An invisible workforce: the neglected role of cleaners in patient safety on maternity units

Abstract

Hospital cleaning has been shown to impact on rates of healthcare-associated infections (HCAIs) and good environmental hygiene is critical to quality care, yet those tasked with the role of ensuring a safe and clean environment often go unrecognised as members of the healthcare workforce. Sepsis is a leading cause of maternal and newborn death, a significant proportion of these cases are estimated to be due to HCAIs. Deliveries in health institutions have now reached 75% globally, and in low and middle income countries the corresponding increased pressure on facilities has impacted both quality of care provided and quality of the birth environment in terms of infection prevention and control (IPC) and HCAIs. The paper discusses the neglected role of health facility cleaners, providing evidence from the literature and from needs assessments conducted by The Soapbox Collaborative and partners in Bangladesh, India, The Gambia and Zanzibar. While not the primary focus of the assessments, common themes emerged consistently pointing to institutional neglect of cleaning and cleaners. The paper argues that low status within facilities, wider societal marginalisation, lack of training, and poor pay and working conditions contribute to the lack of prioritisation placed on health facility environmental hygiene. With increased international attention focused towards health facility water, sanitation and hygiene and a growing focus on IPC, now is the time to address the neglect of this frontline healthcare workforce. We propose that provision of and improved training can enable the recognition of the valuable role cleaning staff play, as well as equipping these staff with the tools required to perform their job to the highest standard. In addition to training, wider systems changes are necessary to establish improvements in environmental hygiene and the role of cleaning staff, including addressing resource availability, supportive supervision, and an increased emphasis on preventative healthcare.

NeoCLEAN: a multimodal strategy to enhance environmental cleaning in a resource-limited neonatal unit

“…Ours is the rst study to evaluate the potential of environmental cleaning as a standalone HAI prevention intervention, with only one prior study including cleaning in a neonatal infection prevention bundle. 20 Furthermore, the key contribution of hospital cleaners and cleaning practices to patient safety is underappreciated in many LMIC settings 24 , despite the substantial risk of pathogen transmission from environmental reservoirs. [4][5][6] In this paper, we report the impact of a multimodal intervention (neoCLEAN) on the adequacy of surface and equipment cleaning in a South African neonatal ward using bacterial cultures, ATP assays and UV marker removal rates.…”

“…27 Prior studies of hospital cleaning in resource-limited settings identi ed lack of training, low societal value attached to cleaning, and disempowerment of cleaning staff, as major factors that perpetuate poor cleaning performance. 5,24 In a survey of healthcare facilities in India, Bangladesh, The Gambia and Zanzibar 24 , few gave formal training to their cleaning staff and the role of cleaning was generally not perceived as important. As African obstetric and neonatal units strive to attain the Sustainable Development Goals for maternal and newborn health and survival and reduce the spread of antimicrobial resistant pathogens, programmes to enhance facility cleaning should be promoted.…”

What does ‘leave no one behind’ mean for humanitarian crises-affected populations in the COVID-19 pandemic?

“…4 Controlling COVID-19 requires multidisciplinary input from doctors to cleaners, whose integral role in prevention of spread of disease is often disregarded. 5 A 2015 survey on infection prevention and control (IPC) preparedness of institutions worldwide showed that preparedness levels were only partially adequate. 6 Without appropriate personal protective equipment (PPE), the health workforce is put at risk of infection with COVID-19.…”

The Clean pilot study: evaluation of an environmental hygiene intervention bundle in three Tanzanian hospitals

“…Newborns delivered in hospitals in LMICs are 3-20 times more likely to develop an infection compared to those in high-income countries [10]. A critical but often neglected aspect of HAI prevention is basic environmental hygiene, particularly surface cleaning and linen management [11,12]. Systematic removal of microorganisms from hospital surfaces impedes direct bacterial and viral transmission to patients and indirect transmission via the hands of healthcare workers or medical equipment.…”