Environmental cleaning toolkit: Module six: Audit

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.
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
• If it can’t be measured it can’t be improved (Carling)
• Feedback of results will occur
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
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
You cannot tell by looking…
You cannot tell by looking…
Learning Checkpoint
Learning Checkpoint
• Which of the following are reasons for auditing.
a) Cleaning is an essential part of reducing healthcare associated
b) Highlights good performance
c) Just because it looks clean doesn’t mean it is clean
d) Allows staff to receive feedback on cleaning
a, c, d
a, b, c
b, c, d
All of the above
Learning Checkpoint answer
• Correct answer is 4 – All of the above
• Each of these is an important reason for auditing.
Roles in the audit process
• Self-evaluation
• Environmental Services staff member
• Supervisor
• Coaching to improve practice
• 3rd party auditor – public health
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
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
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%
Apply identified tools in
a practice setting
• Observations of performance utilize a checklist for an objective
• Advantages are:
Ease of implementation and maintenance
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
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
 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
Apply identified tools in a
practice setting
• Environmental culture
 Not generally recommended
 Presence of microorganism does not mean resident/patient
 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
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)
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
When you return to your job, what will you
do differently as a result of this session?
Thank You!
Image Sources –
Module 6
• Microsoft Office Clipart used in slides 7 & 8
• Images in slides 6 & 7 are © PHO 2013