Introduction to the cleaning standards program
Cleanliness in health facilities plays an essential role in preventing the spread of organisms that can cause health care associated infection (HAIs).
Patients and the broader public expect that health facilities are kept clean and well maintained. Staff have the right to a workplace in which they are able to deliver health care services safely and effectively.
'Cleaning standards for Victorian public hospitals' were first published in 2000 following an informal survey on infection control practices conducted by the then Department of Human Services (the department) in 1998. In response to the need for cleaning standards, the development of an outcome-based cleaning standards for all Victorian public health facilities was commissioned. In 1999 the cleaning standards were developed by drawing on and evaluating existing cleaning standards in the health care sector and in other industries and from evidence available in the general literature.
The cleaning standards have been well received by the public health sector in Victoria and elsewhere. Several jurisdictions both within Australia and abroad have since adopted them. The cleaning standards were reviewed in 2005, 2007 and 2009.
The cleaning standards are designed to simplify cleaning assessments.
A cleaning standard is a statement that describes a desired outcome for cleaning an item or article. For example:
Shelves, bench tops, cupboards and wardrobes/lockers are clean inside and out and free of dust, dirt, and litter or stains.
A cleaning standard can also be a statement or series of statements that describe how critical the cleaning is. It is important that shelves in an administration block are cleaned to the required standard however it is critically important that the shelves in an operating theatre are cleaned with the highest level of intensity and frequency.
A surface, article or fixture to be cleaned is known as an element. An area in which cleaning occurs is known as a functional area. Functional areas are grouped into four risk categories. The relative importance of the cleanliness of an element or functional area can be assessed using cross-reference chart that give elements a weighting according to where they are located. The complete set of standards can be found on the cleaning standards page.
In 2007 the department invited representatives from across public metropolitan health services and rural regions to participate in a review of the 2005 cleaning standards.
Representatives formed the Victorian Cleaning Standards User Group (VCSUG) and provided expert advice and feedback during the review process. Input from this forum, as well as from other relevant stakeholders, was used to inform the review, as well as the development of a cleaning standards auditor training program.
The VCSUG reported that generally the cleaning standards had been accepted enthusiastically by public health services although a number of issues relating to the need for further clarification, refinement or inclusion/exclusion of some content were identified.
Reporting and benchmarking formats for audit performance indicator data were considered by the VCSUG, with a view to releasing state-wide data publicly via the department’s website. It was agreed that de-identified data would be released from April 2007. In March 2007 all public health services were notified of the introduction of an online electronic reporting format (the e-forms) and the requirement for each heath service to provide a generic email address for cleaning standards contact purposes.The VCSUG reported large variances in the frequency of auditing undertaken across regions and health care services. It was agreed that a minimum of three external audits should be undertaken annually by all health services. However, it was also agreed that this should not occur until training opportunities to provide additional external cleaning standards auditors had been developed. In 2008, and in collaboration with key stakeholders, an accredited Course in Cleaning Standards Auditing was developed. More information about the cleaning standards auditing can be found on the 2011 cleaning standards page.
With regard to internal auditing, the VCSUG recommended that the United Kingdom’s approach of determining frequency of auditing based on risk, with some modifications, should be adopted. The cleaning standards prescribe minimum frequencies for internal auditing of all risk categories.
Acceptable quality levels (AQLs) were considered in relation to cleaning standards audit scores. It was decided that AQLs would remain the same (85) except for the very high risk functional area category where the AQL has now been lifted from 85 to 90.There are changes to both the content and format of the 2009 cleaning standards to provide updated or additional information or to provide clarification; for example, cleaning equipment and cleaning/cleaners’ rooms have been added as a new element and a new functional area respectively.
As part of quality improvement and patient safety processes, health services require a comprehensive, continuous, systemic approach to monitoring cleaning outcomes within their facilities. Internal audits should be performed in all functional areas across all functional area risk categories. A systemic program of internal auditing, as well as the results of all internal audits undertaken, should be clearly documented.
A thorough knowledge of the cleaning standards and an understanding of health facilities processes are required for those undertaking both internal and external audits. Auditors should have appropriate communication and interpersonal skills including cultural sensitivity, conflict resolution and problem solving skills. Auditors should also possess organisation, planning and time management skills as well as the observation, analytical, numeracy and technology skills needed to conduct and report on auditing activities.
Cleaning audit scores should be equal to, or higher than, the specified AQL for each functional area risk category. The frequency with which any particular functional area should be audited depends on what functional area risk category it falls under. For further information about frequencies and AQLs go to the cleaning standards or the Overview of auditing.
Feedback should be provided to staff in individual functional areas and results of audits should be tabled at appropriate meetings – for example, quality and risk – and included in the health service quality reports.
Until the end of 2009 health services were required to submit results for one (1) internal and (1) external audit per year. The results of the state-wide external cleaning standards audits for 2006-07 and 2007-08 can be found on the Annual Reports page. Only de-identified aggregate data are published. Health services each have a code, known only to that health service, by which they can benchmark their audit scores with scores from other facilities similar to their own and with data expressed regionally.
From 2010 the auditing requirements changed to one (1) external audit and two (2) non external audits. The difference between an external and non external audit is; an external audit is undertaken by an auditor from outside the organisation, where the non external audits may be undertaken by an auditor that is an employee of the organisation. However, the person undertaking these three (3) audits must be a qualified Victorian cleaning standards auditor (QVCSA). Further information on how to find a QVCSA can be found in the Auditors page. Go to Data Submission for details regarding reporting timelines for 2010-11.
A health service’s program of internal auditing and outcomes will be one of the areas that will be examined when qualified auditors undertake all cleaning standards audits.
Each health service should identify how the cleaning standards audit data will be reported to their management structures. For example, reports on cleanliness will be relevant to the infection control committee/team, the infection control executive sponsor, the quality manager and board of management. Reports should detail variance and action plans where appropriate.
Any queries regarding Cleaning standards for Victorian health facilities can be directed to:
Infection Prevention Program
Telephone: (61 3) 9096 7324 or (61 3) 9096 7870