ECJ EUROPEAN Cleaning Journal

Healthcare environmental hygiene (HEH) is still mostly seen as an aesthetic or ‘cleaning’ issue rather than a clinical one, remaining undervalued and neglected in most hospitals. Paulo Brois, Elleni Rioja, Martina Mo?eni? and Alexandra Peters from Clean Hospitals tell us more about its work to foster international collaboration and raise awareness.

It is well-known that surfaces in healthcare facilities act as reservoirs for a variety of dangerous pathogens. Over the last 25 years, the scientific community has focused primarily on hand hygiene as the leading method to stop the spread of these agents. Around 50–70 per cent of all healthcare associated infections (HAIs) are transmitted through contaminated hands, and up to 30–50 per cent of the HAIs may be linked to environmental transmission.

Despite these numbers, healthcare environmental hygiene (HEH) is still mostly seen as an aesthetic or ‘cleaning’ issue rather than a clinical one - undervalued and neglected in most hospitals. A global pilot survey found that 98 per cent of participating healthcare facilities worldwide were lacking in at least one of the five major components of HEH.

In recent years, several well-designed studies have strengthened the evidence on the role of cleaning and disinfection of surfaces and shared equipment in reducing HAIs. One recent example is the CLEEN study conducted by Brett Mitchell, which showed improving the cleaning and disinfection of shared medical equipment was associated with a 34.5 per cent relative reduction in HAIs, corresponding to an absolute reduction of 5.2 per cent.

In response to the growing body of evidence on the importance of environmental hygiene, the Clean Hospitals initiative was created to promote HEH as a key component of infection prevention and control. Since its inception in 2018, however, the global context has undergone major changes. The Covid-19 pandemic exposed both the strengths and the vulnerabilities of health systems globally and brought infection prevention and control into spotlight. In the aftermath, it would be expected to see a stronger focus on the investment in healthcare, public health, prevention and preparedness.

However, the years that followed have unfortunately been marked by reconfigurations of the international geopolitical landscape and political decisions, with their well-known direct impact on organisations and on global health governance. With the international health system rocked by spending cuts and the withdrawal of the USA from the WHO, the rest of the world needs to work to fill that major gap in public health. We have witnessed the reorganisation of several institutions to respond to this shifting landscape. So Clean Hospitals has also evolved to foster international collaboration and strengthen its effectiveness.

Collective responsibility

Considering the importance of HEH for patient safety, and its complexity in the current context, Clean Hospitals aims to bring together all the relevant actors in environmental hygiene. We aim to reinforce collective responsibility and raising awareness that cleaning is not a low-value activity – it is a profession that requires competence, training and recognition. Recent changes to the organisation include establishing partnerships with institutions such as universities and professional societies, assigning country leads and creating working groups.

Establishing country leads reflects the growing need to connect globally with different realities, as they play a key role in bringing the perspective of their country into the Clean Hospitals network, helping to ensure different healthcare systems, cultural contexts and operational constraints are considered. Another important part of the country lead role is to dynamise the celebration of Clean Hospitals Day, acting as a link between Clean Hospitals and healthcare facilities in their country.

Another recent change is that now healthcare facilities have the opportunity to join Clean Hospitals as participating facilities and have access to our monthly Think Tanks presented by worldwide experts, journal clubs, scientific sessions, participation in working groups, biannual open forums with infection prevention and hygiene experts and the chance to connect with potential industry sponsors for research studies.

Innovation and knowledge-sharing are fundamental. There is currently very little knowledge sharing between institutions and between countries, meaning many facility managers end up working in isolation. We see healthcare facilities implementing completely different (and often suboptimal) solutions even within the same regions because of this.

Now more than ever, we are faced with emerging threats to human health through the healthcare environment. It is crucial to increase knowledge sharing and cooperation between facilities and countries. Healthcare cleaning is about interrupting transmission in an environment full of vulnerable people, invisible risk and constant re-contamination - cleaning in the healthcare environment must be adapted in real time. 

For more information email us at: info@cleanhospitals.com