Case Study National Orthopaedic Hospital Cappagh - CleanPass

To illustrate one of CLEANPASS’s main service areas – Training of support staff in cleaning and decontamination, here is a short case study on how CLEANPASS training impacted the Hygiene Levels at a Dublin hospital.

The first part of our CLEANPASS’s approach is to meet the staff of the hospital and understand the challenges that they face internally. The challenges that each organisation face may differ, but one commonality is maintaining standards in a fast paced modern healthcare system which is a constant contest.

HIQA have published National Standards for the prevention and control of healthcare-associated infections and the HPSC have recently published a framework of Interim Guidance on Infection Prevention and Control for the Health Service Executive 2021.

A hospital is a complex environment to keep clean. Not only is it important to clean everywhere frequently and touch sites are a key consideratio, in the case of Cappagh Orthopaedic, it’s a particular challenge due to the built environments throughout the hospital. For over a century, the Hospital has adapted to meet ever-changing healthcare demands, the hospital is a hive of activity. The former convent is being renovated to make way for new educational and training facilities, an administration centre and a dedicated Outpatient Department for Cappagh Kids.

It is against this backdrop that I am interviewing Declan Brennan who manages the Support Services Department, about his experiences with CLEANPASS and the outcomes of the training conducted with hospital staff.

Declan comes from an industrial engineering background, he tells me that methods of working and how people work interest him. Declan also relates that when he arrived there was a lack of resources and a deficit in time dedicated to cleaning. The attitude was to “just do it” and work with what you’ve got. At the initial stages of our involvement with Cappagh I was invited to meet the Hygiene Services Committee – a team made up of senior staff members who were committed to think of cleaning both strategically and operationally, setting a cleaning plan which is adequately resourced and successfully executed. The existence of the Committee told its own story – there are clear lines of responsibility set out that run right to the executive team for cleaning.

Declan is convinced that buy-in by senior management to household services is what makes a substantial difference. The reporting structure is a key factor for success and means that all key decision-makers are around the table for new initiatives and improvements to get the hearing and traction they deserve.

In the past there has been an institutionalised mindset of “we only do this”, – which made for grey areas where responsibility wasn’t allocated or taken.

The team is 50+ people strong and when the CLEANPASS training got underway it was against the backdrop of a negative HIQA audit in 2015.

HIQA recommended at that time that the hospital review cleaning processes, cleaning frequencies and monitoring systems to ensure that all areas are cleaned to the specification required and to ensure the risks of transmission of infection are mitigated.

One of the supervisors heard about CLEANPASS and suggested getting the training for the Cappagh team. The supervisory team knew by the first coffee break they would be able to tell by the non-verbal signals alone whether the training was being well received by the participants. Fortunately, it was the breath of fresh air they needed – even cleaning veterans who had been providing hygiene services for more than 30 years reported that they had benefited.

There was huge positive influence amongst Cappagh staff – once a person knew how to work systematically, they were eager for their colleagues to do it the same way, so that if someone was filling in they would complete the task to the same standard.

Following CLEANPASS training, Cappagh staff took a hard look at the hours dedicated to cleaning and the number of minutes that staff had per bedspace. Following the audit rep, there was very low morale.

There was now an appetite for learning based on what the first group of participants had told their colleagues, they were banging on the door to receive the CLEANPASS training. Declan relayed that “Our staff, after training, began working smarter not harder, the whole team learned that frequency is our friend”.

Declan went on to tell me that before CLEANPASS the Cappagh team used a buddy system, the quality of training varied depending on the mentor. Declan relayed to me that it had him when he would hear people say ‘I wasn’t shown that before’ when they were working with someone else.

In short, once trained in a systematic way the entire team at Cappagh were delighted with the outcomes from the training, a noticeably cleaner environment – evidenced by HIQA’s revisit in 2016.

HIQA reported “There was evidence of local arrangements for defined risk-based, cleaning responsibilities and frequency schedule for patient care areas. Comprehensive cleaning checklists have been developed for individual clinical areas which clearly identify all of the elements of patient equipment and the environment that require cleaning. Checklists had been revised to facilitate accurate recording of scheduled cleaning requirements. It was evident that there was clarity regarding the roles and responsibilities of staff disciplines involved in cleaning.”

“Household staff, healthcare assistants and portering staff with responsibility for cleaning have completed a cleaning training programme. Hygiene supervisors have also completed relevant training.”

The Cappagh team had no definite clear reporting 7-8 years ago that involved all staff, in comparison to the comprehensive reporting they have now. They learned how to audit through CLEANPASS and how to see what’s wrong, only then can they address it. It was important to Cappagh staff with the help of CLEANPASS to standardise an audit practice and for the team to agree on what good looks like.

The Cappagh team now take a very systematic approach. They have customised CLEANPASS audits that are specific for every room – there is a feedback loop – oftentimes the person whose area is being reviewed is there observing the audit so that everyone is learning.

The five key things that have improved:

1 – There is a highly motivated team, each individual has pride and ownership of their own work – This has contributed to a positive culture.

2 – Clear SOP’s Standard Operating Procedures – Staff members have been systematically shown by the CLEANPASS team what needs to be done in practical demonstrations. They observe exactly what is required and put into practice what they have learned on the CLEANPASS course.

They had the freedom to be honest and they were understood by our supportive trainers. The training involved quite a bit of courage – they had to admit where the problems were in order to address them. The hospital reputation was linked to the reports received from HIQA
Openness to Feedback – An important component is that staff complete audits with the supervisors every time to reinforce the training. The blind spots are being addressed.
Cappagh’s patients notice – Declan proudly hands me a letter hand-written by a patient – and has given me permission to quote:

“Dear Declan,

As the supervisor of the Cleaning and Catering staff at Cappagh Hospital, I just want to acknowledge my thanks. They are all a credit to Cappagh. Each person, although very unique in themselves, is also very intuitive to a patient’s needs. I experienced it first hand and observed it also. The humour they shared is balanced nicely with life experiences. There is an honest to goodness nature with all of the staff that I interacted with in the Cleaning and Catering sectors whilst a patient within the hospital. The kindness and respect and communication from each one of them towards me was an absolute pleasure to experience.

The skill set of the Cleaning and Catering sector within Cappagh should not be taken for granted. They highlight the realistic mechanism of teamwork in all its forms. The dependency on them alongside the nursing, medical and orthopaedic consultants is of the utmost importance. Health and Nutrition is achieved through care and consideration given to individuals needs and I am so very thankful and deeply appreciative of the care and consideration shown to me by your wonderful Cleaning and Catering Staff.

Yours most sincerely, M

Overall the Cappagh team is more familiar with continuous improvement, they know that achieving quality standards is a constant endeavour.

It makes it so much more achievable working on the basis of the standards that CLEANPASS trained them on – these practices are now embedded. Everyone has the same discernment and consistency when cleaning, checking and auditing.