Cleaning is a more complex process than we may think

Healthcare-associated infections are a silent epidemic responsible for 16 million deaths worldwide each year, most of which are caused by contaminated hands and inadequately disinfected environments. Although cleaning, hygiene and disinfection of surfaces have become a priority since Covid, many institutions still do not devote sufficient attention and resources to this. What to look out for when cleaning healthcare facilities was discussed by experts at the Healthcare Cleaning Forum conference at the Interclean Forum in Amsterdam this May.

More than 900 exhibitors attended the Interclean Forum 2024 in Amsterdam. The event, which was all about cleaning and hygiene, was attended by exhibitors from around 120 countries, including Hungary’s B+N Referencia Zrt. research and development department, Lab/Da Innovations with its in-house-developed cleaning robot.

The four-day event also included the Healthcare Cleaning Forum conference, which presented the most important trends in cleaning and disinfection, focusing on healthcare institutions. Although the importance of disinfection in healthcare institutions may seem obvious at first glance, experience shows that in many institutions worldwide, this area of facility management is falling victim to cost-cutting, with severe consequences – reports.

Disinfection can save lives

According to a survey conducted in more than 30 countries with different levels of development, every 15th patient gets some kind of infection during their hospital stay, which could be prevented. Unfortunately, cleaning receives relatively little recognition and resources among hospital issues, but there is also little information on the sector as a whole.

There are no uniform international guidelines and only a few studies on the subject, making it difficult to determine how big a problem inadequate cleaning is globally. However, the good news is that the field is growing rapidly, with an increasing number of articles and events focusing on the issue, mainly driven by Covid –  Alexandra Peters, Head of Research at the Institute of Global Health, University of Geneva, pointed out in her presentation.

Didier Pittet, Professor at the Faculty of Medicine, University of Geneva, added that hand disinfection is a good starting point in preventing and stopping infections. Still, the same disinfection should be done with the environment. Health hygiene is complex, with the human factor, available technologies, and empirical research all determining its effectiveness. To ensure patient safety, the separation between the public and private health sectors must be broken, ensuring access to hygiene in both areas. It is also essential to strengthen the meeting of science and industry, systematically providing feedback to each other.

Asking the average person, everyone knows that hygiene is paramount. Still, it is not always the priority for hospitals, where cost is a factor. For hospitals, cost-effectiveness is always the top priority, – the expert added.

Presenting the figures, Edmée Bowles, a Dutch clinical microbiologist working on epidemic prevention, pointed out that inadequately protected healthcare institutions are responsible for 4.1 million infections and 90 thousand deaths in Europe every year. Investigating the resistance of microorganisms to antibiotics is very important in identifying the problem. Some microorganisms can survive up to 600 days, and disinfection is the only weapon against them.

The best-known methods are hydrogen peroxide (H2O2), ozone (O3) and UV disinfection. The latter is preferable because it is chemical-free and quick since no lengthy preparation is required, and the room can be used immediately after disinfection. It is no coincidence that B+N chose this option when it started developing its own self-propelled UV disinfection equipment. The disadvantage, however, is that the distance and angle of the machine reduce the effectiveness in shaded areas, which have to be cleaned manually afterwards.

Andreas Voss, professor at the Medical Center of the University of Groningen, also noted that cleanliness is not only an appearance, but the safety of patients depends on it—the more microorganisms in the environment, the more infections and the more deaths. The quality of cleaning depends on the cleaner, the method and the type of cleaning agent.

Common hospital shortages

According to the survey carried out in the already mentioned 30 countries, 4 percent of hospitals examined did not have adequate mops, 12 percent did not have hazardous waste separation, 22 percent had open garbage landfills on the hospital premises and 50 percent had no manager for the cleaning staff.

There was a lack of communication between the different areas in many places. So, despite the availability of the most advanced technologies and solutions, at the end of the process, the poor results are always due to the human factor.

At the Interclean Forum 2024 in Amsterdam, Brett Mitchell, an Australian clinical research expert in disease prevention and management, confirmed that cleaning is a complex process in which human behaviour, studies, and the roles and responsibilities of cleaning come into play. Preparation, product, technique, training, feedback and communication within the cleaning team, with nurses and the whole organisation, contribute to the final outcome. Efficiency requires a plan of who, how, where, when and what to do. Part of the practical information is the schedule and frequency of cleaning – reports.

It must be learned and accepted that cleaning is a profession that deserves financial recognition. Unfortunately, however, institutions most often cut cleaning service fees when they need to save money.

30% of hospital infections are spread by hands

It is essential to have proper training, financial resources for cleaning, quality control (visible cleanliness is no longer enough) and the technology used. However, the cleaners, facility management team, nurses, and doctors must all think as a team to achieve adequate efficiency. According to Martin Kiernan, a professor at the research centre at the University of West London, the time spent cleaning and the final result are typically out of proportion to each other. Problems include forgetting to clean surfaces that are frequently touched and inconsistency in where the cleaner starts and in what order they proceed.

The efficiency of cleaning is typically not a priority when designing hospital equipment either, old hospital beds, for example, were much easier to clean than today’s ones with complex functions. Consideration should be given to which cleaning method is best in terms of speed and efficiency. 30% of hospital infections are spread by hands and 20% by frequently touched surfaces, which are touched by everyone from patients to nurses, visitors, maintenance staff, staff and doctors. Examples include door handles, tables and curtains.

However, the human factor is also of paramount importance in the process. Employee skills and opportunities determine motivation, which affects the final result, so professional and financial recognition and appropriate feedback are important. Let’s involve the cleaner in the process so that he or she understands why his or her work is important. This requires appropriate training, education, and verbal and financial recognition of the work. This will increase the quality of cleaning and reduce the spread of infections, Kiernan stressed.

Sustainability in cleaning

British healthcare product expert Clare Nash said that if healthcare were a country, it would be the 5th largest carbon emitter in the world.

When we consider the cleaning products and solutions we use, we must also consider climate change. In the supply chain, 70% of the raw materials are produced by people working in unacceptable conditions. However, climate change is also a factor in sustainable development, for example, through health and well-being, responsible consumption and production, and clean water and sanitation. Of the 118 elements on Earth, 40 percent are seriously threatened.

The key words in reducing the environmental footprint of cleaning are circular economy, recycling, and understanding the life cycle of products. Mining of raw materials has the largest environmental footprint, followed by use, manufacturing, final disposal, and transport.

The potential of artificial intelligence

Finally, we must mention the latest technology pervading the cleaning industry. Artificial intelligence is used in many industries these days, so it is not surprising that the cleaning industry is also increasingly turning to autonomous machines.

The combination of AI and robotics is revolutionising the cleaning industry, allowing autonomous machines to be deployed for essential cleaning tasks to increase efficiency, reduce costs, and improve overall cleanliness. These tools help cleaning staff to focus on more detailed and specific tasks.

AI-powered machines use sensors and machine learning algorithms to navigate and perform cleaning tasks. These devices can detect and avoid obstacles and gather information about the areas to be cleaned.  And with the development of technology, they will be able to operate more and more independently and efficiently – as Péter Zalka, head of Lab/Da Innovations, the research and development department of B+N Referencia Zrt., highlighted.

AI technology can bring many benefits to the cleaning industry, including increasing productivity, improving safety and driving innovation. Although the initial cost of autonomous cleaning machines is still quite high today, they can clean a significant area in a unit of time without human intervention, resulting in financial savings in the long term. In addition, AI-based solutions can also contribute to a more sustainable work process by saving energy.