Written by Veronica Turner.
Not too long ago, the idea that doctors had to wash their hands in between patients was absurd. It took trailblazers such as Ignaz Semmelweis to realize the existence of germs and understand the effects of pathogens. Thanks to them, hygiene, which includes thorough handwashing, is now a fundamental, non-negotiable standard for healthcare providers worldwide.
Modern healthcare units today have well-established cleaning procedures whose efficacy is reviewed periodically by accrediting organizations (like The Joint Commission) and enforced by regulators like the Centers for Medicare & Medicaid Services (CMS).
Such organizations use adherence to these protocols and infection prevention outcomes as key factors in their scoring systems. This means that, besides patient safety, a lapse in environmental hygiene can affect an organization’s financial health and accreditation status.
In this article, we investigate how scientific evidence connects environmental cleaning to infection prevention, how monitoring systems enhance compliance, and the way in which these activities have a direct effect on accreditation metrics and reimbursement models.
Cleaning Protocols and Patient Safety
There is overwhelming evidence of the association between environmental cleaning and patient safety in the literature. Studies have confirmed that high-touch surfaces, such as sink and nurse call buttons, can be a source of pathogens such as Clostridioides difficile (C. difficile), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE).
Without proper cleaning protocols, only about 48% of high-touch surfaces situated near patients are cleaned correctly, according to a multi-hospital study. This shows that gaps in routine protocols directly contribute to pathogen persistence and the risk of onward transmission. It’s also the reason why healthcare-associated infections (HAIs) are one of the greatest hospital and long-term care facility risks and a factor leading to increased hospitalizations, increased cost of treatment, and additional mortality.
The Results of Proper Cleaning Protocols
Based on results from randomized controlled trials, we know that comprehensive cleaning schemes can prevent infection. A comprehensive cleaning scheme usually combines the latest disinfectant strategies, advanced technologies, and proper training to kill a broad spectrum of pathogens on various surfaces.
For example, in a trial (the BETR study), rooms that were cleaned using ultraviolet-C (UV-C) adjunct disinfection were associated with a 11% decrease in patient acquisition of target organisms. That meant fewer C. difficile and VRE infections hospitalwide. Additional clinical studies support that thorough terminal cleaning, especially in rooms previously housing infected patients, can reduce surface contamination by approximately 99%.
Many healthcare workers and even patients still remember the recent COVID-19 outbreak and the chaos it ensued. It was also a time for patients and healthcare workers to understand just how important cleaning can be. Sadly, the lack of well-established cleaning standards and monitoring systems led to numerous avoidable deaths.
Cleaning Protocols and Their Impact on Accreditation Metrics
Healthcare units everywhere should consider the existence and implementation of proper cleaning protocols as a part of their standard of care. In the U.S, organizations are somewhat forced to do this because their procedures are in plain view and open to scrutiny.
All patients have the right to fill in a standardized patient satisfaction survey after they’ve been treated in a hospital or clinic. The most important ones (that are also reported to authorities) are:
- HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems): available at the national level, and collects information on what patients think of the care they received during treatment.
- CAHPS (Consumer Assessment of Healthcare Providers and Systems): a collection of surveys that allow patients to grade their experience in different healthcare scenarios, like hospitals, home healthcare, and specialty providers.
In addition to patient surveys, U.S. healthcare organizations are judged based on the Hospital-Acquired Infection (HAI) rates. The HAI rate represents the frequency with which patients develop an infection while receiving care for another condition. This infection must not be present in the patient or incubating at the time of admission. High HAI rates signal a problem with the quality and safety of care in that unit.
In short, cleaning protocols are a direct and effective method for improving patient outcomes and boosting a unit’s accreditation and safety ratings.
The Role of Monitoring and Auditing
Healthcare units need consistent monitoring to maintain effective cleaning practices. U.S. hospital data demonstrate that audit-and-feedback programs can increase cleaning effectiveness from less than half of surfaces cleaned (~47%) to more than 80% within months.
Monitoring also encourages behavioral changes in hospital or clinic staff. When it’s clear that the organization keeps track of cleaning performance and brings up the topic during staff training, you create accountability mechanisms that are hard to ignore.
The methods used also have an impact on efficiency. Medical cleaning personnel are more likely to use easy-to-implement interventions that provide accurate, immediate feedback, such as fluorescent gel markers and adenosine triphosphate (ATP).
For example, fluorescent gel is the go-to in many units because of its ease of use. Cleaning services staff apply the gel to surfaces before cleaning, then shine a UV light on the surface to check for any glowing residue. If it glows, the surface is not entirely clean or thoroughly disinfected.
The Financial Impact of Accreditation Metrics
Due to rules established by accredited bodies, there is a direct connection between Hospital-Acquired Condition (HAC) rates and institutional performance, accreditation, and reimbursement structures. This is also a way to encourage healthcare organizations to prioritize the safety of their patients and staff.
For example, the CMS established the HAC Reduction Program, which penalizes hospitals that fall into the worst-performing quartile based on their Total HAC Score. These organizations face a 1% reduction in Medicare payments. It may not sound like much, but it can amount to millions of dollars for large organizations.
Another regulating body is the Joint Commission International (JCI), which evaluates and accredits more than 20,000 healthcare organizations in the United States and internationally. This agency considers infection control and cleaning protocols when evaluating performance.
The JCI “Gold Seal of Approval” is a strong indicator that a hospital or clinic is committed to patient safety and best practices. If an on-site inspection finds deficiencies in environmental cleaning, that organization could lose accreditation and face public scrutiny.
Lastly, hospital-acquired conditions themselves are a financial burden, costing hospitals and clinics billions every year. Meanwhile, the cost of housekeeping and environmental services is between 3 and 6 million per hospital per year, on average (excluding extremely specialized infection control beyond normal protocols).
In short, it’s more affordable to have proper cleaning protocols than to take shortcuts and gamble your patients’ safety and the organization’s reputation and accreditation.
How to Operationalize High-Quality Cleaning Protocols
Well-designed, high-quality cleaning protocols use a strategic, multifaceted approach that integrates staff training, modern technology, and a commitment to quality assurance.
Staff Training and Competency
Every healthcare unit needs an on-site environmental services team. These professionals are the first line of defense against HAIs and HACs and a cornerstone of a safe patient environment.
They must be well-trained in basic areas such as:
- Scientific Principles: how pathogens are transmitted and why specific disinfectants are effective against certain microbes.
- Protocol Adherence: Detailed, hands-on instruction on proper cleaning techniques for different surfaces and areas, including the correct sequence of cleaning to avoid cross-contamination.
- Safety and PPE: Proper use of Personal Protective Equipment (PPE) to protect both the worker and the patient.
Each healthcare unit must have a regular training schedule (e.g., once every three months) and a competency assessment system to ensure that staff maintain their skills and stay current with new best practices. Cleaning protocol training is not a one-and-done kind of thing.
Technology and Innovation
Technology can make cleaning protocols more effective and efficient while reducing human error. It also makes the job safer and easier for cleaning staff, benefiting everyone involved in the process.
Here are a few examples of how modern technologies transform medical cleaning:
- UV-C light disinfection (UV-C robots): These are automated systems that use ultraviolet light to destroy the DNA of germs, rendering them unable to replicate. They’re fast and can disinfect entire rooms, including hard-to-reach areas, in minutes.
- Electrostatic Sprayers: This technology applies a positive charge to disinfectant droplets, causing them to cling to negatively charged surfaces. This ensures a more even and thorough coverage of complex and irregularly shaped objects like bed rails and medical equipment.
- Monitoring and Verification Systems: As discussed earlier, systems like adenosine triphosphate (ATP) testing and fluorescent markers provide objective, data-driven feedback on cleaning effectiveness.
Commercial Cleaning Services
Healthcare organizations tend to partner with specialized providers of healthcare facilities cleaning, even if there’s an in-house team that handles routine daily tasks. Commercial services can provide access to a highly trained workforce, advanced technology, expertise in complex regulatory standards, and additional labor for specific needs.
For example, after a patient with an infectious disease is discharged, a commercial service can perform a deep, comprehensive terminal clean using advanced techniques and equipment to ensure the room is completely decontaminated.
Commercial services are also trained and certified to handle the cleanup and disposal of biohazardous materials, a task that requires specific protocols and a high level of expertise.
In Conclusion
As we’ve proven, cleaning protocols are central to patient safety, accreditation, and financial sustainability. Evidence shows that thorough, audited cleaning reduces infections, protects vulnerable patients, and safeguards hospitals from penalties and reputational damage.
Author Bio: Veronica Turner is a health and lifestyle writer with over 10 years of experience. She creates compelling content on nutrition, fitness, mental health, and overall wellness.
References
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