Cleanliness procedures of medium & small hospitals are flawed: Study
Rita Dutta – Mumbai
Emphasis on hospitality and usage of cutting edge technology have surely given medical treatment in India a whole new dimension. But when it comes to cleanliness, most hospitals and nursing homes still function with faulty methods sans proper guidelines, a study reveals.
A survey commissioned by JohnsonDiversey India Private Limited and conducted by Hansa Research in 150 medium and small sized hospitals and nursing homes in Mumbai and Delhi reveals that most hospitals use faulty tools and methods of cleaning, whether it is mopping the floors, washing stains or cleaning dishes. The survey, conducted over a span of six months, had chosen healthcare institutes between 20 to 100 beds.
Speaking to this reporter, Abhay Desai, Head, Marketing, JohnsonDiversey, says, “Our study was aimed at finding the attitude, behaviour and satisfaction indices related to cleaning in healthcare institutes. We found that cleanliness is very loosely defined in most Indian hospitals and the methods used by them leave a lot to be desired.” The research was based on response of supervisors, doers and owner or management of the hospital. On the rationale behind excluding institutes of more than 100 beds from the study, an official of JohnsonDiversey, said, “Large hospitals are mostly conscious about cleanliness.”
The frequency of cleaning general wards was found to be lower than that of ICUs and OTs because of the belief that general wards are less prone to infection. “Functioning without well-laid guidelines on cleanliness, staff was found ignorant of the difference between various modes of cleanliness, even when they had the right equipment. Most thought sanitising and sterilising a room are the same procedure,” says Desai.
The study found that most hospitals used a mop repeatedly to clean various rooms. “While the liquid solution is changed, one mop is used for days together, without being cleaned,” says Desai. While only 70 percent of hospitals use chemicals to clean floor and the rest used detergents, ceilings are mainly cleaned by dusting.
Removing ‘stains’ and ‘patches’ are the key measures for cleanliness. “Hospitals use bleach for removing stains, whether of blood, urine or other fluids. Ideally, bleach is not to be used indiscriminately, as it damages the linen,” adds Desai. The average life of linen in hospitals was found to be six months.
“Cleaning is a scientific process, where different techniques should be used for different types of stains. For instance, a blood stain should be removed by a right blend of detergent, emulsifier and bleaching agent,” says Desai. Interestingly, more than 30 percent of institutes which outsourced cleaning of linen were unaware of the products used for cleaning.
While the usage of washing machine was high, that of vacuum cleaner and dishwasher was less because of low-felt need and high cost. Only 16 per cent used dry cleaners for cleaning carpets. The study pointed to the presence of hand dryers in washrooms of hospitals, which provides a breeding ground for germs.
The satisfaction level with current cleaning system was satisfactory, with only three per cent having faced problems and complaining without any effect. Level of satisfaction was less in the linen section among supervisor, which the owner/manager disagreed with.
About willingness to change, only one out of 10 felt there was a better cleaning system for linen, but were willing to pay only five per cent extra. Willingness to change was more in small nursing homes.
According to Dr Om Shrivastav, Infectious Disease Specialist, Asian Heart Hospital, “Hospitals do not pay much attention to cleanliness, which leads to cross contamination. A general ward can be as fraught with infections as an OT or an ICU, if infection control guidelines are not followed.”
Other surveys also endorse the apathy of hospitals towards cleanliness. A survey conducted by Centre for Enquiry into Health and Allied Theme (CEHAT) in 1996 to assess the physical and clinical standards in 50 hospitals and clinics in Satara district concluded that cleanliness was not a focus area for healthcare institutes. Says Ravi Duggal, Co-Ordinator, CEHAT, “Hospitals will spend money to look posh, but when it came to cleanliness, they were found to violate the standards.”
CEHAT will be conducting a similar study on a larger scale, to be funded by International Development and Research Centre, Canada. “This will be an Action Research Project for a period of three years in six districts, including Mumbai, starting from 2006. Apart from conducting survey, we will monitor them for a period of six months and chart out their action plan,” adds Duggal.
Though the common belief is that large hospitals do follow cleanliness guidelines, it may not be true, always. In a study of “Patient satisfaction with the hospital services” conducted at a large teaching hospital in New Delhi, in 1997, it was observed that cleanliness of toilets was one of five major dissatisfiers among the patients, besides quality of food, explanation of procedure, information about illness and treatment and linen.
In another study of costing of housekeeping services at a large teaching hospital in Delhi in 1997, the dissatisfaction with the toilets cleanliness was maximum.
Experts underline the need for chalking guidelines on cleanliness, supplemented with charts and diagrams for the small and medium-sized institutes.
Says Dr Shakti K Gupta, Associate Professor, Department of hospital administration, AIIMS, New Delhi, “A good housekeeping service is an asset which no hospital can afford to neglect. Good house keeping helps in prevention and control of hospital infections, reduces average length of stay, reduces cost on medical care and reduces suffering to patients, thereby enhancing public relations and patient satisfaction.”
It was observed that the cost on providing housekeeping services in a 865 bed tertiary care hospital in Delhi was Rs 21,96,504 per annum which includes general store items, disinfectant, insecticides and cleaning material. “Being a high cost centre, smaller hospitals and nursing home may be feeling inability to afford that much expenditure on providing good housekeeping services,” says Dr Gupta.
Although housekeeping is recognised to be an essential attribute of hospital care to patients, the budgetary provision for such services gets lower precedence in the overall hospital budgeting system. JohnsonDiversey, which conducted a cleanliness study in the hospitality industry, found that hotels spent more on cleanliness than hospitals.
“The per capita spend on cleanliness in India is a paltry 35 paise, in contrast with Europe which spends around Rs 450,” informs Desai.
Whilst India makes strides with the medical tourism boom, it is important that justice is done to cleanliness with more priority in all categories of the hospitals, say experts.
However, Anupam Verma, Honorary Secretary, Medical Tourism Council of Maharashtra, differs, “Most of the large hospitals vying for medical tourism do have their house in order. Nobody lands in a hospital without doing homework about the standards of the hospital.” Verma, who is director-administration of Hinduja Hospital, however, adds, “It is true that infection control is not religiously followed in hospitals. We are the pioneer in setting Infection Control Committee of India to monitor nosocomial infection.”