Words: Varun Godinho
If there were a single moment in recent memory when embedding hygiene practices and protocols into facilities across healthcare, education and transport environments went from a perfunctory function to a core service, it was the onset of the COVID-19 pandemic. It served as a reminder that failing to install hygiene as part of the essential infrastructure would indeed lead to the loss of lives at an appalling scale.
As Gavin Macgregor-Skinner, senior director at ISSA and Global Biorisk Advisory Council (GBAC), explains, “Hygiene is no longer a support function; it is a pillar of the cleaning industry. Every school, hospital, airport terminal, bus and train depends on cleaning professionals and evidence-based practices to protect public health.”
Infection prevention strategies
When it comes to controlling infections, environmental hygiene is a key consideration. Infectious diseases are caused by infectious agents (bacteria, viruses, parasites and fungi) and their toxic products. Controlling them through rigorous disinfection regimes directly controls the spread of the disease.
Infection control is vital in areas such as healthcare and education, where vulnerable individuals may already suffer from compromised immune systems. In the transport sector, which typically sees high volumes of transient traffic, the risk of an uncontrolled spread is even greater.
Within the healthcare setting, the need to embed hygiene and infection control protocols into the facility’s core services is vital. The Healthcare Surfaces Institute, a division of ISSA and part of the ISSA Healthcare Platform, finds that 1.7 million people get healthcare-associated infections (HAIs) each year, and around 99,000 people die annually, with many more suffering from altered lives that require ongoing medical care as a result of HAIs.
One of the starting points for stemming HIAs is to conduct routine and targeted cleaning using hospital-grade disinfectants approved by relevant bodies such as the Therapeutic Goods Administration (TGA). Facility managers must institute an enhanced cleaning regime of high-touch surfaces (bedrails, nurse call buttons, door handles, bathroom fixtures) and also reinforce practices such as terminal cleaning protocols for rooms after infectious patients have been treated within them.
“Most facilities, including healthcare, education and transport, now enforce strict protocols to ensure cleaning chemicals are up to standard and are registered with a cleaning regulatory body, with regular checks on dilution rates and Safety Data Sheets (SDS). Cleaning companies are no longer permitted to select chemicals independently; approved products must meet set standards,” Master Cleaners Training Institute CEO Liezl Foxcroft says.
“In addition, stringent measures are in place to prevent cross-contamination. These include the use of vacuums equipped with high-efficiency HEPA filters, colour-coded cleaning systems, high-quality microfibre materials and proper laundering of cloths and mops to maintain hygiene integrity.”
At an infrastructure level, the medical facility should increase air exchanges in clinical areas, install HEPA filtration and negative-pressure rooms for spaces with patients exhibiting airborne infections and regularly maintain its HVAC systems to prevent mould, microbial and dust spread.
In educational settings, including childcare facilities, schools and universities, young individuals have developing immune systems. One way to keep the spread of infections among them to a minimum is to establish daily cleaning schedules of classrooms, play areas and bathrooms. These cleaning schedules should ideally be aligned with age-group requirements, which would mean that childcare centres typically require more frequent sanitisation of mouthing objects and their soft toys.
The students themselves can also be made active participants in infection control. One way is to include visual cues such as posters showing proper handwashing and cough etiquette.
At a management level, the caregivers must ensure rapid escalation of cleanup tasks during suspected gastro or flu outbreaks and a clear communication trail to parents about hygiene measures being implemented.
As for transport environments, protocols need to be implemented to ensure frequent disinfection of touchpoints such as handrails, seatbacks, push buttons and an overall overnight deep clean of vehicles, specifically using fast-acting detergents.
Operators of the mass-transit systems can also use data-driven cleaning schedules based on passenger density and time of day to optimise cleaning schedules.
Learnings and policymaking
Macgregor-Skinner says effective infection-spread control begins with making hygiene a measurable component of a facility in order to track its effectiveness. “Measuring hygiene requires moving beyond appearance to scientifically validated performance. You can’t manage what you don’t measure.
“When facilities monitor surface cleanliness using ATP testing, verify high-touch surface compliance, track indoor air quality indicators such as particulate matter and volatile organic compounds (VOCs) levels, and correlate cleaning interventions with reductions in absenteeism or infection rates, they demonstrate that cleaning is a health intervention, not a maintenance task. When facility managers and cleaning companies add to their operations, competency-based workforce training, digital validation tools, and safer product selection metrics, then hygiene becomes part of the measurable infrastructure.”
Once hygiene can be measured, the next step is to have an involved workforce that changes regimented approaches to infection control and instead adapts them to modern-day requirements. A recent study shows hospitals in Australia are adopting a simple cleaning intervention that cuts infection rates, saves money and frees up beds – an approach that has the potential to be used in other settings like aged care and childcare.
Known as the CLEEN study, a clinical trial was conducted at Gosford Hospital and led by Avondale University’s Professor of Health Services Research and Nursing, and Honorary Professor at the University of Newcastle, Brett Mitchell, from Hunter Medical Research Institute’s Infection Research Program.
The trial introduced an additional three hours of cleaning per ward each weekday. Dedicated staff used detergent-disinfectant wipes to clean shared equipment. The results were dramatic. Cleaning compliance increased from about 20 percent to 70 percent, and there was a 34 percent reduction in HIAs.
Mitchell says infections are not only harmful for patients, but they also extend hospital stays and drive up diagnostic and treatment costs. He notes that reducing those infections enhances patient safety and makes the entire health system more efficient.
Foxcroft cautions decision-makers against cost-cutting exercises that could compromise IPC protocols. “We continue to observe a ‘race to the bottom’ in pricing within the healthcare sector,” she says. “It is critical that procurement teams receive better training on why robust Infection Prevention and Control (IPC) training for cleaning staff is essential when awarding new cleaning contracts or selecting providers for healthcare facilities.
“Greater emphasis should be placed on the training and competency verification of cleaning staff during the Request for Proposal process. Currently, many cleaning staff are either not trained in IPC or, where training exists, there is often no ongoing competency assessment or refresher program.”
At a national level, there is a call for government policies to align with widespread IPC measures. Earlier this year, the Australasian College for Infection Prevention and Control, Australasia’s peak body for infection prevention and control, released a position statement urging the Australian Government to embed IPC expertise within the Australian Centre for Disease Control (CDC) structure. It argued that the measure would ensure expert IPC guidance during future pandemics, a comprehensive national IPC infrastructure, consistent IPC protocols, and a One Health approach for disease prevention.
As Macgregor-Skinner succinctly concludes, “When design and management of the built environment includes hygiene metrics as a function of architecture, workforce training, product selection and daily operations, we move from reacting to illness to preventing it. That is the now and the future – cleaning as a critical health service that safeguards people, strengthens resilience, maintains function and keeps society moving.”
