Perceptions of Clean in Healthcare
Donna Mitchell, Sector Marketing Manager, Healthcare, Diversey, UK & Ireland, explains why the perception of cleanliness can be as important a consideration for hospital patients and their visitors as the quality of medical care.
Cleaning teams in hospitals and care homes put a huge amount of effort into their housekeeping operations. The aim is to create and maintain safe facilities that provide a pleasant environment and protect patients, guests, staff, and visitors against infections. But doing the work is only part of the equation – people also need to “feel” safe and that often comes down to “perceptions”.
Healthcare facilities have long understood the relationship between hand hygiene and surface disinfection and how these can break potential chains of infection. The choice of products on offer is large and facilities have developed – with support from suppliers like Diversey – robust and efficient routines to meet their objectives. Rates of hospital associated infections have fallen steadily in recent years.
This success is excellent news but why are perceptions important? We know from studies in hospitality that guests appreciate cleanliness above almost any other factor when making decisions about where to stay, the recommendations they make, and the reviews they leave. There are, perhaps, fewer commercial considerations in the UK healthcare sector although similar factors are likely to be important when patients, guests, visitors, or staff form and share their opinions.
Very few similar studies have explored patients’ reactions to cleanliness. One that did a few years ago did conclude – mirroring hospitality studies - that patients formed perceptions of cleanliness using evidence largely based on sight, sound, and smell.
The first, and perhaps most significant, factor in perceptions is appearance. People will understandably be more likely to believe a facility is clean if it looks clean. The study mentioned above suggested that people always expect a hospital’s floors, walls, ceilings, doors, and toilets to be clean. There is however plenty of evidence to show that pathogens can linger on surfaces that appear to be clean. This is why it is important to have a consistent cleaning regime that includes regular surface disinfection – especially of frequent or multi-person touch points - even if there is no apparent soiling.
Cleaning teams may have confidence in their processes and products, but perceptions are still important. One way to improve them is to clean more visibly and explain why.
Many facilities have for reasons of practical necessity adopted processes such as daytime cleaning that are carried out when people are present. The latest infection prevention "best practice" goes further by ensuring that hand hygiene and surface disinfection are carried out with high frequency and targeted at critical touch points and tasks. Concepts such as the Five Moments of Hand Hygiene and the Five Targeted Moments of Environmental Disinfection (5 TMED) are simple and effective and easy to understand. They are also easy to explain to patients and visitors and, as they are often carried out when a patient is present, can be a highly effective way to reinforce positive perceptions.
Hand hygiene plays a central role because person-to-person contact or touching contaminated surfaces are two of the main ways most infections spread. Regular hand disinfection has been critical in healthcare facilities since this link was understood but has been reinforced even more during the Covid-19 pandemic. Washing hands with soap and water is effective but in healthcare settings disinfectant hand rubs that meet relevant standards such as EN14476 can offer additional protection and reassurance. Disinfection points need to be readily available and easily accessible. Dispensers mounted on walls or floor-stands in key locations are an ideal long-term solution, but additional portable pump dispensers or personal bottles can maximise accessibility and compliance in the short-term.
Choice of cleaning equipment can also make a positive impression. Modern trolley systems, for example, allow cleaning team members to carry all their products, tools, and equipment neatly and tidily around a facility while also being highly visible. The modular TASKI Trolley system allows almost infinite configurations so that teams can create the ideal workstation for ergonomic, efficient, and productive working.
Equipment such as compact scrubber driers or backpack vacuum cleaners are ideal for busy and confined spaces because they are unobtrusive. They can be used when people are present with less disruption. Cordless battery powered models remove the need for a trailing mains cable which aids mobility and removes a potential trip hazard from the working area.
Larger scrubber driers, especially the ride-on models used in corridors and open areas, also offer an opportunity to highlight cleaning processes. In themselves these advanced machines demonstrate a professional approach. Many hospitals have added special branding and messaging to their machines to make them more "user friendly", explain what they are doing, or to encourage people to “wash your hands”.
The use of floor care machinery leads to another factor in perceptions: sound. Everyone is familiar with, for example, the sound a vacuum cleaner makes and hearing one will reassure that an area is being cleaned. But excessive sound can be unpleasant and unwelcome. The latest generation vacuum cleaners and floorcare machines are more powerful yet far quieter than previous-generation models which makes them better suited to busy areas.
Hospitals and care homes are often full of smells that will affect perceptions. Even odours with pleasant associations – such as food – can be overpowering if they are too strong. Modern cleaning products contain ingredients that can eliminate or neutralise bad odours and their causes to help create a pleasant environment.
While the chlorinous smell of disinfectant might suggest a clean environment, it can be rather unpleasant and, in the worst extremes, overpowering. Many facilities continue to use chlorine-based products and strong odours should not be a problem when they are used correctly for the appropriate task. However, there are times when alternatives might be suitable. Products in Diversey’s Oxivir range, for example, contain patented Accelerated Hydrogen Peroxide, which offers advantages over traditional disinfectants. These include broad spectrum efficacy against a wide range of pathogens, suitability for more surfaces, and no unpleasant or overpowering odours.
Many hospitals and care homes have reduced or eliminated their reliance on cleaning products altogether. Microfibre cloths and mops, for example, can clean hard surfaces effectively when used with water alone. Scrubber drier pads impregnated with microscopic diamonds offer a chemical-free alternative for cleaning hard floors.
Touch can also be a factor on perceptions. Sticky tabletops, bed rails, door handles, light switches or other surfaces can easily give the wrong impression. A typical cause is using a product incorrectly or at the wrong concentration. This is easily remedied by choosing the right products and using them properly.
Cleaning and hygiene are critical aspects of any healthcare facility’s daily routine. The main requirement is always to create a safe environment for patients, guests, visitors, and staff. Configuring processes properly and choosing the right combination of products is critical. This will help cleaning teams to meet their objectives consistently to meet and maintain the highest possible standards. And that will always improve reputation and perceptions.