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Blood and Marrow Transplant Environmental Cleaning (BMTEC) Project

Aim

  • To ascertain the methods by which units are cleaned (e.g. frequency and process), resourcing, training, and education of environmental service personnel and clinical governance;
  • To facilitate compliance with the Environmental Cleaning Policy NSW (PD2012_061) in regard to external auditing.
  • To measure and benchmark the level of cleanliness of the transplant wards of the BMT Network.
  • To inform quality improvements in environmental cleaning standards in BMT/Haematology units (an extreme-risk functional area).
  • To assess sustainability of improvements made.

Benefits

With the support of the BMT Network Council and ACI, the BMTEC project provides the following benefits:

  1. Enhanced compliance with the Environmental Cleaning Policy NSW (PD2012_061).
    The categorisation of risk in the Policy provides a basis for recommendations of frequency and minimum cleaning standards for each functional area. Additionally, the policy outlines measures to evaluate cleaning outcomes and the acceptable levels of quality that should be achieved for a given category of risk. The BMTEC’s external cleaning audits provide feedback on the adequacy of environmental cleaning and areas for improvement, as measured against the Environmental Cleaning Policy.
  2. Support activities toward National Safety and Quality Health Service Standards (NSQHS) and Hospital Accreditation.
    The Australian Commission on Safety and Quality in Health Care (ACSQHC) has developed 8 NSQHS standards to promote the quality and safety of health service provision in Australia. The governance of cleaning services, gauging consumer expectations, and the implementation of cleaning standards of environmental hygiene make environmental cleaning an issue that cuts across multiple NSQHS standards. The BMTEC project addresses these three critical areas of the NSQHS standards.
  3. Respond to concerns brought to the Health Care Complaints Commission (HCCC) regarding complaints about the hospital environment and management of facilities
    The BMTEC project will support improvements in environmental cleaning, with a goal of reducing patient complaints.
  4. Help minimise health care costs and hospital-associated infections (HAIs).
    Measures to contain or eradicate HAIs cannot be fully effective without attention to environmental cleaning, as many HAIs persist in environmental reservoirs.

Background

The Blood and Marrow Transplant Network and the Agency for Clinical Innovation (ACI) recognise that hospital cleanliness serves many purposes. A clean environment is a key strategy to minimise hospital-associated infections (HAIs), provides a safe environment for staff, patients and visitors and reflects the philosophy of the hospital’s care and concern.

This initiative has the full support of LHD Chief Executives and has the portability across other high-risk areas such as Burns, ICU and Renal.

Partnerships

The BMT Network of the Agency for Clinical Innovation has collaborated with Health Care Association Infections, Clinical Excellence Commission (CEC) throughout the BMTEC project. In 2018 the BMT Network will work with CEC to review the environmental cleaning audit tool and the NSW Environmental Cleaning Policy (PD061_2012). It is anticipated the audit tool will be available electronically via the CEC Quality Audit Reporting System.

The BMT Network includes 15 BMT wards from 11 local health districts.

Key Activities

In 2013 the ACI BMT Network began the Environmental Cleaning Project within 15 NSW BMT units. With the goal of reaching the NSW Environmental Cleaning Policy’s (PD061_2012) recommended 90% AQL for extreme risk functional areas within healthcare facilities.

As shown in figure 1, in the round one audit conducted in September 2013 one of the 15 BMT units achieved the recommended 90% AQL for extreme risk functional areas. Since this time the majority of units have demonstrated consistent improvements in cleanliness in each round of audits.External Environmental Cleaning Audit Results graph 2013 - 2016

The BMT Network has facilitated two Environmental Cleaning Forums in 2014 and 2017. These provided the opportunity for cleaners, nurses, environmental service managers, clinical governance, CEC and ACI to network and share innovations in cleaning and discuss environmental cleaning procedures and policy.

In 2014 the BMT Network also supported cleaner and cleaning audit training days facilitated by an external infection prevention organisation.

Overall, the Environmental Cleaning Project has demonstrated:

  • Improved public perception of BMT units as noted by 98% patients in the BMT Network patient survey.
  • Continued use of documentation and completion of cleaning schedules
  • Continued understanding of the need to maintain high standard of cleaning in the high risk BMT units
  • Improved communication between the environmental services team and nurses, highlighting the importance of a multidisciplinary approach to cleaning

Evaluation

The project has spanned over 5 years and demonstrated sustained improvement to unit cleanliness across the BMT Network.  A survey of the directors of clinical governance, nurse unit managers and environmental cleaning managers has been completed in 2018 to assess the change of practice since the initiation of the project. In addition a sixth round of external audits will be conducted in late October - early November.

For More Information

Please visit the ACI Blood and Marrow Transplant Network Resources section for the 2016 and 2015 State-wide Environmental Cleaning Reports.