ICS Magazine

Team Cleaning in a Healthcare Setting

December 14, 2000
Team cleaning is a flexible, efficient and cost-effective cleaning system that has been successful in office buildings, school districts and other commercial environments. In recent years, team cleaning has been tested in the healthcare industry with great success. However, to meet the standards of healthcare infection control programs and regulatory agencies such as the Joint Commission on Accreditation of Health Organizations (JCAHO) and the Occupational Safety and Health Administration (OSHA), a different approach to team cleaning is required. To understand why these changes are appropriate, you must first understand the basic philosophy of team cleaning.

Team cleaning improves production time and the quality of cleaning by refining jobs/tasks to their purist form, then transforming these functions into separate specialist positions. Unlike zone cleaning, another industry standard, employees are not accountable for all cleaning tasks in an assigned area, but form a staggered assembly line that allows each specialist to cooperatively “assemble” their component of the cleaning program in a prescribed sequence and manner throughout a facility.

The traditional team cleaning structure consists of four specialists: Light Duty Specialist; Vacuum Specialist; Restroom Specialist; and Utility Specialist.

This configuration of specialists is very effective in non-medical facilities, but does not meet the cleaning challenges and standards in a major healthcare environment. In October of 1994 at the Kaiser Permanente Medical Center in Fontana, California, (a 1.2 million sq. ft. medical center), we addressed this issue during the planning and test phases of team cleaning and developed a health care model consisting of seven specialists.

We expanded the existing “team” by adding three new specialist positions, a medical waste specialist, mopping specialist, and a project specialist. The new positions were extracted from duties that the light duty, restroom, and utility specialist performed. We felt these changes would improve productivity and meet the following infection control and regulatory guidelines that require:

  • The appropriate cleaning and disinfecting of all fixtures in inpatient and outpatient areas.

  • A cradle-to-grave medical waste control program for proper handling and transporting of solid waste (regular trash), soiled linen, biohazardous waste, sharps containers (holding syringes, blades, and broken glass), trace amounts of chemotherapy and pathology waste.

  • Adherence to OSHA Rule 29 Bloodborne Pathogen standards.

  • Universal Body Substance Precautions and PPE (personal protective equipment) guidelines.

From the light duty specialist we created a medical waste specialist position. The traditional light duty specialist in a non-medical environment empties trash and recycling bins, dusts, picks up paper clips, paper and pencils from the floor, and spot cleans door glass and other surfaces. In a healthcare setting, the scope and demands of these tasks increase dramatically. “Emptying trash” includes the removal of office-type refuse, recyclable materials, soiled linen (which is handled as an infectious product), biohazardous waste, sharp containers and on a limited basis, trace amounts of chemotherapy and pathology waste. In addition to dusting and spot cleaning, the light duty specialist would disinfect non-floor surfaces of clinical exam rooms, special procedure/minor surgery rooms, utility rooms, labs, pathology/morgue work stations, central sterile supply, radiology exam rooms, and also stock paper towel and soap dispensers in these areas.

The workload volume alone of transporting medical waste, solid waste, and recyclable waste from our facility emphasized the need for the medical waste specialist position. For example, in 1996 the Fontana medical center collected more than 17.1 million lbs. of waste products and soiled linen.

By creating a medical waste specialist, we ensured consistency in the following regulatory requirements and cleaning tasks:

  • Free from the duties of collecting waste, the light duty specialist can ensure appropriate levels of hygienic and aesthetic cleanliness in the medical center’s general internal physical environment.

  • All biohazardous waste containers are lined with red plastic liners labeled with a biohazardous symbol. All biohazardous waste containers and transport carts are properly labeled. Bagging of biohazardous waste takes place at the point of origin and each liner is individually tied. Biohazardous waste is handled and transported through the facility by a trained specialist from the point of origin to the biohazardous waste holding area.

  • The fewest employees possible are exposed to medical waste products. Before the team cleaning program, on a nightly basis, we had 40 housekeeping positions that were responsible for the removal of biohazardous waste. By creating a medical waste specialist we reduced that number to nine. This reduced our employee exposure rate to medical waste by 70%.

  • The light duty and medical waste specialist production time is increased by separating daily cleaning and disinfecting of work areas from medical waste removal.

From the restroom specialist—a group that must daily clean 400 public and staff restrooms—we created the mopping specialist. The traditional restroom specialist is responsible for stocking dispensers, emptying restroom trash, cleaning and sanitizing fixtures and floors, sweeping/vacuuming and mopping tile floors in restrooms. In Kaiser’s initial team paradigm, all exam rooms, special procedure/minor surgery rooms, utility rooms, labs, and radiology exam rooms have tile floors that would be cleaned and mopped by the restroom specialist using the mop bucket on the restroom service cart. Given our concern that cross contamination from public and staff restrooms to patient care areas could occur, and given the existing workload volume of the restroom specialist, we created a mopping specialist to handle cleaning and disinfecting floors in ancillary areas. By creating a mopping specialist we ensured consistency in the following disinfecting and cleaning tasks:

  • Free from having to mop ancillary floors, the restroom specialist can concentrate on effective restroom cleaning. Public and staff restrooms are consistently cleaned, disinfected and stocked daily. This focused attention on restrooms has enhanced customer perception of overall facility cleanliness.

  • All clinical care areas such as exam rooms, special procedure/minor surgery rooms, utility rooms, lab work stations, and radiology exam rooms are mopped daily by the separate mopping specialist which eliminates the opportunity of cross contamination from public and staff restrooms.

  • The restroom and mopping specialist’s production time is increased by separating daily restroom cleaning, restocking, and disinfecting, from mopping of ancillary patient care tile floors.

From the utility specialist we created a project specialist. The traditional utility specialist polices and vacuums stairwells, transports trash collected by the medical waste specialist from the floors to the compactor, cleans brass, glass, blinds, deep cleans and refurbishes carpet/tile and performs light maintenance. A project position was needed because of the workload involved in maintaining the tile and carpet in our facility. By pulling the floor care duties from the utility specialist and creating a project specialist we ensured consistency in the following regulatory requirements and cleaning tasks:

  • The utility specialist would have time to properly transport medical waste. The transporting of medical waste in a healthcare facility in the state of California is very time consuming because of the state of California’s Medical Waste Management Act that requires solid waste, soiled linen, and biohazardous waste be transported to the appropriate holding area in separately labeled transport carts.

  • Productivity and consistency in scheduled project cleaning for carpet and tile floor care are maintained.

The only specialist position we didn’t make changes to was the vacuum specialist. This person uses a backpack vacuum to complete tasks. Backpack vacuums have a greater maneuverability than canister and upright vacuums, and increase productivity significantly.

The vacuum specialist’s responsibilities include vacuuming under trash cans in each work station, vacuuming all other traffic areas, vacuuming upholstery and repositioning furniture, turning off lights upon completion of room and securing the area as requested. With the backpack vacuum, we were able to reach a productivity level between 6,000 to 8,000 sq. ft. per hour, depending on the service area. We chose a backpack vacuum with a four-filter system that contains 96-99% of 1 micron and larger dust particulate vacuumed. The type of vacuum we selected met our infection control policy that requires vacuums used by the environmental services department be of a type and model that does not add airborne particles to the environment.

Conclusion

The results of our transition to team cleaning are noteworthy. The seven-specialist team reduced our labor cost by 28%, while maintaining or improving the quality of cleaning. Our customized team cleaning program successfully addressed all regulatory standards, while reducing worker exposure to biohazardous waste by 70%. Due to the success of the program, the Fontana facility has also implemented team cleaning in in-patient areas. As a result of these findings, we believe team cleaning will become the standard in healthcare facilities.