Nursing Home Care and Cleaning

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1 Article for: New England HealthCare Article Due Date: June 15 or sooner Article Type: Small Feature Magazine Editor: Shawn Client: Enviro Subject: Cleaning Nursing Homes/bring in Green cleaning Word Count: 1000 Copy Editor: KH Nursing Home Care and Cleaning By Mike Sawchuk A few years ago, an 80-bed Connecticut nursing home sent their building service contractor (BSC) an ultimatum: either meet the terms of your three-year, $442,000 contract with our facility or get out. Meeting with the owners of the cleaning company, the nursing home administrators warned the company that this was its last opportunity to get the job done right. Rooms were not being cleaned to contract specifications and the number of housekeepers on duty varied from day to day, administrators said. I told them this was absolutely their last chance. If I had to talk to them again, it would be about firing them," added one of the administrators. Fortunately, things did improve for this nursing home. A new on-site supervisor was hired along with a number of new housekeepers. The BSC promised to provide more thorough and ongoing training of its workers and conduct monthly inspections of the facility all in an effort to improve their performance and retain the account. Although it is not known whether the nursing home renewed their contract with this cleaning firm, the administrators did note that, as of this writing, the service has improved, and in some cases even

2 surpassed expectation, according to one nursing home attendant. Nursing Home Issues In all fairness to the cleaning contractor, nursing homes have very specific cleaning needs and can be very difficult to clean and maintain. Unlike offices or schools, which typically allow the cleaning professionals to do their jobs while occupants are away, nursing homes have people living and working in them 24 hours a day, seven days per week. Further, these facilities typically rank with day-care centers, schools, and some medical facilities as home to a host of infectious diseases, germs, and bacteria that are rarely encountered in other types of cleaning situations. Worse, because the residents are older, often with weakened immune systems, they are more susceptible to infections and disease. Nursing home cleaning crews will also encounter cleaning situations not usually found in other locations. For instance, spills may be more common, as are toileting accidents, which must be cleaned up quickly and thoroughly without further embarrassment to the resident. A lot more attention may be required to cleaning high-touch areas, such as door handles, light switches, railings, and so forth. And some residents may not perform regular and proper hand washing, making cross contamination a real concern. For BSCs and nursing home administrators, the best way to handle the cleaning challenges in nursing homes is to have a system a process that addresses these different cleaning situations as well as the pressing hygiene, sanitation, and environmental issues specific to these locations.

3 A Nursing Home Cleaning System The professional industry has developed a variety of cleaning systems such as zone cleaning, specialist cleaning, day cleaning,* and so on. Each of these, and likely a mixture of all three, can be put to use to maintain a nursing home. However, some of the specific components of a nursing home cleaning system include: Evaluating cleaning needs based on who lives in the facility. Some long-term-care facilities have healthy, active residents who have few special cleaning needs. Others have older or more infirm residents that require special care not only from the facility s staff but from the cleaning crew as well. For instance, they may have accidents more often or may more frequently spill drinks on floors and carpets. Clarifying the responsibility of the BSC. Usually, the BSC will clean only common areas, not medical or special care stations. In addition, the analysis must take into consideration such things as how often residents use certain areas; how many residents use the areas; and the types of floor coverings (carpet or hard surface), furniture, and other items that can impact cleaning needs. Creating the cleaning schedule based on resident needs, traffic patterns, types of soils, load of soils, etc. A cafeteria floor cannot be mopped and cleaned at breakfast, lunch, or dinner breaks. Instead, other common areas can be serviced during mealtimes. This requires supervisors and the cleaning crew to determine which areas can be cleaned, with what and how, at what times.

4 Selecting/using effective products. Need effective cleaners, not simply overusing the least expensive neutral cleaners. Also need to ensure the proper and careful use of effective disinfectants or cleaner/disinfectants. Need to ensure the product has the kill claims required (not all hospital use disinfectants have the same kill claims), and are used as per the manufacturer s instructions pre-clean first (yes, requires a two step process), and dwell/wet time (yes the surface must remain wet for that time a spray and wipe will not due). Work loading to use each cleaning worker s time most effectively. With an effective work loading system in place, cleaning supervisors know approximately how long it takes to perform all cleaning tasks in each area of the facility as well as the number of custodial workers required. This includes performing not only cleaning duties but also noncleaning tasks such as getting equipment, replenishing supplies, and going to and from trash-collection areas. Workloading must match the scope and requirements expected. Determining an effective way to handle spills, toileting accidents, and emergencies. This usually requires some sort of paging/communication system so custodial workers can be called when they are needed quickly. Additionally, the supervisor should know exactly who is available and can be called at specific times during the day. Cleaning Agents Today the trend in the professional cleaning industry is to incorporate Green cleaning products and systems wherever

5 possible. For a nursing home, this may be even more imperative than in other types of facilities. As mentioned earlier, older people may have weakened immune systems. Respiratory and related problems are quite common as well. Some conventional cleaning products can have an adverse impact on indoor environmental quality, especially for seniors. Specifically, they may contain ingredients or produce fumes that can be health-threatening. Fortunately, Green equivalents of most cleaning products are available that perform as good as, if not better than, conventional cleaning products. However, to ensure the benefits of Green cleaning products are captured, BSCs and administrators are advised to make sure the products have been certified by a recognized, independent Green certification body such as GreenSeal or EcoLogo and that they are used properly. Training in the use of the products is also necessary and can be used as an opportunity to reeducate cleaning professionals on proper cleaning methods and procedures. Additionally, nursing homes should install auto-dispensing systems. These systems precisely dilute the Green cleaning chemicals depending on the cleaning task at hand. This helps reduce costs from a free pour system by 25 to 60%, is more environmentally sustainable as it reduces overall packaging and transportation impacts, and it helps to eliminate chemical waste as it protects the health of cleaning workers and building occupants. Both BSCs and nursing home administrators need to recognize that cleaning and maintaining a nursing home can be difficult and, in many ways, is unlike cleaning any other type of facility. However, by working together, with the goal

6 of providing a healthy, sanitary, and environmentally safe environment for the residents, most obstacles and challenges can be met. Mike Sawchuk is a cleaning industry veteran. He is vice president and general manager of Enviro-Solutions, a leading manufacturer of Green cleaning products with offices in the United States and Canada. * With zone cleaning, one cleaner cleans an entire area by themselves; with specialist cleaning, several cleaners work together as a team, each performing specific cleaning tasks; day cleaning, as the name implies, is performed during the day while occupants are using the facility.