How clean is your practice?

Graham Jacob from the National Patient Safety Agency describes what their new cleanliness code means for practices

To continue to provide NHS services after 1 April 2012, all primary care premises will need to be registered by the Care Quality Commission (CQC).

To comply with the CQC standards for registration, primary care premises will have to meet a number of ‘Essential Standards of Quality and Safety', with one of these standards relating to the provision of a clean and safe environment.

Similar requirements are already in place for provision of hospital services, care home providers and will come into force for dental practitioners in April 2011.

What does this mean for GPs?

Regulation 12 of the Health and Social Care Act 2008 requires that all CQC registered persons ensure service users, staff and others are protected against identifiable risks posed by infections.

This includes, ‘the effective operation of systems designed to assess the risk of and to prevent, detect and control the spread of a healthcare related infection' and ‘the maintenance of appropriate standards of cleanliness and hygiene..', in the premises in which care is delivered.

This requirement means GPs will have to demonstrate they have in place a system to reduce any infection risk.

Where can GPs go for more guidance?

A Department of Health Code of Practice will be issued, further explaining these requirements and will provide extensive detail regarding what this will mean for primary care premises in practice.

Until then, the best available guidance comes from the National Patient Safety Agency (NPSA) in the form of the recently issued National Specifications for Cleanliness in the NHS.

This document sets out a simple step-by-step approach for GPs in how to assess the risk of infection in their practice and organise appropriate cleaning services.

These specifications have been developed from existing guidelines in hospitals and care homes and with the assistance of the CQC. Following these specifications will mean practices have the necessary assurance and documentation to demonstrate that the requirements of CQC registration have been met – although not the only way.

What should GPs do?

Care has been taken to ensure that the NPSA specifications take a proportionate approach to the issue. Recommended steps to take include:

1. Producing a short, broadly-focused cleaning plan, setting out how cleaning services will be resourced and delivered and ensures that cleaning staff are appropriately trained

2. Listing the areas and items which need to be cleaned (experience suggests that without such a process it is easy for items to be overlooked)

3. Assessing the infection-related risks of those items and the required level of cleanliness

4. Estimating the frequency that cleaning needs to be undertaken in order to achieve and maintain that level of cleanliness (and therefore ensure safety)

5. Colour-coding cleaning materials and equipment to ensure any infection risks through cross-contamination are addressed

6. Identifying those responsible for cleaning specific items/areas (again, experience suggests it can be easy for items to be missed or for one person to think it is someone else's responsibility);

7. Putting in place a monitoring process to ensure any shortcomings are identified and rectified.

The NPSA specifications also have some useful examples of best practice and downloadable versions of cleaning plans, responsibility framework and a score sheet available on the NPSA website.

None of the steps set out above are particularly onerous, and they are designed to ensure that any additional costs are minimised. There may be some time commitment in undertaking the initial setting up of these processes. However once this is completed, future maintenance should be a relatively straightforward process requiring only a periodic review to ensure they are still relevant, accurate and effective.

Graham Jacob is healthcare cleanliness lead at the National Patient Safety Agency

Click here to download the full guidance from the NPSA