A clean and hygienic environment is a surrogate indicator of the quality of services provided by a hospital. It is also considered to have a tremendous psychological impact on the patients and the family members. Nevertheless, cleanliness remains an important concern for patients, the caregivers as well as the hospital management. It also provides the right setting for good patient care practice.
In a broader perspective, Hospital environmental cleaning can be said to be holistically associated with Hospital Housekeeping management. Hospital Housekeeping management is defined as, “The branch of general management which deals with cleanliness of the hospital, general environmental hygiene, sanitation and disposal of waste using appropriate methods, equipment and manpower”(Vearncombe M & Provincial Infectious Diseases Advisory Committee, 2012).
The environment around the patient influences the incidence of infection in hospitals and other health care settings(Hardy et al., 2006). Much of man’s ill health can be traced to adverse environmental factors which pose constant threat to his health. One of the factors that contribute to the frequency of HAIs is the hospital environment (Park K, 2015).
According to the study conducted in UK (Plowman, 2000), if the incidence of HAI observed could be reduced nationally by 10%, resources to the value of £93.1 million (about 150 million Euros) could be saved. This would be equivalent - for example, to 364056 bed days, or 47902 finished consultant episodes. These estimates may be considered the ‘gross’ benefits of prevention (Plowman, 2000)
The presence of microorganisms in the Hospital environment, can be reduced by simple measures like cleaning and disinfecting. But, only a few standards exists worldwide, for examples in countries such as U.K.(The Revised Healthcare Cleaning Manual, 2009) and Australia(NSW Government Health Policy Standard, 2012)(Department of Health State Government of Victoria, 2011).
The standards of environmental hygiene within hospitals were published for the first time in I999 by the Infection Control Nurses Association (ICNA) and Association of Domestic Management (ADM) in their book Environmental Cleanliness in Hospitals. This represented a new starting point for standards of environmental hygiene within hospitals. (C et al., 2003) The guidelines are considered an essential “foundation” for healthcare policy, planning, delivery, evaluation and quality improvement by clinicians, managers and policymakers (Gagliardi et al., 2015). Guidelines provides the recommendations that can enhance healthcare quality and outcomes based on scientific research, in order to simplify the processes (Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines, 2011)
Since then, there has been the appearance of large scale guideline production organisations worldwide, such as UK National Institute for Health and Clinical Excellence or Scottish Intercollegiate Guidelines Network the Ontario Cancer Guideline Program the World Health Organisation and professional societies Such organizations and those interested in producing and using guidelines now have a high profile society in the Guidelines International Network (Shekelle et al., 2012). Also, various professional bodies have come up with their Guidelines for Hospital environmental cleanliness as well. Such as Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings by Provincial Infectious Diseases Advisory Committee (PIDAC) (IPAC, 2009), Cleaning standards for Victorian health facilities (Department of Health State Government of Victoria, 2011), APSIC Guidelines for environmental cleaning and decontamination(Ling et al., 2015) etc. In India as an effort towards achieving standardisation in environmental cleaning “National Guidelines for Clean Hospitals” were launched in May 2015(KAYA KALP National Guidelines for Clean Hospitals 2015, 2015a).
Despite recognition of their crucial function, guidelines are not always translated to policy or practice. (Gagliardi & Alhabib, 2015) A study conducted by Richard Grog et al. (Grol et al., 1998) in the Netherlands showed an overall compliance to the guidelines’ recommendation of 61%. It also concluded that the compliance to evidence based recommendations was more in comparison to generic ones.
A study conducted by Ben Heskestad et al. in Norway, shows higher guideline compliance after an educational intervention involving feed-back on performance. (Heskestad et al., 2012) It showed an increase in the compliance over the period and the compliance was 54% in 2005, 71% in 2007, and 64% in 2009.
However, it was not clear as to what extent had these been implemented in the hospitals and what were the impediments in these guidelines. Therefore, this study was an attempt to compare the existing hospital housekeeping Practices vis-à-vis these guidelines, and identify the gaps, if any, among various government-run tertiary care hospitals.