The few studies that have evaluated hygiene routines in farrowing accommodation to date have focused on pathogen elimination from pens, with little attention paid to pig growth and no information provided on pig health or medication usage. This study aimed to determine if implementation of an optimised farrowing accommodation hygiene routine could improve pig health and growth and reduce medication usage pre- and post-weaning (PW). Forty seven sows were blocked on parity, previous litter size and body weight and assigned to two treatments: T1) Basic hygiene: cold water washing only with minimal drying time; T2) Optimised hygiene: use of detergent and a chlorocresol-based disinfectant with a 6-day drying time. Total bacterial counts (TBC) and Enterobacteriaceae counts and adenosine triphosphate (ATP) swabs were obtained from different areas within the farrowing pens. Pig growth and medication usage were monitored from birth to slaughter and carcass data was obtained at slaughter. On entry of sows to the farrowing pens, TBC and Enterobacteriaceae counts and ATP concentrations were lower on pen surfaces subjected to the optimised compared to the basic hygiene routine (P<0.05). Pre-weaning diarrhoea prevalence was lower in pigs born into optimal compared to basic hygiene pens (0 versus 22 %; P<0.001). The number of clinical cases of disease and injections administered to piglets per litter was 75 and 79 % less for the optimised compared to the basic hygiene routine, respectively (P<0.001). This led to reductions of 77 % (P<0.001) and 75 % (P<0.01), respectively in the volume of antibiotics and anti-inflammatories administered per litter in the optimised hygiene group. Pigs from the optimised hygiene treatment were also heavier at weaning (P<0.01) and their average daily gain (ADG) was higher from day 21 to weaning and day 22-49 PW (P<0.05). However, these growth improvements did not carry through to the finisher period. In conclusion, implementation of an optimised hygiene routine reduced the bacterial load in farrowing pens, leading to a reduction in diarrhoea and clinical cases of disease and therefore, medication usage, in suckling pigs. Pig growth was also improved during the suckling and early PW periods. Based on the results, an easily implementable farrowing room hygiene protocol with demonstrable benefits for pig health, growth and welfare can be provided to farmers.