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Ensuring Cleanliness in hospitals

General cleanliness requirements

The cleanliness activities taken up by the hospital need to ensure minimum following:

  • There is no visible dirt/grease/stains in any area of the hospital including roof top, floors and walls
  • There are no cobwebs/bird nests and other incubations due to pests and animals
  • There is no seepage on the roofs and walls of the hospital
  • Patients mattresses, furniture, fixtures are without grease and dust
  • There is no foul smell in any area of the hospital
  • The floors of the different areas of the hospital are kept dry. When wet mopping is used, appropriate safety measures need to be adopted by the hospital like use of signage (Wet Floor)
  • There is availability of appropriate cleaning and disinfection materials and equipment needed for different areas.
  • The hospital uses standard methods of cleaning for different areas
  • The hospital ensures that monitoring of cleanliness activities is done at pre-defined intervals and corrective actions are taken when needed
  • The drainage and sewage is well maintained to avoid any leakage, blockage and easy flow through the drain.

Process

The best way for improving the cleanliness at health facilities would be to follow conventional time tested approach of PDCA cycle -

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The Medical Superintendent or the Head of Facility must plan as to what he / she wants and then work on the how to implement the processes.

Human resources

Number of sanitary staff :Though the IPHS Guidelines have recommended number of staff for this purpose, actual requirement would be dependent on case load of the facility.

A single person can manually clean upto 250 sq. m per work shift.1 The more important issue is that the staff should be available on 24 x 7 basis as per requirement.

The standard recommended by the IPHS for a 100 - 200 bedded hospital is 15 sanitary workers + 7 for the emergency OT (3) and main OT(4) put together + 1 for the blood store. (Total of 23 workers) pooled into a central pool corresponds to the general recommendation of 01 sanitary worker for 10 beds with a 10 % leave relief.

Rotation of staff in critical areas like OT, Laboratory, ICU & Wards may be kept at minimum.

Responsibility and accountability : An in-house Housekeeping in-charge should be appointed with a direct reporting to the Facility In-charge or the Nursing In-charge. In case of the sanitary staff’s number is more than 30, an additional sanitary supervisor (01) can be appointed for every additional15 sanitary workers. The housekeeping responsibility should bedelegated through the in-house supervisor to the contractor’s supervisor to maintain single chain of control thus ensuring better supervision and accountability. However it must be emphasized that the responsibility of keeping an area / department clean lies with the in-charge of that area / department. He / she should co-ordinate with the Housekeeping supervisor for deputing the staff for their respective departments.

The common areas should be directly supervised by the housekeeping supervisor.

Skills and competency : The housekeeping / safai staff deployed in health care facilities must be sensitized for the importance of a clean hospital and its surroundings and also to the requirements specific to such facilities. They must also be sensitized to the fact that they are also vulnerable to Hospital Acquired Infections (HAI)&Occupational hazards and must be adequately trained on prevention and reporting of them.

Rational Deployment : Rational deployment of the sanitary staff in shifts must be planned prior and implemented properly so that the cleanliness is maintained continuously. Areas with no or very minimal patient interaction and visitors like the office and stores can be cleaned once a day and can be grouped with other such areas whereas the critical areasare required to be cleaned more frequently

Infrastructure - issues of design and inadequacy

  1. Poor design of the facility and toilets are often not conducive for cleanliness with poor drainage and sewage facilities. Attempts should be made to correct the civil infrastructure over a period of time e. g. gradient of drains, installation of overhead tank in each block, de-silting and repair of septic tank, etc.
  2. A facility should have an adequate number of toilets and bath facilities, which would largely depend upon the case load.
1.
Water Closet 1 for every 8 beds (male)
2.
Ablution Taps 1 for each water closet plus 1 water tap with drainage arrange-ment in the vicinity of water closet.
3.
Urinals 1 for every 12 beds (Male Only)
4.
Wash Basin 1 for every 12 beds
5.
Baths 1 bath with shower for every 12 beds
6.
Bed pan washing sink 1 for each ward in dirty utility and sluice room
7.
Cleaner’s sinks and sinks/slab for cleaning mackintosh 1 for each ward in dirty utility and sluice room
8.
Kitchen sinks 1 for each ward in ward dishwashers pantry

Adequate water supply

Adequate water supply must be ensured for the cleaning activities. Requirement of an average hospital is given below.

Water Requirement of Health Facilities

Number of beds Amount of water in litres per day per bed
25-100 350
101-300 400
301-750 450

Outsourcing of Housekeeping Services:

Outsourcing of the housekeeping service should be considered. A comparison shows that for bigger facilities with more staff, outsourcing of the services will be more useful. A comparison of both approaches is given below.

Comparison of in-house vs outsourced service

1. Number Fixed as per the authorization Can vary depending on workload
2. Control Direct control Through contractor
3. Discipline Long drawn administrative process Responsibility of contractor
4.Continuity of staff Assured hence standard of service can be more stable Staff can keep on changing hence standard of service can vary
4. Leave / Availability of staff No leave relief Contractor provides leave relief if so specified in the TORs
6.Job description As laid down by authorities As per the TORs of contract
7.Ensuring quality At times difficult to maintain Deliverables should be clearly spelt out with inbuilt penalties for poor performance
8. Decision making – whether in-house or outsourced Less than 10 staff are required More than 10 staff are required

The TORs for the outsourcing of the service should be clear and unambiguous rather than laying down just the number of staff required. It should include the standards of service, methodology, deliverables, monitoring practises and penalties for deficient services.

Patients and visitors to the facility

For maintaining high standards of cleanliness, involvement and cooperation of patients and the visitors would be of paramount importance. This could be achieved by appropriate BCC & IEC activities. Help of non-governmental RKS members, PRI members, NGOs and local body members should be taken in spreading awareness among patients and visitors.

Source: Swachhta Abhiyaan Guidelines for Public Health Facilities



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