European Cleaning Journal editor Michelle Marshall visits Beaumont Hospital in Ireland - which has the busiest accident and emergency department in the country. She finds out how hygiene standards have improved dramatically thanks to the close partnership between hospital management and the cleaning contractor, Resource Group.

Based in Dublin, the Irish capital, Beaumont Hospital provides emergency and acute care services to a local community of around 300,000 people. It also houses the busiest accident and emergency (A&E) department in the country and is a national referral centre for neurosciences and transplantation. Employing over 3,500 people and housing 800 beds, Beaumont is also one of Ireland's leading teaching hospitals.

Responsible for this highly challenging cleaning contract is Resource, the largest support services company in Ireland with a turnover of €150 million and 15,000 employees across the UK and Ireland. It won the contract at Beaumont in 2007 for a fixed period of one year with the option of two one-year extensions. Last year it retained the contract for a further year and now has a team of over 150 dedicated staff providing general cleaning services, specialist cleaning and window cleaning. Female operatives account for 70 per cent and 80-90 per cent are foreign nationals (all of them must speak English in order to get past interview stage at the hospital).

Illie Pop is service delivery manager for the contract - having been promoted through the ranks from cleaning operative he is clearly well respected by management and staff alike and is central to the efficient running of the operation. He explained how the contract is structured. "We clean the bed spaces of the hospital using discharge teams, where operatives are divided into teams of six, with a supervisor. Each time a patient is discharged, the hospital staff simply log a call to us and one of the teams goes in immediately to clean the bed and the area around it."

Pop continued: "When each call comes in, we ask whether there have been any infections that may require particular cleaning. For example with C.diff cases we deep clean using Hypochlorite and steam clean following a colour coding procedure.” Resource aims to be at the forefront of infection control techniques.

This method of working in teams maximises the efficiency and turn-around for new admissions to bed spaces as well as ensuring infection control benefits. Resource divides the hospital into zoned areas and operatives stay working within their designated area. "We have found this to be the most effective way of working," explained Roisin Dumigan, business development manager. "Operatives are assigned to specific wards and there is a supervisor on each floor."

Round-the-clock service

The discharge teams are generally available from 9am to 7pm but will stay longer if required by the hospital. A night shift starts at midnight and those staff clean the main corridors, stairs and other units that cannot be accessed during the day. The evening shift starts at around 4.30pm and this team looks after lecture theatres, laboratories, kitchens etc. Daytime cleaners work from 8am and finish at various times. Naturally there must be a round-the-clock service in the A&E department.

As Broni explained, setting out a specification on a contract like this is extremely challenging because a level of flexibility always has to be taken into account. "We must be reactive because situations change by the hour in a hospital like this. For example, it may be necessary to deep clean and decontaminate a ward at short notice."

Resource operatives are responsible for collecting clinical and non-clinical waste, bagging it and taking it to waste stations situated around the hospital. Also under their remit is regular refilling of the alcohol hand gel dispensers dotted throughout the building.

Fiona Edwards is head of hygiene and general services at Beaumont Hospital and she explained why the contract with Resource works so well. "What we really appreciate is the close relationship between us. For example if there's an issue to deal with we don't say it's Resource's problem - all problems are our problems."

The role of each and every cleaning operative is clearly crucial to the operation's smooth running and this is very much recognised by both client and contractor at Beaumont. Staff turnover has reduced dramatically since Resource took over -only six members of staff have left this year and sick leave is under three per cent. Edwards continued: "Back in 2004/5 the cleaners were seen as being separate from hospital staff, they were employed by the contractor and kept apart. Now the cleaners still wear Resource uniforms and they are visible as being from Resource but they see how they make a real difference to the running of the hospital and they are acknowledged for making that difference."

Twice a year cleaning staff have the opportunity to meet with Edwards personally so she can update them on changes in management etc, and invite them to raise any matters of concern to them. "Because we have total transparency with our contractor, I can treat Resource's staff as my own and speak to them whenever I like," she said.

The hospital runs regular in-house courses offering information about issues such as hand hygiene, influenza and norovirus. Cleaners are invited to attend any sessions appropriate to their job function along with all other hospital staff - another way in which they are encouraged to feel part of the team. "Cleaners are recognised as being just as crucial as any other staff in the hospital," said Edwards. "This is well illustrated in our contingency plans for dealing with H1N1 virus, where cleaning is classed as a top priority and cleaning operatives are classified as frontline staff."

Staff recognition at the core

Some of the cleaners at Beaumont Hospital have, in fact, been there longer than many of the clinical staff and the management is keen to recognise and acknowledge long service and retirements. Broni explained that Resource also runs award schemes for staff on a monthly and annual basis, based on performance, attendance etc. "Recognition of our staff is at the core of Resource's values," he said, "along with training." He firmly believes the success of contracts such as Beaumont can be partly attributed to the opportunities offered by the company's own training academy.

When a new member of cleaning staff joins Beaumont they are assigned a 'buddy' to offer them guidance and support. Everyone is trained to British Institute of Cleaning Science (BICSc) standard and their training 'passport' tracks their progress through the company. This commitment to the workforce very much impresses Beaumont Hospital as a client, Fiona Edwards pointed out.

Edwards also explained the positive effects of a more efficient cleaning operation on cases of hospital of acquired infections (HAIs). These have decreased dramatically. "Hygiene is now a key performance indicator (KPI) at board level. This covers a host of aspects other than cleaning - laundry, hand hygiene, waste management for example, and it has been a major focus area. We have changed the whole perception of the hospital through dealing with hygiene."

Standards for hospital hygiene were set in 2007 by the Irish Health Information and Quality Authority (HIQA). These brought a new scoring mechanism consisting of categories: 'very good', 'good', 'fair' and 'poor'. "In 2007 we were awarded the 'good' award and were one of only seven hospitals nationally to achieve this rating. No hospital achieved the 'very good' rating. In 2008 we again achieved a 'good' rating and were in the top four hospitals nationally," said Edwards. "In 2008 we were very happy to have doubled our 'A' rating scores and we continue to aim for improvements yearly." The number of complaints received by Resource has also seen a dramatic drop.

Monitoring of cleaning standards is an important focus for the hospital and on Wednesday of each week there is a multi-disciplinary audit of hygiene. A team of seven or eight people representing Resource and the hospital decide at random which areas they will inspect. From a strict set of criteria they carry out their inspection and anything less than 85 per cent is a failure. "Failures are rare and the average has been 90 per cent so far this year on hygiene," said Roisin Dumigan.

Both Resource and Beaumont are confident of meeting HIQA standards this year. Edwards explained how new standards coming in next year will focus more on infection control. "Things are moved forward a great deal now that standards do exist," she said. "The structures and governance have to be in place or the service aspect doesn't work on a continuous basis."

The state of the facilities generally has been much higher on the list of priorities in recent years and much effort has been put into the décor and general environment of the hospital, as well as the cleanliness. "The hospital is now brighter, cleaner and more pleasant to be in," explained Edwards, "and that has proved to be most important from the feedback we receive from staff and patients." This is evident when walking around the building, which is painted in bright and uplifting colours.

The contract will go out to tender again next year - when it may be a hygiene contract made up of different services - and Edwards explained that price and quality scored equally in the past when evaluating bids. "We are certainly under pressure to save money and be more efficient but we will not compromise on hygiene because in the long term it is more costly to have higher infection rates etc, plus we absolutely must meet HIQA standards.”