Written evidence submitted by the Association of Healthcare Cleaning Professionals (AHCP) (CLL0093)

The Association of Healthcare Cleaning Professionals (AHCP) welcomes the opportunity to make this submission of written evidence to the Health and Social Care and Science and Technology Select Committees’ joint inquiry into lessons learnt from coronavirus.

Lessons Learnt:

The deployment of non-pharmaceutical interventions like lockdown and social distancing rules to manage the pandemic

Public health and health service messaging has focused on hand hygiene, masks/face coverings and social distancing/patient isolation. Less emphasis has been placed on the need for environmental cleaning and disinfection. There is no hard and fast ‘rule’ around how long the SARS-CoV-2 virus will survive on hard and soft furnishings, with new and emerging evidence suggesting the length of time it survives varies considerably depending on the temperature and humidity of the environment; the ventilation; the viral load shed by the person carrying the virus and the nature of the surfaces the virus lands on. What is clear is that a failure to clean and disinfect shared patient/client equipment and the environment immediately surrounding COVID positive patients/individuals will undermine other infection prevention interventions such as hand hygiene and the use of personal protective equipment (PPE) and contribute to the spread of the virus.

During the pandemic, supply chain issues and the NHS Supply Chain PUSH system in some organisations meant that cleaning staff were often issued with products they were not familiar with, and had received little or no training in.  Similarly, local procurement teams and care home / domiciliary service managers were having to source products themselves. At one point the market was flooded it seemed with well meaning but not always quality assured and efficacious products that could have put cleaning staff and patients at risk e.g. alcohol hand rubs, sanitising solutions, wipes and ‘disinfectent sprayers’.

The need to increase the number of cleaning staff quickly put increased demand on supervisory and training staff to try to ensure staff had received adequate training prior to carrying out their duties, to both protect patients and residents as well as themselves. It has to be said that in many organisations cleaning staff did feel they were recognised as part of the multi-disciplinary team approach to tackling the pandemic but this was not a universal experience.

Going forward we would like to see,

• greater emphasis on the role of environmental cleaning in the fight against infectious diseases such as COVID19, against healthcare associated infection and infectious diseases,
• a simple system that identifies cleaning/disinfecting products that have been assessed as ‘fit for purpose’ i.e. have been tested to the correct standards in appropriate laboratories, to negate the need for local assessment; and prevent products from entering the NHS and care home/social care sector that make false or misleading claims in their marketing material / on packaging
• an increased investment in training and education for staff performing environmental cleaning and equipment decontamination
• a recognition that to respond the demands of isolating patients during a pandemic the burden falls not just to clinical staff but cleaning staff too, and when the need for increased clinical care environments arises this is always mirrored by an increase in the need for cleaning resources
• better support for non-NHS providers e.g. those commissioned to carry out surgery and cancer treatments for the NHS, to access the PUSH supplies and essential/emergency stocks along with a more robust “sharing” supply chain during times of crisis
• greater involvement of those with expertise and ‘hands-on’ knowledge in providing cleaning and infection prevention services in national pandemic guideline development and decision making

The impact on the social care sector;  

The issues highlighted above were also issues in the social care sector. Increased demand to provide physical ‘nursing’ care for clients within social care settings meant additional strain on staff employed to provide both care and cleaning responsibilities. Issues of supply chain interruptions; lack of access to products being secured by Government for NHS facilities and a lack of control over approaches to care homes from companies supplying non-proven cleaning/disinfection technologies were all issues encountered in social care.

The AHCP would like to see

• greater accessibility and availability of products to non-NHS units recognising the mutually supportive role both health and social care play during a pandemic with microorganisms knowing no boundaries
• greater communication about stock availability, opportunities to access ‘pooled’ resources, and more ‘joined up thinking’ around ensuring that all health and social care providers were  included in initiatives to overcome supply chain issues (recognising that issues differed for members in different parts of the UK)
• a simple system of assurance of cleaning and disinfection products ( a seal of approval from a recognised body such as those that exist in some countries outside of the UK) that are fit for purpose so that our members are not inadvertently using products that may put them and/or the patients/clients at unnecessary risk
• Great guidance from central Government or public health agencies around new and emerging technologies so that organisations - both health and social care – do not invest in sometimes very costly but ineffective technology
• Investment in infection prevention and control (IPC) expert advice outside of healthcare organisations extending into the care home and the social care sector. IPC experts need to work closely with health and social care cleaning professionals to both advise on frequently changing & evolving guidelines, provide training and education and monitor performance & compliance. However, stretched IPC resources within healthcare organisations and a lack of health protection and community infection control staff meant that advice was not always readily available, if at all.

The impact on BAME communities and other at-risk groups; 

Many AHCP members and frontline cleaning staff are members of a BAME community. All of the issues highlighted around lack of adequate PPE and PPE not fit for purpose have been well rehearsed and apply equally to healthcare cleaning staff as they do to clinical staff. Cleaning staff were, are, expected to clean in and around clinical areas caring for COVID positive patients and to ‘terminally’ clean environments when patients are discharged or die.

The national UK.Gov guidelines advocate the use of sodium hypochlorite (bleach) as an environmental disinfectant. Members will have been working with increased usage of bleach-based solutions on a routine basis during the pandemic. Bleach is a known respiratory irritant. It is therefore important that cleaning staff are issued with effective PPE not just to protect themselves from COVID19 but from repeated exposure to use of bleach, often in confined spaces. It reinforces the need for adequate training of cleaning staff in preparation and usage of cleaning and disinfecting products.

• In preparation for any future pandemic consideration must be given to ensuring that cleaning staff are included in any planning assumptions for provision of PPE and training.
• When a vaccine becomes available that members of the cleaning workforce, particularly those from BAME communities and with other increased risks of infection, be included in the first wave of frontline staff vaccination.

The UK’s prior preparedness for a pandemic;

The National Standards of Cleaning for Hospitals in England were last published in 2007. A process of revision of the standards, led by NHSE, was started in December 2017 in which AHCP has been engaged. Draft standards have been circulated for feedback but to date the revised Standards have yet to be issued.

The ‘art of cleaning’ is now very much a science too, with an established and growing body of evidence to support best practice.

The AHCP argues that

• national standards of cleaning for health and social care should be revised and updated on a regular basis so that should we face another pandemic they are always up to date and ready to use
• The standards should be evidence based and include reference to the latest technologies (that can act as an effective adjunct to more traditional manual cleaning and disinfection)
• They should be fit for purpose within health and social care settings already dealing with the ongoing challenges of preventing and controlling the spread of healthcare associated infections as well as the emerging issues posed by multi-drug resistant pathogens
• And a cost impact assessment should be carried out before the proposed draft Standards are reissued.

Government Communications and Public Health Messaging

The AHCP suggests that surfaces should be added to the ‘Hands-Face-Space’ messaging i.e. ‘Hands-Face-Surface-Space’

Increased public health messaging around how, why and when to clean effectively will pay dividend not just during this pandemic but in preventing the spread of other communicable diseases such as norovirus and food hygiene related illness.

Time spent now educating the public – from a young age – on the importance of cleaning would mean that should we face another pandemic future generations would be better prepared from the off.

Again, a simple system of labelling sanitising products so that the public can be assured they are purchasing suitably effective products would be welcomed along with education around how to clean effectively to prevent the transmission of pathogenic microorganisms.

Understandably, infection prevention and control advice changed as the pandemic evolved. However, frequent and sometimes conflicting advice and guidance (often issued late on a Friday) posed challenges in assimilating the guidance into practice particularly in environments without access to IPC support.

The AHCP would like to have seen greater involvement from those with knowledge and skills specifically in environment cleaning and decontamination involved in guideline development or at least consulted for an opinion whenever possible.

About the AHCP

Established 40 years ago as the Association of Domestic Managers, the AHCP aims to support it’s members to provide a service committed to excellence, safety and cost effectiveness, as well as to promote and develop measurable standards of service, responsive to changing needs of the NHS and other clients.

The AHCP provides it’s established network of members and branches with the opportunity for mutual learning; assistance and support; information sharing; identifying emerging challenges and opportunities. It is establishing world-wide links; lobbying relevant influential bodies including governments; commissioning and developing relevant research and contributing to and developing learning opportunities for members.

The majority of its members work in cleaning, facilities and non-clinical support roles as well as infection prevention  & control, education and training, and industry.

For more information: https://www.ahcp.co.uk/

Contact: Denise Foster or Matthew Rea

Nov 2020