Cleaning for Sustainability
23 July 2012 Last updated:
1 October 2014
Cleaning for Sustainability
The case for using steam cleaning and microfibre cloths for a healthier hospital, environment and bottom line.
By Sustainability Victoria
In a hospital, cleanliness is critical to prevent the spread of disease and provide quality care. How we keep a hospital clean is an important consideration: how frequently will we clean? What products do we use? How safe are the products and practices? What will it cost each year?
In 2011, Southern Health, the largest public health service in Victoria, conducted a cleaning trial to examine the health, environmental and financial benefits of using steam cleaners and microfibre cloths. They replaced dry-cleaning, detergent and water, disinfectant and other chemicals, a mop and wringer bucket and disposable or dorset cloths.
As well as reducing the environmental impacts of standard cleaning practices, it was hoped these changes would lead to a healthier and safer environment for patients and staff.
About the project
In July and August 2011, Southern Health introduced two new cleaning practices to two of its wards at Casey hospital and Chestnut Gardens residential aged care facility:
- Ultra microfibre cloths replaced dorset cloths, which are reusable and require water and detergent for cleaning (Casey hospital) and disposable cloths (Chestnut Gardens). Both facilities were able to replace string mops and wringers, buckets of water with detergent and disinfectants using the new cleaning technology.
- Supersaturated steam cleaners which sanitise an area by lifting dirt and organic matter (also known as bioburden) replaced the need for manual scrubbing in the cleaning of rooms at discharge of patients/residents and also as an alternative to dry cleaning of window drapes.
The trial was initiated by Southern Health's Sterilisation and Infection Control Co-Director Elizabeth Gillespie.
"I undertook a literature search and we followed up with some experimental testing using a borrowed steam cleaner. By May 2011, we had been able to convince our colleagues at Southern Health that a trial would be feasible in two clinical areas of Southern Health."
Funding for the trial was provided by Sustainability Victoria and the Australian Infection Control Association Covidien scholarship with in-kind funding from Southern Health.
About standard cleaning practice
At Southern Health, as in most Victorian hospitals, cleaning is undertaken in clinical areas using dorset cloths, mops and buckets, with detergent and water. When rooms require additional disinfection, such as for patients with gastroenteritis in strict isolation, hypochlorite solution is also used1.
A new approach
By choosing to use steam cleaning and microfibre cloths, water use could be minimised, as could the need for frequent staff exposure to cleaning chemicals as the microfibre cloths used no chemicals with minimal water and the steam cleaners use supersaturated dry steam. The steam cleaners were used on all surfaces including floors in patient rooms, bathrooms, utility rooms, and corridors (i.e. wherever there were hard floor surfaces such as vinyl, tiles or linoleum), but could also be used to clean window drapes, saving significant time, money and effort. microfibre cloths replaced dorset cloths and disposable cleaning cloths, microfibre mops were used either as a manual system (daily) or with the steam system (on discharge).
The following steps were taken:
- Management support gained
- New equipment selected2
- Test wards identified
- External infection control audit conducted by Department of Health (May 2011)
- Internal infection control audit conducted
(June 2011 – Chestnut Gardens)
(July 2011 – Casey Hospital Ward D)3
- Rooms cleaned using new materials and processes (July – November 2011)
- Internal infection control audit conducted
(August 2011 – Chestnut Gardens)
(September 2011 – Casey Hospital)
- Focus groups conducted with cleaning staff to gather feedback and assess support for new processes and materials (October 2011)
- External infection control audit conducted by Department of Health (November 2011)
- Findings assessed and recommendations made (December 2011)
- Training materials developed and new approach to be rolled out across Southern Health operations. (May 2012).
The use of steam cleaning and microfibre cloths delivered excellent results including improved health, safety and well‑being for staff and patients, reduced water and chemical use and significant cost opportunities.
Health and safety
- Improved cleanliness. Cleaning effectiveness increased from 91% to 96%4
- Less presence of bioburden. From 10% retention to 4%
- Less exposure to chemicals for staff
- Less potential for slips on wet floors and other injuries
- Less fatigue for cleaning staff.
- Less water and chemical use. Water use for cleaning reduced around 90% in wards5. Using the steam cleaner meant that staff no longer had to fill and empty buckets of water.
- Reduced waste. Microfibre cloths can be used up to 500 times and can be recycled6. $25 reduction in consumables used per clean plus reduced waste costs.
- Less chemicals used. Projected over $32,000 per year saved in detergent costs7. Projected over $5,000 saved per year chemical use (hypochlorite)7. Reduced dry cleaning of drapes saved $100 per standard window.
- Less need for labor intensive, acute bed cleans. The time it took to clean a standard room decreased from 160 minutes to 40 minutes in rooms where patients were accommodated in strict contact precautions i.e. for gastroenteritis, vancomycin resistant enterococcus with diarrhea.
Overall reduction $142 per bed cleaned, due mainly to reduced time for each clean. Equivalent of nearly $1.35 million could be redirected per year to other activities that enhance the environment at Southern Health.
"The results of this trial surprised me. I didn’t think the cleaning staff would love it so much and that they would ask us to keep it in place. I also didn’t think the water use would drop by so much, so consistently, or that the risk of slips and falls could be reduced. We are really excited about the outcome of the trial and are now progressing to implement this cleaning across all of Southern Health."
The greatest challenges for Southern Health were finding the funding for the trial and then ensuring staff were trained properly and supportive of the training. Support from the management team at Southern Health was critical to the trial going ahead.
"It is a challenge when introducing new methods to the workplace as you will find lots of complaints. Work with your staff as a team and show how the products work and how it makes it easier. Staff may find the steam machine hard at first, but as time goes by they will find it so rewarding."
As a result of the trial, Southern Health has developed procedures and protocols for daily cleaning and discharge in aged care and acute care wards, operating suites and emergency departments which can be adopted in other hospitals without the need for a trial (unless a trial is considered necessary to gauge organisational support).
The Green Cleaning trial proved a success in terms of reducing both environmental and economic cost opportunities, but perhaps the best results are for staff and patients with improved infection control and better OH&S conditions.
If these practices were adopted across the state’s hospital system, the cleaning methods have the potential to deliver multimillion dollar cost opportunities, improved health outcomes and reduced environmental impact.
The use of steam cleaning and microfibre cloths could also have transferable benefits to non-health organisations such as schools, businesses and other government departments.
- Hypochlorite solution at 1,000 parts per million is a concentration high enough to kill bacteria and spores such as Clostridium difficile.
- A 40 x 40cm ultra-microfibre cloth with a life-cycle of 100-200 washes and a 32 x 32 cm ultra-microfibre cloth with a life-cycle of 500 washes were selected. Two different steam sanitisers were also used following risk assessment and energy use evaluation. The larger unit was already owned by Casey Hospital and a smaller unit was trialed based on recommendations from a northern Victorian hospital user.
- This was achieved using the 3M Clean Trace Adenosine Tri-phosphate (ATP) measuring kit. Using pre-moistened swabs, samples are taken and read using the luminometer. A result is achieved in 10 seconds, after cleaning the process is repeated and the remaining level of bioburden or ATP is determined.
- Dorset cloth and detergent use results in 10% bioburden retention. Microfibre cloth results in 4% bioburden retention. Also includes aesthetic assessment.
- From 1,422 litres per month to 137 litres per month (Casey) and from 3,305 litres to 394 litres (Chestnut Gardens).
- On average 4.3 microfibre cloths are used per day per acute bed and 1.3 are used per day per aged-care/residential bed. 30 x 30cm sized cloths were found to be the preferred size.
- If rolled out across Southern Health based on an average 182 strict contact precaution terminal cleans per week.
Sterilisation and Infection Control Co-Director
Southern Health, Victoria
Phone: 03 9594 2964
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