Introduction to the cleaning standards program

Page content: How the cleaning standards were developed | What is a cleaning standard? | The 2007-2008 review of the cleaning standards | Auditing | Reporting and benchmarking

Cleanliness in health facilities plays an essential role in preventing the spread of organisms that can cause health care associated infections (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.

How the cleaning standards were developed

‘Cleaning standards for Victorian public hospitals’ were first published in 2000 following an informal survey on infection control practices conducted by the Department of Human Services (the department) in 1998. In response to the need for cleaning standards, Eastern Health (then the Inner and Eastern Health Care Network) was commissioned to develop outcome-based cleaning standards for all Victorian public health facilities. Between May and November 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 very 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 2004/2005 and again in 2007/2008.

What is a cleaning standard?

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 charts that give elements a weighting according to where they are located.  The complete set of standards can be found on the 2009 cleaning standards page.

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The 2007-2008 review of the cleaning standards

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 statewide 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 eForms) and the requirement for each health 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 2009 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 2009 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.

Auditing

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.

There are no restrictions on who can perform internal cleaning standards audits; however from 2010 only qualified Victorian cleaning standards auditors (QVCSAs) will be able to perform external audits.  Further information about how to find a QVCSA can be found in the Auditors page.   

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 organisational, 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 to go 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 appropriated meetings – for example, quality and risk – and included in health service quality reports.

Reporting and benchmarking

The cleaning standards are a performance requirement of the department for Victorian public hospitals and health services.  The cleaning standards can be applied to all Victorian health facilities, regardless of whether their cleaning services are contracted or performed in-house.

Until the end of 2009 health services are required to submit results for one (1) internal and (1) external audit per year.  The results of the statewide external cleaning standards audits for 2006/2007 and 2007/2008 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 bench mark their audit scores with scores from other facilities similar to their own and with data expressed regionally. 

From 2010 health services will no longer be required to submit scores for internal audits however they will be required to submit scores for three (3) external audits per year.  A health service’s program of internal auditing and outcomes will be one of the things that will be examined when qualified auditors undertake external cleaning standards audits.

Each health service should identify how the cleaning standards audit data (both internal and external) will be reported within 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, the cleaning contract manager and the board of management. Reports should detail variances and action plans where appropriate.

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