Best Practices for Environmental Cleaning
Module 6 - Audit
Learning Objectives
1. To explain the purpose and function of an audit.
2. To describe the audit process.
3. To apply identified tools in a practice setting.
2
Why audit?
• Cleaning is an essential part of reducing healthcare
acquired infections
• Just because it looks clean, doesn’t mean it is clean
• Objective measurement that can be used as a quality
indicator
• If it can’t be measured it can’t be improved (Carling)
• Feedback of results will occur
3
Why audit?
• Transparent process
• Highlights areas of good performance – identifies a
job ‘well done’
• Identifies opportunities for improvement
• Identifies deficiencies in building/equipment
• Ensures consistency between staff and areas
4
Types of audit
• Direct observation
 Visual assessment
 Observation of performance
• Indirect observation
 Patient/resident satisfaction surveys
• Measurements of cleanliness
 Environmental cultures
 ATP bioluminescence
 Environmental marking
5
You cannot tell by looking…
6
You cannot tell by looking…
7
Learning Checkpoint
8
Learning Checkpoint
• Which of the following are reasons for auditing.
a) Cleaning is an essential part of reducing healthcare associated
infections
b) Highlights good performance
c) Just because it looks clean doesn’t mean it is clean
d) Allows staff to receive feedback on cleaning
1)
2)
3)
4)
a, c, d
a, b, c
b, c, d
All of the above
9
Learning Checkpoint answer
• Correct answer is 4 – All of the above
• Each of these is an important reason for auditing.
10
Roles in the audit process
• Self-evaluation
• Environmental Services staff member
• Supervisor
• Coaching to improve practice
• 3rd party auditor – public health
11
Roles in the audit process
• Joint ‘walkabouts’
 ES staff
 ES & Infection Prevention & Control
 Other combinations (e.g. clinical personnel)
• Hotel clean vs hospital clean audits – difference in
expectations
12
The audit process
• Standardized approach
• Checklist will be used
• Done over time – all departments audited
• Feedback will be given to staff on scoring
• Part of quality improvement cycle
13
Apply identified tools in a
practice setting
• A number of tools are available for auditing
• Visual assessment quantifies whether or not dust,
debris or soil are present
 Rating is an average of the number of items inspected
and those meeting the criteria
 Hotel clean – 80% acceptable
 Hospital clean – 100%
14
Apply identified tools in
a practice setting
• Observations of performance utilize a checklist for an objective
review
• Advantages are:

Ease of implementation and maintenance

Cost-effective

Results are meaningful

Provides an opportunity for staff involvement

May assist in reducing HAIs over time
• Disadvantages are:

Labour intensive

Might be impacted by Hawthorne effect
15
Apply identified tools in a
practice setting
• Patient/Resident/Client Satisfaction Surveys
 Indication of how people see the services that are provided
 Not indicative of the services that are provided – subjective
evaluation
 If surveys are used response must:
 Be measured (i.e. yes/no)
 Have a benchmark that is used for comparison
 Have a standardized delivery system
16
Apply identified tools in a
practice setting
• Environmental culture
 Not generally recommended
 Presence of microorganism does not mean resident/patient
infection
 If used consider:
 Do not do random, undirected sampling of air, water and
environmental surfaces
 Conduct only as part of an epidemiologic investigation or to
assess hazardous environmental conditions
 Limit sampling to biological monitoring of sterilization
processes, water and dialysate in haemodialysis, or shortterm to measure impact of infection prevention measures
17
Apply identified tools in a
practice setting
• ATP bioluminescence
 Requires specialized equipment
 Quantitative method
 ATP is a chemical substance present in all living cells
 Detection indicates that organic material still present
 Can be used to provide instant feedback on surface
cleanliness, demonstrate deficiencies in cleaning protocols
and techniques to staff
 May also use in evaluating new cleaning methods (i.e.
steam, microfibre cloths)
18
Apply identified tools in a
practice setting
• Environmental marking

Measures thoroughness of cleaning using a marking system

Involves use of a colourless solution applied to objects in the
environment prior to cleaning followed by detection of residual
marker after cleaning

Solutions used must be environmentally stable, quick drying,
easily removed with cleaning, and invisible in regular room light

Marker should be applied to high-touch surfaces

May be used to assess routine cleaning on a daily basis or
vacancy cleaning

Must be quantified by:

Calculating percentage of marked object cleaned in the area or

Deriving a cleaning score based on amount of fluorescence
19
When you return to your job, what will you
do differently as a result of this session?
20
Thank You!
21
Image Sources –
Module 6
• Microsoft Office Clipart used in slides 7 & 8
• Images in slides 6 & 7 are © PHO 2013