Clean and safe environment

Infection risks are minimised when the environment is clean and well maintained. A visually clean and hygienic environment that is well maintained and free of clutter and unnecessary items supports a health consumer’s right to access safe and high-quality care in an environment that makes them feel safe.

Essential elements of an environmental cleaning process include developing an environmental cleaning program, which can be a complex process. As a minimum, a successful environmental cleaning program in a small healthcare service should address the following outcomes: 

• Relevant environmental risks are identified, assessed and responded to appropriately and as required. This could include increasing the frequency of cleaning in response to changes in rates of communicable diseases within the local community, for example, COVID-19 
• As part of a healthcare service’s overall infection prevention and control program, staff responsible for environmental cleaning are provided with training on the principles of infection prevention and control. This includes training in 
• the correct use of various cleaning equipment 
• handling and storage of cleaning solutions 
• the appropriate use of personal protective equipment (PPE)
• A detailed cleaning schedule for the entire healthcare service describes recommended cleaning frequencies, cleaning procedures and policies and role responsibilities of all staff. For more information about developing a cleaning schedule refer to the Environmental cleaning practices in small health service organisations fact sheet
• Cleaning outcomes are routinely evaluated and monitored by routine auditing and action is taken where issues or risks are identified
• Cleaning equipment and products are assessed for their suitability for environmental cleaning in the facility. This includes using products listed on the Australian Register of Therapeutic Goods and consistent with the manufacturer’s instructions for use and recommended frequencies.

• What processes does your healthcare service use to ensure a clean and hygienic environment?
• What processes are used to evaluate that the environment is clean and hygienic?
• How does your healthcare service ensure the appropriate workforce is trained in cleaning processes for routine and outbreak situations, and novel infections?

• Identify infection risks associated with the healthcare environment. 
• Develop an environmental cleaning process for the healthcare service, addressing the outcomes described above. 
• Facilitate training for the workforce on the healthcare service’s environmental cleaning process.
• Implement the healthcare service’s environmental cleaning process and schedule. 
• Evaluate environmental cleaning practices for compliance with policies, procedures and protocols and measure outcomes of cleaning processes.
• Review position descriptions or contract specifications as part of the appraisal or contract review process, and provide feedback to the relevant person or group on achievements or areas for improvement.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Documented cleaning process that includes essential elements 
• Cleaning schedule for the healthcare service
• Documented cleaning schedules and evidence of physical observation or audits that indicate that cleaning has been completed 
• Evidence that the relevant workforce has undertaken training in infection and prevention control 
• Evidence that cleaning equipment and products used are listed on the Australian Register of Therapeutic Goods.

Commission resources

• Environmental cleaning and infection prevention and control resources – environmental cleaning is a critical element of standard precautions and should be a feature of every health service organisation’s infection prevention and control program.
• Addendum NSQHS Standards Accreditation Workbook 2021 Infection Prevention and Control Standard – provides users with updated information on reflective questions and examples of evidence for the 2021 Preventing and Controlling Infections Standard within the NSQHS Standards. Principles and strategies are broadly applicable.
• Infection Prevention and Control eLearning Modules: Clean and safe environment course – an online learning module on hand hygiene and infection prevention and control.
• Australian Guidelines for Infection Prevention and Control in Healthcare – the guidelines have been developed for use in all healthcare settings, including office-based practices. They contain guidance on personal protective equipment (PPE), standard and transmission-based precautions and outbreak management in section 3.

Infection risks associated with the healthcare environment are minimised when the environment is clean and well maintained. In particular, processes should be in place to minimise infection risks for:

• New and existing equipment, devices and products used in the healthcare service
• Clinical and non-clinical areas, and workplace amenity areas
• Maintaining, repairing and upgrading buildings, equipment, furnishings and fittings
• Handling, transporting and storing linen (if applicable) 
• Novel infections, and risks identified as part of a public health response or pandemic planning.

Infection risks to be considered may include:

• Dust 
• Aerosols 
• Air handling 
• Filters and filtration 
• Sinks, drains and other plumbing
• Water quality, biofilms and supply 
• Sewerage and wastewater 
• Infectious agents 
• Waste materials 
• Disruption of services and utilities 
• Patient, carer and workforce safety 
• Extra cleaning and reprocessing requirements for critical equipment. 

• How are infection risks for new and existing equipment, devices and products determined? 
• What processes are in place for minimising infection risks associated with maintaining, repairing and upgrading buildings, equipment, furnishings and fittings?
• What processes are in place for minimising infection risks associated with linen?
• What processes are in place for identifying and mitigating risks associated with novel infections, and risks identified as part of a public health response or pandemic planning?

• Define and implement a process based on a risk assessment of infection risks to evaluate and respond to those risks for:
  • new and existing equipment, devices and products used in the healthcare service
  • clinical and non-clinical areas, and workplace amenity areas
  • maintaining, repairing and upgrading buildings, equipment, furnishings and fittings
  • handling, transporting and storage of linen (if applicable) 
  • novel infections, and risks identified as part of a public health response or pandemic planning.

The type and comprehensiveness of evidence used is dependent on each healthcare service context, but could include: 

• Risk assessment of infection risks
• Process to evaluate and respond to infection risks for:
  • new and existing equipment, devices and products used in the healthcare service
  • clinical and non-clinical areas, and workplace amenity areas
  • maintaining, repairing and upgrading buildings, equipment, furnishings and fittings
  • handling, transporting and storage of linen (if applicable) 
  • novel infections, and risks identified as part of a public health response or pandemic planning
• Example of changes made to cleaning processes in response to an identified infection risk. 

Commission resources

• Processes and product selection for routine environmental cleaning – flowchart to guide routine environmental cleaning. 
• Infection Prevention and Control eLearning Modules – Clean and safe environment course – an online learning module on hand hygiene and infection prevention and control. 
• Addendum NSQHS Standards Accreditation Workbook 2021 Infection Prevention and Control Standard – provides users with updated information on reflective questions and examples of evidence for the 2021 Preventing and Controlling Infections Standard within the NSQHS Standards. Principles and strategies are broadly applicable.
• Infection Prevention and Control eLearning Modules: Epidemiology and outbreaks course – an online learning module on hand hygiene and infection prevention and control.
• 2021 Recommendations for the control of carbapenemase-producing Enterobacterales (2021 CPE Guide) – provides updated guidance on recommended strategies to prevent, detect and contain CPE in Australian health service organisations.