The importance of designing out IPC risks

Source: NHE May/Jun 17

Lee Peddle, national chairman of the Association of Healthcare Cleaning Professionals and facilities manager – Soft FM at Central and North West London NHS FT, explains why estates changes must also factor in cleanliness and its associated infection prevention and control (IPC) risks.

When we are making estates changes, what are our priorities? We factor in service delivery and patient needs. We consider the accommodation and space requirements of both patients and staff. But do we always ‘think clean’? Do we always design in IPC right from the start? 

Despite considerable progress and improvement, hospital-acquired infections (HCAIs) continue to be one of the most common adverse events in healthcare delivery and a significant major health problem both within the UK and internationally. It is estimated that around 300,000 patients a year acquire a HCAI in the UK. International research shows that when healthcare facilities and staff are aware of infection problems and take all appropriate steps to prevent them, rates of HCAI can decrease by up to 70%.    

The Health and Social Care Act 2008 Code of Practice provides detailed criteria on how healthcare providers need to ensure compliance that service users are cared for in clean, well-maintained environments that minimise the risk of HCAIs.  

Designing out risk 

How do we ‘minimise’ the risk? As a cleaning professional, I can minimise the risk by having appropriate cleaning frequencies and techniques. I can minimise the risk by controlling the cross-contamination of cleaning equipment and materials. I can minimise the risk by ensuring all staff are well-trained and resourced to undertake their work. But, long before all of that, cleaning services can be supported in minimising the risk before they put a mop to the floor or a cloth to a surface.  This can be achieved by designing in cleaning and IPC right from the very start. Designing out as much of the risk as possible. That is true minimisation. 

One of the biggest challenges we face in the NHS is that the estate is growing older and more difficult to maintain with every passing year. Can we really afford to not comprehensively design in cleaning and IPC when we are completing new builds, redesigning and refurbishing buildings? It isn’t just about the large projects, factoring in cleaning and IPC within even the smallest of changes can make a significant difference and help reduce risk. 

Flooring has long been an area of debate in healthcare premises. are they really a risk area or is cleaning really more about appearance? A study completed in 2016 found that a non-pathogenic virus intentionally exposed to patient bedroom floors, which were only cleaned when visibly soiled, led to 77% of high-touch surfaces within those rooms being contaminated and 100% of adjacent rooms having traces of contamination. Whatever you believe, the fact is that soft floors and poor-quality hard floors are much harder, sometimes impossible, to effectively decontaminate. Additionally, they are often more time-consuming to clean, taking up time that could be used more effectively. 

It is essential that we continue to move towards hard flooring and wipe clean furniture only being used instead of carpets and soft furnishings in clinical areas. Additionally, hard flooring should be smooth, consistent, hard-wearing and have coving to reduce the trapping of dirt and debris in the edges and corners.  

Easily cleanable surfaces 

Few would disagree that touchable surfaces are a route of transmission. To support effective cleaning, it is essential that surfaces are easily cleanable. If a surface is not smooth and impervious then it is much more likely to harbour bacteria. It is also important that surfaces are hard-wearing and durable. Surfaces in clinical and patient areas should be able to withstand enhanced cleaning processes, including disinfection with chlorine-based products.  

Over the past few years we have seen a significant move towards hands-free operation of facilities with the implementation of sensor taps, automatic lights, hands-free toilet flushes and automatic doors. Given the ongoing and unquestionable relation between hand hygiene and infection, it is essential that the environment does its part to reduce risk. Door handles, for instance, are a significant mode of transmission. A recent study found that a single door handle contaminated with a virus had transmitted to more than 40% of workers and visitors in the facility within four hours.  Removing the door handle is the very definition of designing out risk. 

Designing in IPC and thinking clean does not, however, have to be expensive or radical — more simplistic methods of reducing risk still have their place. These can include limiting the number of unnecessary surfaces such as ledges and edging, which gather dust and encourage clutter, providing adequate storage facility to reduce clutter, and ensuring that wherever possible furniture is of a simple and easy-to-clean design. 

In 2013, the chief medical officer’s report on infections and the rise of antimicrobial resistance stated that the design, construction and maintenance of healthcare facilities had a substantial bearing on the risk of developing HCAIs.  

There it is, in black and white. The design and development of the NHS estate has its part to play in the fight against HCAIs. IPC is the responsibility of every employee, and prevention is most definitely better than cure. We should work together to design in IPC and ‘think clean’.




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