1. The Health Roundtable Cleaning clinical areas without chemicals Research and methodology Presenter: Elizabeth Gillespie Hospital Code Name: Monash Health Poster Session HRT1306 – Best Practice Health Service Cleaning 18 th and 19 th April 2013 Sydney

2. The Health Roundtable KEY PROBLEMS  Major delays  Two-step cleaning 160minutes & $142 to complete (182 per week)  Dry cleaning required for window drapes, significant delays and $100 per window.  Evidence of transmission in some areas ?? environment implicated  Evidence of 2-step cleaning compromised at times when workforce overloaded and under resourced

3. The Health Roundtable AIM OF THIS INNOVATION  Eliminate the delays.  Improve the overall cleaning results – ie removal of environmental contamination at every discharge  Reduce OH & S risk  Reduce infection risk  Reduce environmental footprint

4. The Health Roundtable BASELINE DATA -  Literature search to view latest cleaning options  Desktop testing to determine possibilities  Assessments incl:  visual, flourescence, bioluminescence (ATP) and microbiological  Using ATP  10% bioburden remained after cleaning with detergent and water  4% bioburden remained after 2-step cleaning  2% bioburden demonstrated after MFC & steam  Development of daily and discharge cleaning protocols  Commenced pilot in 32 bed acute ward and 60 bed aged care facility  Conducted before and after data collection

5. The Health Roundtable KEY CHANGES IMPLEMENTED  Pilot (microfibre and steam technology) remained on request of cleaning staff and implementation plan developed for remainder of 2150 bed health service  Extensive training for cleaning staff  Credentialing of cleaning staff - certificate issued  Chemicals eliminated  Specific protocols/procedures developed - daily, discharge OR, ED  Two step cleaning eliminated  One discharge procedure regardless of the patient’s perceived risk.  OH&S risk reduced  Water useage reduced 90%  100 mins [$142] saved per discharge clean (where previously 2-step)  Cleaning staff excited & happy  Cleaning assessments based on evidence using fluorescent marker & ATP

6. The Health Roundtable OUTCOMES SO FAR  Favourable feedback from cleaning staff via focus groups  2-step discharge cleaning reduced by 100 minutes  Water use reduced by 90%  ATP testing demonstrated bioburden reduced to 2- 4% for discharge cleans  Visual audit result improved from 91% to 96% in acute care  Detergent and disinfectant eliminated for environmental cleaning (100% saving)  VRE & Clostridium difficile able to be removed  Fluorescent marker a positive teaching tool and cleaning assessment methodology  Demonstrated success during a gastro outbreak

7. The Health Roundtable LESSONS LEARNT  Collaboration between infection control and cleaning service improves outcomes  When cleaning staff are very well trained & credentialed they demonstrate superior cleaning expertise.  Careful evaluation of the cleaning process using fluorescent markers – low cost system (~10 cents per room) enables detection of issues.  Involvement of infection control in cleaning processes important since 20 – 40% of hospital acquired infections are attributed to cross infection via contaminated environmental surfaces.