Weighting & scoring
Weighting refers to an aspect of the auditing and scoring process that reflects the importance of various elements within different functional area risk categories.
Although each element should be cleaned to the required standard regardless of where it is located, door handles in a record storage and archive area pose less of an infection risk than door handles in an intensive care unit (ICU) and are therefore weighted accordingly when audited. Likewise the required cleaning standards are important in low risk functional areas such as an administrative area but critically important in very high risk funcwrittetional areas such as an ICU. Therefore functional areas are risk categorised and weighted accordingly when audited.
Weighting also addresses the urgency for rectifying identified problems within each functional area risk category. Weighting is expressed numerically for the purposes of scoring cleaning standards audits. Both the timeframe for addressing problems and the numerical expressions are linked to the concept of risk and required levels of cleaning frequency and intensity.
The following table demonstrates the relationship between numerical weighting of functional area risk categories, the level of cleaning frequency and intensity needed to meet the required standard, and the timeframe for rectifying and re-auditing any problems identified through the cleaning standards auditing process.
|Numerical weighting||Functional area risk category weighting||Required level of cleaning frequency and intensity||Timeframe for rectifying identified problems and re-auditing|
|7||Very high risk category A||Critically important: constant||Immediate|
|6||High risk category B||Highly important: frequent||0–48 hours|
|4||Moderate risk category C||Very important: regular scheduled basis and as required in between||2–7 days|
|2||Low risk category D||Important: infrequent on a scheduled or project basis||1–4 weeks|
An audit score sheet is provided in the cleaning standards. A separate audit sheet should be used for each functional area. Examples of a functional area include:
- a general ward area comprising a number of rooms including toilets, bathrooms and showers, sterile and non sterile stock storage areas, utility rooms, day room, pantry and a nurses station
- an operating theatre complex or department comprising recovery, operating theatres, sterile storage area, scrub rooms, anaesthetic areas, toilets and other rooms
- an outpatients area comprising a number of treatment rooms, office area and utility rooms
- a department such as a physiotherapy department comprising a number of treatment rooms, rehabilitation area and offices.
Sampling within a functional area should ensure that all types of rooms are audited (for example, bathrooms, toilets, offices, bedrooms and pantries) and that approximately 20 per cent of the functional area (by square metre area) is audited. The 20 per cent sampling within clinical functional areas should be biased towards clinical and patient areas, and not towards offices and non-clinical rooms within the functional area.
Where a room or area is used for a number of different purposes with different risk weightings, the purpose with the highest risk weighting should be applied when auditing. For example, a treatment room may be used for performing invasive procedures (very high risk category A) on some days as well as for outpatients’ consultation on other days (moderate risk category C). In this example, regardless of the purpose the treatment room is being used for on the actual day of the audit, the treatment room would be audited as a very high risk category A area.
Where there are offices, tearooms and storerooms attached to very high risk category A areas, the design and layout on the area may influence what category these areas should be audited as.
For general internal and external audits, all 15 elements relevant to a functional area should be assessed. Every element should be assessed as either acceptable or unacceptable based on the written cleaning standard for each element.
Auditors need to exercise discretion and commonsense when making judgements about the acceptability or unacceptability of an element, taking into account the degree of associated risk. For example, one or two scuff marks on a floor, or an isolated smudge on a window does not indicate that that element should fail. The element must consistently fail across the functional area to be recorded as unacceptable; for example, smudges would need to occur on several windows within the functional area for that element to fail. However, in the case of a blood or bodily fluid spill, the element would automatically fail if this was evident once in a functional area.
Auditors should also take into account the condition of the infrastructure in making an assessment. For example, it may be impossible to achieve a uniform lustre on a damaged floor surface. In this case the element is deemed unacceptable but the reason must be noted with a directive to contact the appropriate person to resolve the issue.
A demerit-based system is used for scoring. A functional area starts with 100 points and points are deducted when an element within the functional area fails. The weighting given to each element within different functional area risk categories distinguishes the relative importance and risk. The process of scoring is the same for both internal and external audits.
Scoring a functional area
Using the audit score sheet in the cleaning standards, the auditor(s) record the functional area under audit (for example, ICU), the date and their names. The auditor(s) assess and score each element within the functional area; an element scores zero (0) if it is acceptable resulting in no points being deducted from 100. An element scores one point (1) if it is unacceptable.
When the audit of a functional area has been completed weightings are applied to the elements that scored 1. The cross-reference charts contained in the cleaning standards are used to determine the actual demerit points for each unacceptable element. For example, if the functional area is the ICU and an element that scored 1 (unacceptable) was the ‘patient equipment’ element, the actual demerit points that would be recorded in column D would be 7. If an element that scored 1 (unacceptable) was the ‘pantry fixtures and appliances’ element, the actual demerit points that would be recorded in column D would be 6. All the demerit points recorded in column D are added up and the total is subtracted from 100.
Example: scoring a functional area
(The functional area in this example is the ICU).
|Element||Comments||0, 1 or
|External features, fire exits, stairwells||0|
|Walls, skirtings and ceilings||0|
|Ducts, grills and vents||0|
|Electronic fixtures and appliances||0|
|Pantry fixtures and appliances||1||6||0–48 hours||√|
|Toilets and bathroom fixtures||1||7||Immediate||√|
|Furnishings and fixtures||0|
|Total demerit points (add column D)||20|
|Score: (subtract the total of column D from 100)||80|
In the example above the ICU scored 80.
Scoring a functional area risk category
Once all functional areas have been scored, an average score for each functional area risk category should be obtained for both an internal and an external audit of a health facility. To obtain an average score for each risk category the auditor should add the scores for all functional areas in a risk category together and divide the total by the number of functional areas that were audited.
On the following page is an example of how a functional area risk category is scored.
Example: scoring a functional area risk category
(The functional area risk category used in this example is high risk category B).
|Coronary care unit||100|
|Level 1 nursery||90|
|Medical ward south||86|
|Surgical ward west||86|
|Surgical ward south||82|
|Sterile stock storage||94|
|Pharmacy clean area||90|
|Total score of all functional areas||873|
|Number of functional areas audited||10|
|Functional area risk category score:
(divide the total score of all functional areas by the number of functional areas audited)
In the above example the health facility scored 87 in their high risk functional area category B.
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.