Adopting best practices in floor cleaning at Healthcare facilities
Dated: 26-11-2013

Lisa Koh Poh Sim, Manager-Housekeeping, Zulekha Hospital speaks about the significance of floor cleaning and the procedures and best practices adopted at their hospital in an interview with Swaliha Shanavas

The Housekeeping Manager comes from a hospitality background and it shows straight away in her approach as she smilingly greets and leads me into the meeting room. Having worked in the hospitality industry in the US for 12 years, she moved on to the healthcare sector and is presently enjoying her role in this field. “Irrespective of the industry, ‘housekeeping is housekeeping’ and the maintenance procedures are similar in all types of facilities,” she says.

But, the key difference between the healthcare sector and other industries is that the topmost concern and priority here is sanitisation and infection control. “Disinfect, disinfect, disinfect… is the first thought on the minds of hospital staff,” she adds.

Zulekha Hospital has two facilities – one in Sharjah and the other in Dubai. Both the hospitals successfully underwent and got accredited through standards such as the JCI, CAP, DQA and ISO. The Joint Commission International (JCI) is a US based accreditation body dedicated to improving healthcare quality and safety around the world. The accreditation is an international gold standard for hospitals. Zulekha Hospital achieved the unique distinction of achieving accreditation for both its hospitals, becoming one of the first few hospitals in UAE to achieve this unique and coveted accreditation. The Dubai Quality Award (DQA) is based on the Excellence Model of the European Foundation for Quality Management (EFQM). DQA programme has been a developing process for Zulekha Hospitals – achieving Dubai Quality Appreciation Award in 2008 and the Coveted Dubai Quality Award in 2012 for Excellence in service – by being the first Healthcare organisation in UAE to get awarded.

The group housekeeping in-charge manages both Dubai and Sharjah facilities. The two groups of cleaning staff at the hospitals have team leaders who take care of the day-to-day cleaning activities. The Housekeeping Manager oversees the operations, dividing her time equally between the two based on the daily and periodical requirements. Her team handles all the cleaning procedures, ensuring sanitisation is done, all the areas are disinfected and there is no cross-contamination.

Floor cleaning and maintenance procedures

Basically, the hospital has two types of flooring – vinyl and marble. The areas that have vinyl flooring include the wards, OPDs, doctors’ rooms, inpatient rooms, etc. The public areas and all their lift landing areas have marble flooring, which is avoided in other areas because it is not ideal for all areas due to chances of slip and fall accidents causing injuries to patients, visitors and staff.

Regular dust and wet mopping is done early in the morning and then in case of spillage, etc, and floor maintenance work is carried out overnight, says Lisa Koh. Basically, maintenance involves the crystallization for their marble flooring, while the vinyl flooring is maintained with neutral cleaning material and no sealer or wax is used for various reasons. The only area where they seal their floors is in the Operation Theatre (OT) Complex. This is done as part of the infection control procedures. Other than that it’s all natural floor care and maintenance.

“For routine floor cleaning we use only a multipurpose cleaner. We prefer the matte finish for our floors and avoid a high gloss finish as it is dangerous, and it is best to avoid slip and fall accidents. As for our vinyl flooring, we cannot use any harsh chemicals as the floors are pre-treated, so we use only neutral cleaners which have disinfecting qualities as well, since we have to take care to disinfect the floors – particularly at the OT complex. In fact, all the cleaning products we use are environmentally friendly. Everyone’s trying to go green, right?” she smiles.

The hospital uses low-noise machines that do not cause any disturbance and cleaning their marble floors is not a problem, as they are all in public areas such as the lobbies, lift landings, etc, she states. Normally, detailed cleaning is done at night. “Obviously, we cannot undertake heavy-duty cleaning during the day due to continuous activity and heavy movement. So we do it during the “graveyard shift” which runs from 11 pm to 7 am, the period of very low movement.”

“In case of the marble areas, we first use the steel wool pads to crystallize the marble. As part of the daily maintenance routine, we use the white pads to buff the marble to remove scratches and improve the appearance of the floor. First, the cleaning staff dust mop and wet mop the area; with a buffing pad affixed to the buffing machine, they buff the floor from one corner to the other,” the manager explains.

In case of vinyl flooring, intensive cleaning involves only damp mopping with multipurpose cleaners in Sharjah due to the new flooring and natural materials used. The current Sharjah facility is the new building to which 90% of the operations have been moved. In Dubai, they follow the strip and wax procedure but avoid a high-gloss finish. As part of the weekly schedule, the team undertakes detailed scrubbing for all the vinyl floors.

The critical areas such as Operation Theatre Complex floors are totally disinfected when the cleaning process is on each and every day at both the opening and closing of each shift, and sometimes disinfected more than two times a day, based on the use of the Complex and when there is an ad hoc request or some spillage, etc.

The washroom floors have homogeneous tiles, so there is only a need for routine cleaning and scrubbing. But as part of their cleaning protocol, they use strong disinfectants, particularly while cleaning the public area washrooms to ensure there is no contamination.

Floor cleaning equipment and laundry

They normally use 14 oz Kentucky mops, which are changed periodically as per required standards. Generally the mops are replaced on a monthly basis, Lisa Koh says. Every hospital has its own floor cleaning systems, and so does Zulekha. In case of isolated areas, one mop per room is used for cleaning and for the general IP rooms (in-patient) it varies depending on the specific conditions on a particular day. On an average, they use about 50-60 mops to clean the floors during the course of a day.

Asked if this would not prove to be more expensive in the long term, and also on the choice of these mops vs. microfiber, she agrees microfiber mops are good, but it is important to consider the cost factor as well. Lint free mops are good and the hospital uses these. In housekeeping manager’s view, “It is not all about using advanced material and technologies to get good results. Effective solutions can also be simple, inexpensive and lead to other benefits, but it is important to strictly follow proper procedures and to know how to maintain the mops through proper cleaning and sanitisation,” she stresses. Where she comes from, microfibre is widely used, but in this part of the world, these materials are only just beginning to be used and the initial investment is quite high. Yet, they are reviewing the options, and will gradually introduce these new materials and techniques in a phased manner.

Zulehka Hospital is self-sufficient with two small in-house laundry facilities – one in Sharjah and the other in Dubai. Each unit has two machines (70 lbs load capacity), plus one domestic washer which is used to wash the mops.

High-risk areas & monitoring

The hospital environment is totally different from other facilities. So, following the cleaning process, the floor is sanitised. It is part of the routine, as it is mandatory to do so each and every time the floor is cleaned.

The housekeeping staff dedicated to specific sections such as the wards, OT, public areas, etc, work in three different shifts. The team has specialised kits for blood spills, chemical spillage and other such applications to clean the floors and related areas, as and when the need arises. They isolate the affected areas and clean the spills as per the protocol depending on the type of spillage. This is then certified by the Infection Control unit, who are the ‘guardian’ here. The waste is disposed according to procedures.

The housekeeping team goes to great lengths to avoid contamination of any kind. For instance, when a high risk patient enters a specific area of the hospital there is a risk of contamination, so they immediately clean the area and deploy air disinfection system to kill micro-organisms such as germs, bacteria, etc, when it is required. The necessary chemicals are provided by the Infection Control unit.

Rigorous test runs are conducted, particularly at the OT as it is a high risk area, and in other relevant areas of the hospital at regular intervals to evaluate the effectiveness of the cleaning procedures through surface sampling for bacterial contamination and also air sampling for airborne bacteria and dust. These tests are conducted by the specialised team at the Infection Control unit.

Staff safety and training

The janitorial staff are trained, and well versed in the routine and procedures. “Yet, when they join us, we train and educate them on the specific procedures and impress upon them that they have to wear protective equipment irrespective of the situation or conditions in the specific areas. In hospitals, we have to protect our staff from slips and trips, cross-contamination, infections and so on. So we ensure they know the floor cleaning procedures and have their Personal Protective Equipment (PPE) at all times. It is part of the procedure to discard their PPE as they leave each room after cleaning, and use the new set while entering another to avoid cross-contamination. The gear is all disposable. For instance, when they clear up the medical waste before cleaning, they have to put on their mask and plastic apron and throw them away after the task. The hospital also ensures that staff practice hand washing techniques, they have to sanitise their hands on completing each task and while moving from one area to another. We monitor the teams and conduct spot checks to ensure they follow all the procedures,” states Lisa Koh.

Bringing some cheer

Coming from a hospitality background, she has tried to bring in some positive aspects from that sector here. “The very notion or mention of ‘hospital’ brings to mind a different, slightly negative thought and feeling, and I have been trying to change that a bit by making the atmosphere ambient and welcoming with a neat and clean entrance and lobby area; clean, sparkling floors; and pleasant smell, etc. I really feel proud as visitors have been telling me that our lobby and other areas look more like a hotel than a hospital.”

 

 
 
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