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A Guide To Improved Hospital Cleaning

An in-depth look on cleaning in the healthcare industry during a pandemic and beyond.



janitor worker cleaning hospital with Tennant Company commercial floor scrubber

Hospital environmental services departments (EVS) have always been critical members of the patient care team. During the global COVID-19 pandemic, with hospitals on the front line, it is more important than ever for EVS teams to establish confidence in their hospital cleaning and infection prevention processes.

This toolkit provides a set of principles and protocol to help your hospital’s EVS team enhance overall cleanliness, improve infection prevention protocol and increase patient (and staff) satisfaction during the time of global pandemic, and beyond.

Healthcare Cleaning Solutions that Drive Patient Satisfaction

The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey is the national standard for hospitals focusing on patient satisfaction and loyalty, and scores matter for a number of reasons. 

Research draws a strong connection between patient perception of facility cleanliness and outcomes that indicate satisfaction and loyalty on the HCAHPS[1] . Furthermore, there is a correlation between patient satisfaction responses on the HCAHPS and specific safety outcomes.

For example, data on the HCAHPS survey shows that when patients report being satisfied with room cleanliness, the risk of healthcare associated infection (HAI) is decreased. Survey results are now also linked with hospital funding. Under the Affordable Care Act’s value-based payment model, HCAHPS scores determine CMS (Center for Medicare & Medicaid Services) reimbursements.

A Closer Look at Hospital Cleaning Questions on the HCAHPS

In the HCAHPS, patients are asked about 27 questions. Two of these questions are specifically related to the hospital environment.

  1. During this hospital stay, how often were your room and bathroom kept clean?

  2. During this hospital stay, how often was the area around your room quiet at night?

The following tools will help your EVS team to ensure higher scores on these two questions, leading to more positive survey results but also helping patients to heal, increasing safety and promoting a cleaner, healthier environment for everyone in your hospital. It’s worth noting that most guidance for increasing HCAHPS scores recommends consistent and frequent communication. As you implement many of the steps provided in this toolkit, remember to communicate those efforts with your patients and visitors.

Lowering Noise with Protocol + Prevention

Patients need uninterrupted rest time to heal. Research has shown that noisy environments cause spikes in blood pressure, interfere with healing and hinder pain management efforts.[2]

That’s why it is so important to choose cleaning equipment that is quieter than conventional cleaning machines for your hospital setting. (We look at noise reduction equipment options more thoroughly in the “Guide to Choosing Cleaning Equipment” section of this toolkit.)

Noise reduction efforts should go beyond cleaning equipment, too. There are many protocols that can be incorporated to help to minimize noise levels so that patients may rest and heal. This can include any of the following steps:

  • Working with hospital management to respect “quiet zone” areas and times

  • Providing patients with a notice of work that may create noise or vibrations

  • Asking patients if they’d like their doors closed and providing complimentary earplugs

  • Replacing or repairing noisy carts and doors promptly

  • Installing acoustic panels that absorb sounds near patient rooms

  • Wearing soft-sole shoes

  • Training that incorporates the importance of speaking and working quietly while near patient rooms.
Tennant company does cross training for service employees
Tennant Company helps training customers on machines

Prevention Helps Keep Hospitals Clean + Quiet

With thorough prevention measures in place, you can reduce the frequencies of using louder cleaning equipment, particularly related to floor care. Preventive matting at entryways will reduce soil inside a facility by up to 80%. All dirt stopped at the door is dirt that does not need to be vacuumed or cleaned up throughout the day, allowing your EVS team to follow quiet-hour rules and keep the use of machinery to a minimum. Some preventive guidelines include:

  • Choose hospital-grade floor mats.

  • Place mats directly next to any doors, without space between the door and the mat.

  • Consider 15 feet of matting at entryways using a three-mat system of coarse scraper mats, combination wiper/scraper mats and wiper mats.

  • Sweeping outside near entryways can prevent dirt from coming in, which will minimize the time that burnishers and vacuums need to be used.

  • Small, maneuverable scrubbers and vacuums that are quieter should be used to prevent dirt from being tracked further into the facility when possible.

Cleaning equipment manufacturers release new accessories that clean better and quieter. Even without investing in new equipment, you may be able to add more efficient and quiet accessories, including newer filter types, to help reduce noise. Regular maintenance of floor equipment also helps keep noise levels down.  Even the most innovative and efficient machines can become louder without the proper maintenance. Preventive maintenance that helps manage volume includes:

  • Replacing wheels that become worn

  • Replacing vacuum belts

  • Oiling wheels to prevent squeaking

  • Replacing filters

  • Cleaning pads and checking squeegees after every use.

Managing Odors with Detergent-Free Cleaning

When we talk about managing odors through cleaning in a hospital setting, we are referring to eliminating malodors as well as the traditional scents associated with a “clean smell.” Harsh odors from chemicals can contribute to breathing issues in patients with compromised health, including EVS staff who breathe them in each day. Detergent-free cleaning not only helps keep patients safe, but also reduces waste, decreases shipping costs and minimizes exposure to VOCs (volatile organic compounds).

In a healthcare environment, there will always be the need for the use of hospital-grade disinfectants. However, a hospital can be strategic about the areas where effective, detergent-free cleaning is used to enhance cleanliness while limiting exposure to harmful chemicals and enhancing indoor air quality that promotes healing and safety. Plus, it’s more sustainable to choose detergent-free cleaning when you can. Using fewer chemicals generates less waste and uses less water and energy, reducing costs. Some opportunities for detergent-free cleaning at your hospital include:

  • Scrub floors with fewer chemicals. Detergent-free floor scrubbing leverages an innovative technology that electrically converts water into a cleaning solution that cleans effectively, improves floor traction and safety, and reduces environmental impact. And it can save you money by reducing the cost of training, purchasing, storing and handling of chemicals — while also using up to 70% less water than conventional methods.

  • Coat floors while minimizing odors. Advanced low volatile organic compound (VOC) floor coating systems can replace floor strippers and finishes that contain heavy metals. These coatings are not susceptible to hand sanitizer spills, and reduce labor costs by eliminating burnishing. Other floor coating systems can cure instantly through exposure to UV light, so they won’t emit noxious fumes that can affect patients, staff and visitors.

A Guide to Choosing Equipment that Reduces Labor Costs

Forward-thinking hospitals and clinics need to stay ahead of the technology curve to maintain their competitive advantage. With innovative technologies from quieter vacuums to robotic floor cleaning machines, you can give your teams the proper tools to do their job more efficiently, keeping patients more satisfied and healthier.

Quieter Cleaning Equipment

When it comes to choosing equipment that can aid in noise reduction efforts, EVS teams may focus on floor cleaning equipment. Many newer floor equipment models have noise reduction technology making them highly effective while fitting into the hospital's overall commitment to quiet.

Carpet Cleaning Equipment: Newer, rapid-drying carpet cleaning equipment can lower noise levels considerably while also reducing cleaning time. Many of these machines use a quieter microfiber technology which leaves almost 90% less water on the carpet compared to older methods and allows carpets to dry in under 30 minutes.[3]

Vacuums: Backpack suction-only vacuums are generally lightweight and can effectively clean as well as traditional vacuums on a variety of surfaces, while generating less noise. While slightly louder than a backpack vacuum, dual motor vacuums are still quieter than older models.

Burnishers: Newer push-model burnishers come with quiet modes. Even larger rideable burnishers can have noise levels as low as 69 decibels.

Detergent Free Cleaning Equipment

There is a wide variety of technology on the market to aid in effective, detergent-free cleaning. Some of the most effective technology electrically converts water into an innovative, detergent-free, solution that cleans effectively when used with a floor scrubber. This technology uses less water, meaning operators have fewer empty-fill cycles. Because there are no chemicals to buy, mix, or store, you can also significantly reduce labor costs and simplify operations and maintenance.

Robotic Cleaning Equipment

The rapid advance of safe autonomous technology is creating new applications for robotics in healthcare operations. Robotic floor cleaning is emerging as an opportunity for healthcare organizations to unlock consistent cleanliness and operational efficiency. 

Robotic floor cleaning is particularly useful in hospital reception and lobby areas, cafeterias and high-traffic hallways. Investing in more efficient methods of cleaning these high-traffic, large surface areas will free up labor and focus for more detailed cleaning tasks in patient rooms and other high-risk areas.



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