ECJ EUROPEAN Cleaning Journal

Sophie Rice, EMEA healthcare segment manager for Kimberly-Clark Professional explains why washroom facilities play an increasingly critical role in maintaining hygiene standards and driving a positive perception of every hospital.

A dirty or badly-maintained washroom is a nuisance and a potential health hazard, but it's even more than that. It also reflects badly on the overall standards of hygiene practiced across the site and portrays a negative image of how the healthcare facility is managed and ultimately the care provided to patients. If the site cannot even keep its washrooms clean and tidy, what might be lurking in the corners of its wards or treatment rooms? Can it be trusted to provide safe, hygienic healthcare to the most vulnerable in our society?

The washroom is a very public part of the healthcare facility and it sets a standard: that standard needs to be high and the lasting impression positive.

Good hand hygiene is essential throughout healthcare premises to prevent the spread of Hospital Acquired Infections (HAIs) and this can all start in the washroom. In the UK, health secretary Jeremy Hunt has recently confirmed government plans to halve the number of gram-negative bloodstream infections by 2020 (such as E-coli), as part of this initiative, for the first time the NHS will be required to publish staff hand hygiene indicators.

Hospital employees may need to wash their hands several times every hour to comply with World Health Organisation (WHO) guidelines and its ‘five moments of hand hygiene' for healthcare workers.

But hospital employees are not the only people who need to observe good hand hygiene practice in healthcare premises: family and friends visiting patients can also spread infection if they do not wash their hands. Therefore any barriers to good hand hygiene need to be addressed such as lack of awareness, time, skin irritation and an unwelcoming washroom.

Within a hospital there are four key groups of people that regularly visit the washroom: patients, staff, visitors and cleaners. Patients with compromised immune systems need an area that is safe. A shared washroom facility has the potential to spread infection so it is vital this risk is minimised. Patients may also have reduced mobility, so think about the functionality of the area and avoid specifying equipment, for instance, dispensers, that may be too large for the space available and therefore difficult for patients and other users to manoeuvre around.

Staff want a clean and tidy area - often a visit to the washroom brings a brief respite from the pressures of a busy day and a demanding job, so it is important the environment is a pleasant one.

Visitors want to know their loved ones are being cared for in a clean and well-kept facility and that their hospital experience is as positive as it can be. And cleaners need a well-designed facility that is easy to keep clean and with no dirt traps where bacteria can hide.

Each of these user groups will have a different perspective of hygiene. Therefore education is important; informing users of the correct hygiene process and how to help the spread of infections by reducing cross-contamination. Posters can be an effective means of communicating with all user groups about good hygiene practice and may include simple instructions to reduce cross-contamination, such as avoiding reaching into the towel dispenser and touching several towels.

Get the basics right

Delivering a satisfactory washroom experience is not rocket science. We are not talking about installing designer sinks or built-in music systems. It's the simple things that matter, it's all about making sure that the washroom is clean, looks inviting, and smells fresh - thus improving the user experience and reducing complaints. But how can you do that?

Cleanliness and hygiene are the two fundamentals of excellent washroom standards. Simple steps are the key to running a successful washroom. It goes without saying that equipment must be in good working order, so toilets need to flush and sinks need to drain.

Ensuring the washroom is well-stocked with good quality, relevant products, including hand towels, soap, toilet paper, sanitising gel and moisturising lotion, is also really important. Offering well-known, branded products that users recognise elevates the washroom experience.

Don't be tempted to think the addition of hand care products, such as moisturising lotion is a luxury, especially for cash-strapped healthcare environments. It isn't. It can be an essential part of ensuring a good hand hygiene programme is followed. Skin irritation is a major barrier to good hand hygiene; in fact, it is the number one reason for the failure of hand hygiene compliance in hospitals.

In Britain one in five nurses - equivalent to 80,000 - have reported work-related skin problems as a result of repeated hand washing. Therefore any steps taken to help staff to care for their skin may also encourage improved hand hygiene compliance, reduce infection and positively impact on health and wellbeing.

Drying vital

Drying hands is also an essential part of the hand washing routine. Some microbes remain on hands after washing and can be easily transferred if hands are not properly dried. There are many different hand drying methods, but the World Health Organisation unequivocally recommends drying hands thoroughly with a single use towel.

This method has been found to help prevent cross-contamination from wet hands into the air and the rest of the body. A study by the University of Westminster showed that drying your hands with a single use towel reduces germ count by up to 76 per cent.

If opting for single-use paper towels for hand drying it is important to ensure bins are conveniently located and regularly emptied to encourage usage and prevent overflow of used towels spilling over onto the floor. Modern dispensers can also help to prevent product jamming or tearing and stop the cleaning staff overfilling the dispenser, which can result in jamming. This helps to manage waste and keep the washroom tidy and litter free.

Rolled hand towels that deliver more sheets per roll, combined with an effective dispensing system can help with washroom waste and overall tidiness; specifying better quality hand towels means lower usage rates, thereby reducing overflowing bins and waste in the washroom.

Simply put, using less product generates less waste. Bins need to be emptied less frequently, freeing up domestic teams to carry out other important cleaning tasks. Disposal costs are also reduced, helping the overall waste budget.
Don't just think about what you can see.
Think about odours as well - the ‘inhale moment'. If it doesn't smell clean, then the brain thinks it isn't clean. Smells and stains therefore need to be eliminated, so consider introducing an odour control product or system. You can have all the marble tiles you like in a washroom, but if it's not clean and smells bad then no-one is going to be impressed.

Reducing cross-contamination

Suppliers are continuing to innovate with the development of new products, formats and dispensers to meet diverse needs in the washroom market. In the healthcare sector, this often involves products that minimise the risk of cross-contamination, either in use or during the cleaning process. For instance, stocking a good quality, soft paper hand towel may reduce the number of towels used through improved absorbency, which in turn lowers cost and waste.

Using less product means more time between refills, so reducing the instances of contact with cleaners and therefore removing an opportunity for cross-contamination.
One-wipe clean dispensers with no dirt traps are ideal for the hygienic healthcare environment. Products that are easy to use can help to drive compliance, especially for extremely busy staff.

Encourage hygiene

More proactive managers will also seek ways to educate washroom users in best practice on hand hygiene, which in turn may help to overcome bad habits. Hand hygiene is an everyday habit that we all learn as children. As such it is important to understand habitual behaviours and work to change bad hand hygiene habits.

So, for instance, siting hand sanitisers by the washroom doors means users can sanitise their hands after touching the toilet door, or facial tissues they can grab to protect their hands while exiting. A word of caution though. Don't fall into the trap of thinking that using a hand sanitiser is in itself sufficient. WHO is quite clear that good hand hygiene is the biggest weapon we have against bacteria in hospitals and washing hands properly and as recommended is the best way to stop the spread of bacteria.

Providing a pleasant washroom experience and maintaining high standards of hygiene in the washroom are vital considerations for any hospital. The top washroom complaints are a bad smell (82 per cent), clogged toilets or not flushed (79 per cent) and a dirty, unkempt overall appearance (73 per cent). The best way to deal with complaints is to stop them being made in the first place by ensuring that the quality of your washroom consumables is satisfactory, that any maintenance issues are tackled before they even become an irritation and seeking feedback from washroom users.

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