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Blood and Marrow Transplant Environmental Cleaning (BMTEC) Project

Aim

  • 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

The NSW Agency for Clinical Innovation (ACI) Blood and Marrow Transplant (BMT) Network recognises that hospital cleanliness serves many purposes. A clean environment is a key strategy to reduce hospital-associated infections (HAIs), provide a safe environment for staff, patients and visitors, and reflects the hospital’s philosophy of care and concern. The release of the NSW Environmental Cleaning Policy (PD2012_061) in 2012 provided the impetus for this initiative, having highlighted BMT units as extreme risk functional areas and recommending a 90% Acceptable Quality Limit (AQL) for environmental cleanliness.

In 2013, the ACI BMT Network began the Environmental Cleaning Project with the aims to:

  1. Establish a baseline level of environmental cleanliness
  2. Ascertain the methods by which BMT units are cleaned
  3. Review resourcing, training and education of environmental services
  4. Pilot and validate the Clinical Excellence Commission (CEC) Environmental Cleaning Audit Tool
  5. Inform quality improvements in environmental cleaning standards in BMT/haematology units

During the five year project two environmental cleaning forums have been held. Each of the forum were open to cleaners, environmental service managers, nurses and clinical governance.

The first forum held in 2014 aimed at providing more information and examples regarding implementing policies and procedures to meet PD2012_61. The second day provided training for cleaners and auditors utilising the experience of an external consultant - Infection Prevention Australia. At the second forum in 2017 the first 4 rounds of external audit results were reviewed with the view of continued improvement and possible amendments to the PD2012_61 were discussed.

Six rounds of external audits have been conducted against the CEC Environmental Cleaning Audit Tool. Results demonstrate a trend of improvement (Figure 1) from the initial round in 2013, with the last four rounds having a median result above the 90% AQL. The rounds in 2015 and 2016 had the least number (3) of centres below the AQL. Individual reports were provided with recommendations to address non-complying elements. External Environmental Cleaning Audit Results graph 2013 - 2016

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.