By Brian Clark*

On Tuesday 26 October 2010, the National Health and Medical Research Council (NHMRC) published the final version of the 2010 Guideline for the Prevention and Control of Infection in Healthcare. This 262 page document includes changes that were brought about by public input after draft Guidelines were issued for public comment in January 2010. The NHMRC also published its responses to all submissions received and it is clear that input from the cleaning industry brought about significant changes to the final document.

Both documents can be downloaded from http://www.nhmrc.gov.au/node/30290.

The draft guidelines attracted 81 responses from a broad section of stake holders including Healthcare practitioners, industry organisations, manufacturers, suppliers and individuals with five submissions that can be attributed to the Australian Cleaning industry sector. These included three industry organisations, namely the National Upholstery, Carpet Cleaners and Restorers’ Association (NUCCRA), The Carpet Industry Association Limited (CIAL) and the Australasian Consumer, Cosmetic, Hygiene and Specialty Products Industry (ACCORD). The remaining responses were from two companies involved in manufacture, supply and consultancy to the healthcare sector.

Carpet manufacturers and suppliers had the most to lose as the draft document was extremely detrimental to the use of ‘carpet’ in healthcare settings and if published in the original form would have severely damaged carpet’s strong position in the healthcare market.

The CIAL argued the draft did not take into account the wide variety of floor covering materials, including textile floor coverings, which are on the market; the benefits of correctly chosen textile floor coverings in healthcare environments; and the significant variations in construction, fibre type, backing, design and cleaning characteristics.

In response, the NHMRC altered the terminology and watered down the original comments about carpet not being recommended and redrafted the Guideline to highlight that a risk assessment needs to be undertaken to determine the infection prevention aspects of choosing flooring.

However, the CIAL submission failed to get the removal of statements in the guidelines that reinforce a perception that carpet in a healthcare setting is more difficult and more expensive to maintain than hard flooring.

The NHMRC did concede, however, on page 235 that ‘Textile floor finishes should not be considered unless there is a comprehensive maintenance and replacement program in place complying with AS/NZS 3733. Care and maintenance of floor covering (and the) need to consider manufacturer’s recommendations’.

While CIAL argued the case for carpet, the submission from NUCCRA highlighted the importance of good cleaning practice and operator training. This was supported by the CIAL. NUCCRA also argued that the terminology used to describe recommended carpet cleaning methods was incorrect. For example the terms ‘shampooing’ and ‘Steam Cleaning’ were juxtaposed, despite the fact that they were two different methods and that the term ‘Steam Cleaning’ did not relate to the description of Hot Water Extraction as the preferred method for restorative and corrective cleaning in Australian Standard AS/NZS 3733.

NUCCRA’s submission brought about a significant change, with Hot Water Extraction set in place as the preferred method for the cleaning and decontamination of hospital carpet, with the following statement on page 72 of the guidelines: ‘After a spill has been removed as much as possible (see Section B1.4.3), the carpet should be cleaned using the hot water extraction method, which is recognised by AS/NZS 3733:1995 to minimise chemical and soil residue’.

The NUCCRA submission also brought the Upholstery standard, AS/NZS:4849.1.2003, to the attention of the committee and it is now referenced in the final document. Despite this, the NHMRC overlooked necessary changes to the description of carpet cleaning methods that may cause confusion if viewed independently of the main document with the terms ‘shampooing’ and ‘Steam Cleaning’ remaining in the table on page 160.

The submission from ACCORD was also acknowledged by the NHMRC with the recommendation that a TGA-registered hospital grade disinfectant must be used for the disinfection of surfaces and instruments, and for specific infectious outbreaks, the TGA-registered disinfectant should have label claims specific to the organism of concern.

Overall, the call for public comment into this important healthcare guideline brought about some significant changes to the document overall, and emphasises the importance of cleaning in infection control. The input from this industry was significant as it provided informed evidence and referenced standards and practice that would otherwise have been overlooked.

It is unfortunate, however, that other industry organisations, including the supplier and contract cleaning and segments, which see healthcare as a key market, were not able to or did not bother to make their voices heard.

Recognition of our industry’s responses and the changes they brought about reinforces the fact that we are able to be heard, be noticed and can present reasoned and referenced argument which can bring about change and improve the recognition of the importance of this industry in all aspects of public health and wellbeing.

*Brian Clark is an industry consultant and the principal of Janitech