to contribute to the overall patient experience and to high quality patient-centred care.
Delivering a high-quality healthcare cleaning service is complex, demanding and not to be underestimated. The aim is to ensure all cleaning-related risks are identified, minimised, and managed on a consistent, long-term basis, irrespective of where the responsibility for providing cleaning services lies.
Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 requires that healthcare premises are clean, secure, suitable, and used properly and that a provider maintains standards of hygiene appropriate to the purposes for which they are being used. Further, the code of practice for preventing and controlling infections, and related guidance, states NHS bodies and independent providers of healthcare and adult social care in England must adequately resource local provision of cleaning services. They should also have a strategic cleaning plan and clear cleaning schedules and frequencies so that patients, staff, and the public know what they can expect.
An effective healthcare cleaning service should:
The National standards of healthcare cleanliness 2021 (the national standards) apply to all healthcare settings – acute hospitals, mental health, community, primary care, dental care, ambulance trusts, GP surgeries and clinics, and care homes, regardless of the way cleaning services are provided. They provide a common understanding of what it means to be a clean healthcare setting and give healthcare organisations in England a framework for detailing the required cleaning services and how ‘technical’ cleanliness and the efficacy of the cleaning process should be assessed.
They replace the National specifications for cleanliness in the NHS 2007 (and amendments) published by the National Patient Safety Agency, and the Healthcare cleaning manual, revised by the Association of Healthcare Cleaning Professionals (AHCP) in 2013. Together with the Health and Social Care Act 2008 and associated regulations, these provide an assurance framework to support compliance with the core cleanliness standard and the code of practice. The cleaning methodologies referred to are provided for guidance only.
The standards do not state precisely how cleaning services should be provided, e.g. by direct employment or contracting out. Such matters are for local determination. Ultimately, local management teams are accountable for the effectiveness of cleaning services.
The standards provide clear advice and guidance on:
Commitment to Cleanliness Charter
The Commitment to Cleanliness Charter sets out an organisation’s commitment to achieve a consistently high standard of cleanliness in all its healthcare facilities using the functional risk category, cleaning frequencies and cleaning responsibilities for each functional area.
The charter demonstrates an organisation is serious about providing a safe clean environment by referencing the new star rating system which reflects the cleanliness of the whole area regardless of who is responsible for cleaning it.
All organisations are required to display the charter where it will be seen – for example, in or near ward and department entrances, outside lifts used by the public, and in circulation areas and waiting rooms. Templates have been provided so that charters throughout the NHS are of the same standard and format, so easily recognised by patients, the public, and staff. We recommend the charter is printed on A3 paper as a minimum, so it is easy to read.
It may not be practical to display the charter in some areas, such as an ambulance. An organisation must always seek a derogation to confirm that it is acceptable not to display the charter by submitting their completed charter to nhsi.estatesandfacilities@nhs.net, together with details of how they propose to make it easily accessible.
Organisations can edit the charter template, e.g. to insert logos and contact details, but some fields and headings are fixed and cannot be changed, such as cleaning task, cleaning frequency and responsibility, as this information must be retained to appropriately inform patients, the public and staff about cleanliness. For this reason, Appendix 5 (separate document) gives more information on how to complete the charter, as well as editable templates for all functional risk areas and for blended areas, as well as worked examples.
Risk categories and standards for functional areas
All healthcare environments should pose minimal risk to patients, staff, and visitors, but because different functional areas do not carry the same degree of risk, they will require different cleaning frequencies and levels of monitoring and auditing. For example, a records storeroom will not require as frequent cleaning as an intensive care unit.
All functional areas must be assessed and assigned to one of six functional risk (FR1–6) categories.
Maximum timeframe for rectifying cleaning problems Priority of rectification Maximum timeframe for rectifying cleaning problems Rapid response items – this includes all areas regardless of functional risk rating where there is a health and safety, patient safety or IPC issue Assessment of task should be within 20 minutes with task completed in no longer than 1 hour Cleaning these items should be recognised as a team responsibility. Where necessary and cleaning staff are unavailable, e.g. at night, the task should be the responsibility of other ward or department staff. It is important that all tasks are clearly outlined and that all staff understand their responsibilities and methods of cleaning, including what the appropriate equipment and materials to use are:
FR1 Assessment within 20 minutes and task completed at the next scheduled clean or within 2 hours (if the area is accessible), whichever is soonest
FR2 Assessment within 20 minutes and task completed at the next scheduled clean or within 4 hours (if the area is accessible), whichever is soonest
FR3 Assessment within 1 hour and task completed at the next scheduled clean or within 12 hours (if the area is accessible), whichever is soonest
FR4 Assessment within 1 hour and task completed at the next scheduled clean or within 72 hours, whichever is soonest
FR5 Assessment within 24 hours and task completed at the next scheduled clean or within 96 hours, whichever is soonest
FR6 Assessment within 24 hours and task completed at the next scheduled clean or within 120 hours, whichever is soonest
Identifying the FR category for functional areas is the crucial first step in applying the standards: the cleaning, monitoring and audit frequency and audit target scores are all directly linked to this. Cleaning specifications – elements, cleaning frequencies and performance parameters.
Once an organisation has identified its functional area risk categories, it must produce a ‘cleaning specification’ with more detailed information on how cleaning will be carried out. This specification should include:
Organisations may also include information on who is responsible for cleaning each item (element), but this should be in addition to, not instead of, developing a cleaning responsibilities framework.
National colour-coding scheme
A national colour-coding scheme for all cleaning materials and equipment is widely applied throughout healthcare organisations to reduce cross-contamination risk between different types of area, e.g. bathrooms and kitchens. For example, cloths (reusable and disposable), mops, buckets and non-disposable gloves that are colour-coded red are only used in bathroom facilities. The colour coding is clear and permanent. Any deviation/derogation from this requires approval from NHS England.
Audit process
The integrity of the audit process is fundamental to providing assurance that an organisation is delivering safe standards of cleanliness. Accurate, honest, and open audit reporting underpins the ethos of the standards – to drive safe standards and continuous improvement, whether a cleaning service is insourced or outsourced.
Organisations must have a robust process and transparent approach to auditing, to ensure the new standards are met. The audit process will ultimately encourage quality improvements and must not be punitive.
There are three audits:
1. technical audit: checks and scores cleanliness outcomes against the safe standard.
2. efficacy audit: checks the efficacy of the cleaning process at the point of service delivery, i.e. the correct use of colour coding, equipment, materials, methodology, as well as supporting policies and procedures.
3. external audit: provides quality assurance and checks both the technical audit and the efficacy audit.
Shield Area Management will be responsible for carrying out regular Technical Audits on the areas that we are contracted to clean.
Technical audits
These regular audits, undertaken by appropriately experienced staff, are a continuous and integral part of the day-to-day management and supervision of cleaning services.
Technical audits should be randomly undertaken at different times and on different days, but with consideration for the frequency of cleaning and the cleaning schedule.
The time or frequency of cleaning and associated risk category need to be regularly reviewed and adjusted if indicated to continuously improve safe cleaning standards.
Auditors need to exercise discretion in judging the acceptability of any element (see Appendix 7 for the technical audit process – opens in a separate document), for example, one or two scuff marks on a floor, an isolated smudge on a window or a hand towel/tissue dropped on a floor in an otherwise clean area should not be scored as unacceptable.
The audit score must accurately reflect the standard of cleanliness at the time. The need for transparency and openness is paramount to drive continuous improvement, for example, if some areas fall below the standard it is important for Organisations must be able to identify any areas falling below the standard so they can act to resolve the underlying cause.
Our Management will complete a technical audit form and input it onto an electronic audit scoring sheet. The results will be shared with the practice and used to monitor and improve our service delivery if necessary. A copy of the technical audit will be emailed to head office service department to be stored on the contract file for future reference the audits will be kept for three years.
Efficacy Audit
Shield Senior Management will carry out an annual Efficacy audit to ensure we are compliant in all areas.
