Perhaps the most pervasive service across the hospital is the housekeeping. This is also one of the most important services for prevention of healthcare associated infections and for compliance to Biomedical Waste Management rules. While housekeeping maintains the ambience clean, they must adhere to certain work practices that are recommended by accreditation bodies and regulatory bodies. Below is the list of all such requirements which housekeeping must ensure.
A. Housekeeping procedures
1. Standard housekeeping procedures should be used across the organization. The documented procedures should be available with the supervisor/housekeeping manager. For staff these procedures should be documented in a simplified manner and in a language that the housekeeping staff can understand. These procedures must include following
a. Categorization of various types of areas and surfaces which housekeeping staff needs to deal with for cleaning
b. General cleaning procedures for different types of surfaces, furniture, fixtures and items used in patient care
c. Procedure for terminal cleaning, i.e. the complete cleaning of the room or an area after a potentially infected patient has been discharged. It is also done after a clinical procedure, which has potential to spread infection in environment; such as invasive procedures.
d. Procedure for blood and body fluid cleaning
e. Cleaning of high risk areas such as isolation room, ICU, operation room etc.
2. Brooming, dry dusting or any housekeeping activity that can spread dust in environment should not be done in any patient care areas. Instead mopping and wet cleaning should be done.
3. For management of large spills of hazardous materials such as blood, mercury, chemicals etc. there should be a team of 3-4 people within housekeeping which is specially trained on handling such spills.
4. The housekeeping department must have a documented list of disinfectant and cleaning agents along with their dilution factor, to be used on different surfaces and areas
5. The housekeeping staff must be trained on the standard housekeeping practices, use of disinfectant. The records of training must be available.
6. Training must be provided, even if the housekeeping is outsourced.
7. Monitoring of housekeeping services should be done regularly to observe its effectiveness.
8. Housekeeping staff, may be involved in patient handling activities such as transportation of patient on stretcher, helping patients with bathroom activities, transferring items such as medicines, blood samples, files etc. from one place to another. In such situation, safety instructions to be documented for each such activity and staff be oriented on the same.
B. Housekeeping staff
1. Number of housekeeping staff required should be planned. This should be based upon estimated workload. Bed strength, average bed occupancy, area inventory list, total area for cleaning, number of washrooms etc. can be used as some of the measures for estimating number of staff required for housekeeping.
2. Regulatory requirements related to labour laws must be adhered to. Even if the housekeeping is outsourced, hospital being the principle employer, must ensure that these laws are complied with
a. Payment of gratuity act – Mandates conditions under which gratuity is payable and minimum amount of gratuity
b. Employee provident fund and miscellaneous provisions act – Conditions under which EPF is mandatory and minimum amount to be contributed in EPF
c. Payment of bonus act – Determines minimum bonus payable to workers in different scenarios
d. Minimum wages act – Regulates minimum wage to be paid as per the skill classification of the worker
e. Payment of wages act – Responsibility of wage payment, its frequency and mode of payment
f. Shops & establishment act – This act regulates maximum working hours, holidays, overtime, rest-interval etc.
g. Workmen’s compensation act – This act makes employer responsible for paying compensation to worker in case of accidental injury during the course of employment
h. Maternity benefit act – benefit of leave and payment to be given to a pregnant employee
(Check this post on 'all legal documents required by a hospital')
(Check this post on 'all legal documents required by a hospital')
3. Health check-up of housekeeping staff must be done annually. Those suffering from communicable diseases should be sent on leave
4. Housekeeping staff should be vaccinated for hepatitis B. Pre-exposure prophylaxis should be given to all staff
5. Post exposure prophylaxis should be given if the staff gets needle stick injury or is exposed to infection
6. Antecedent verification should be done for each housekeeping staff. If housekeeping is outsourced, the agency should be asked to do this and submit the proof to hospital
C. Biomedical waste (BMW) related
1. Availability of standard colour coded waste bins in all patient care areas and areas where BMW is generated
2. Appropriate segregation of waste in coloured bins. The segregation should be done at the time of waste generation. In no circumstances, the waste should be segregated by hand by housekeeping staff, after it has been mixed
3. The waste bins should be emptied before it is full (ideally when the waste is 3/4th full)
4. Dedicated place of for temporary storage of BMW, before it is sent for disposal
5. No storage of waste either within hospital or in common storage area, for more than 48 hours
6. The waste bins and the bags should contain BMW hazard symbol
7. The housekeeping staff should use personal protective wears while handling BMW
8. The syringes, IV tube sets and similar other materials should be cut before disposing
D. Training and awareness of housekeeping staff
1. Standard processes of housekeeping activities, including the cleaning agents, its dilution, frequency of cleaning etc.
2. No brooming or dry dusting policy in patient care areas, specially ICU
3. Cleaning of blood spills
4. Infection risks that they are exposed to, like from sharp injury, exposure to blood etc.
5. Infection prevention measures to be used while performing housekeeping functions
6. Personal protective gears and when and how to use
7. What to do in case of a needle stick injury
8. Harm from exposure to radiation and prevention method (specially for housekeeping staff posted in radiation areas)
9. Cleaning of blood and body fluid spills and spills of other hazardous items (for spills in large quantity, the specially trained spill management team should be called)
10. Biomedical waste segregation (they should know which type of waste goes in in which coloured waste bins)
11. Hand washing technique and other hand hygiene measures
12. Safety precaution to be taken while handling BMW
13. Other important rules related to BMW, such as time and place of storage, no manual segregation after waste is mixed up, cutting of syringes and plastic bottles before disposal
14. Safety practices while transporting patients on stretcher and wheelchair
15. Safety practices to be followed while transporting items such as medicines, samples, sterilized packs etc.
16. Other general topics that they must be trained on
b. Emergency codes and their role during various emergency situations
c. Use of fire-extinguisher
QUALITY INDICATORS
2. Compliance rate to safety practices while doing housekeeping functions
3. Compliance rate to BMW regulations
4. Compliance to frequency of cleaning as determined
5. Needle stick injury rate amongst housekeeping staff
