Revising cleanliness in hospitals

Anne Hayes, Head of Market Development for Governance & Risk at BSI shows that the latest revision of the hospital cleanliness specification is not only about improving hygiene levels but patient trust

According to the Mid Staffordshire NHS Foundation Trust Public Inquiry by Robert Francis QC in February 2013, “A well-run ward has very high standards of cleanliness and hygiene. Not only is a clean ward more likely to be a healthy one, but it is also an environment which will improve morale and confidence.”

He could not be more correct in his appraisal as the 2 issues directly impact each other. Especially since an already unwell patient can not only physically but emotionally deteriorate if their care surroundings are poor. Therefore the provision of a clean and safe healthcare environment is a top priority for all healthcare organisations. It provides one of the major elements for effective infection prevention and control, promotes patient confidence and demonstrates the existence of a positive safety culture.

So crucial is this point, the absolute requirement to provide clean, safe healthcare is now written into a range of key legal processes and documents which govern the delivery of NHS-funded care. NHS organisations in England that provide regulated activities must be registered with the CQC (Care Quality Commission) and have to meet the requirements specified in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010b) in order to be registered. Regulation 12 specifies requirements for cleanliness and infection control. The Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance, December 2010, contains guidance about demonstrating compliance with the CQC’s registration requirements for cleanliness and infection control.

Additionally, the NHS Constitution pledges that the NHS will commit to ensuring that “services are provided in a clean safe environment that is fit for purpose, based on national best practice.” The Secretary of State for Health, all NHS bodies as well as private and voluntary sector providers supplying NHS services are required by law to take account of the NHS Constitution in their decisions and action.

With this in mind, BSI worked with the Department of Health (DH) who sponsored the revision of PAS 5748:2011 Specification for the planning, application and measurement of cleanliness services in hospitals for its use in NHS hospitals in England (published November 24 2014). As with all standards developed by BSI, there is no mandatory requirement for their implementation. As such, NHS hospitals can choose whether or not to use this specification as there are currently no statutory or procedural requirements to do so. Organisations may wish to adopt PAS 5748:2014 as part of their governance strategy and risk-assessment protocol and to provide evidence of intention to comply with part of the CQC’s registration requirements for cleanliness and infection control.

As Robert Francis states in his 2013 report, “It is not just the responsibility of cleaning staff to keep the ward spotlessly clean, but of all staff. Consultants and senior executives should be just as alert to picking up and disposing of waste on the floor as cleaning staff. All who detect something that needs cleaning should alert those responsible for taking action immediately.”

PAS 5748:2014 recognises this wider accountability and takes a top-level to grassroots view. Key staff such as chief executives, directors of infection prevention and control, directors of nursing, lead nurses or matrons are some of the people who can ensure patient safety is a priority within the NHS in England. This framework for a risk-based cleaning system takes a continuous improvement approach to hygiene, taking into account the number of problems that can occur due to poor cleaning. It provides for the planning, application, measurement and review of cleanliness services in hospitals.

Some of the things that it covers:

  • Governance of cleanliness service;
  • Assessment of the risk of a lack of cleanliness;
  • Providing cleaning tasks;
  • Measuring cleanliness on the basis of visual inspection;
  • Implementing corrective action;
  • Conducting performance analysis and implementing improvement actions.

The specification builds on the experience and content of the national specifications for cleanliness in the NHS (NSC) 1, the most recent version of which was published by the National Patient Safety Agency in April 2007. It does not replace it but will exist alongside to provide an alternative means of demonstrating an intent to comply with part of the registration requirements of the CQC. It is expected to be used in conjunction with The Revised Healthcare Cleaning Manual 2, which gives general and specific guidance on how to operate the provision of cleaning services within a healthcare environment.

What it includes:

  • An update to the risk assessment clause (Clause 4) to include supportive material based on work carried out since the 2011 publication;
  • This work is represented as a completed risk assessment of all 50 scored elements (Annex C) as well as a range of typical functional areas likely to be found at all hospitals (Annex D);
  • An example of overall risk category outcomes using the completed risk assessment of elements and functional areas is provided at Annex E

PAS 5748:2014 is free to download for NHS staff in England at the following link: .


1 The national specifications for cleanliness in the NHS:

2 The Revised Healthcare Cleaning Manual:


Anne Hayes

Head of Market Development for Governance & Risk



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