Checklist

Much has been made lately of the need to keep hospitals clean, and rightly so: the number of infections contracted by patients while in hospital has reached high levels. Specifiers and designers can play a big part in improving hygiene standards. Currently many are unwittingly contributing to the problem by using common practices and assemblies that make cleaning difficult.

To minimise the risk of infection, specifiers have to consider factors that are not always at the top of their lists. They should check how easily materials can be cleaned and their propensity to retain particles. Additionally, access for cleaning should also be carefully thought through before systems are assembled on site.

1. Strategy

A design strategy needs to be adopted from the outset. There are clear published guidelines and these should be the first port of call. Designers should consider whether joints, corners, junctions, fixtures and fittings are easy to clean or likely to hold dirt. Consider those areas where cleaning is most needed or difficult to carry out. Include easy-to-clean surfaces wherever possible.

The degree to which cleaning should be carried out and achieved should be set at a much higher level than in normal commercial cleaning.

2. Details

The manner in which material is put together is important. Sealed joints are the best method. These should be finished with an appropriate smooth-finish flexible material that will enable an easy-clean process to be employed. Gaps of any kind should be avoided, especially shadow gaps, which would be difficult to clean and would attract a build-up of dirt behind the joint. Sharp arises, corners and grooved materials that do not seamlessly flow around details are also to be avoided.

Skirtings should be specified with smooth surfaces, and joints in the flooring should be sealed. Highly absorbant surfaces should be minimised and not specified at any low level area at all. Materials such as curtains should be wipeable or treated to enable easy cleaning.

Unseen cavities in the construction should also be avoided. The surface design details should be studied closely to identify areas where cleaning is difficult. This should be done in much the same way as the air seal line is identified in designs to prevent air leaks in the final construction.

3. Materials

Many modern materials have a fully sealed surface, which should be checked with the manufacturers, particularly for large areas. Consider also the way in which the material is joined, fixed and therefore cleaned. It may be that a material that is otherwise suitable may require exposed fixings that would be difficult to clean adequately.

4. Products

There are products on the market that claim to reduce the risk of infection. That doesn’t necessarily make them a panacea. Reliance on a product to do the job is not a substitute for the correct application of well-detailed and constructed solutions that can be maintained properly. That said, the products specified may well contribute to the overall success of the scheme.

Many product details and technical literature skim over jointing and practical methods of fixing in favour of extolling the benefits of the material. Often, only the most basic suggestions about installation are given. When designing for easy cleaning, analyse exactly how the product will be used and ensure that there are no gaps, rough edges or screw heads that could become dirt traps.

5. Procedures

Keeping track of the original design aims and principles is never easy with healthcare projects, particularly given the long timescales involved. Establish a “bible” of principles that will act as a fundamental reference and get the team to refer to this on a regular basis to ensure that everything remains on track. Experience shows that it is very difficult to ensure the appropriate and correct measures are used when the building is in operation. Cleaning materials and procedures are often changed because of contract negotiations or a lack of skill. This can have a negative result on the finishes and damage them in the longer term.

6. Information

Information on cleaning and maintenance often does not reach the people undertaking the work. With this in mind, the eventual cleaning and maintenance procedures, including the original design principles, should be clearly demonstrated and placed in the hands of the cleaning team.

Some education is also needed. Many believe that a highly polished surface demonstrates that it is clean, but this is not necessarily the best option. Polished floors offer slip hazards, and a matt finish can just as easily be cleaned. Smooth corners and crevices are also easy to keep clean. This may seem like common sense but it is not very commonly found and many buildings suffer as a consequence, as do patients.

Key references

• Towards Cleaner Hospitals Department of Health 2004 policy document
• The NHS Healthcare Facilities Cleaning Manual is downloadable from http://tinyurl.com/cyyep
• Building Note 40 NHS Estates (including technical memorandums 56, 58, 61)