Introduction

There should be a well-defined place for everything and everything should be in its place, is central to housekeeping services. With the growth of the hospitals in the private sector, particularly the emergence of corporate culture in hospital, more and more importance is being attached to the house keeping services. The concept of housekeeping service has originated from the hotel industry, but it has become a basic requirement of the hospitals also. The clean aesthetic and hygienic environment play a great role in attracting the customers, their retention and also in their delight. It is not only restricted to the external customers or end users of the services but also to the internal customers of the hospital. The internal customers of the hospital are doctors, nurses, paramedical staff and auxiliaries. Soothing and comfortable environment increases efficiency of the staff of the hospital. In bonus it is responsible for the patient satisfaction, in turn increased utilization rate of the hospital services. In nutshell, all hospital activities directed towards a clean, safe, hygienic aesthetic and comfortable environment is called hospital housekeeping.

 

History

Housekeeping services started in the middle of 17^th century. Florence Nightingale also emphasized the need of good housekeeping services. In 1960 the hospital housekeeping services were recognized as a separate discipline. Now with recognition of the quality assurance program a new housekeeping technique has been developed by the name of “5 S” technique. The “5 S” technique of housekeeping is gaining importance for application to other fields of the industry. It is equally applicable in the hospital housekeeping services.

 

Objectives

1. To maintain designated hospital areas and equipment clean so as to prolong their life, reduce likelihood of accidents, assist economical use, and enhance well-being of patients, staff, and visitors and hospital public image.
2. To wash windows and window screens and walls at high and low levels.
3. To decontaminate patient areas after infected cases
4. To collect soiled linen and distribute clean linen and to collect and dispose of dressings and other waste matter.
5. To control foul odours, insects and rodents to safeguard patients outdoor clothing, baggage, and personal effects.
6. To store and control extra beds and mattresses.
7. To move and re-arrange furniture.

 

 Policies

1. To perform tasks quietly with minimum disturbance and every consideration for patients’ comfort.
2. To issue clean linen.
3. To dispose of waste materials by incineration or other method to identify linen and clothing by, for example, sewn-on label or marking.
4. To associate with fire-fighting and other disasters.

 

Procedures

1. Dusting, scrubbing, polishing, washing, sweeping, and mopping of surfaces.
2. Stain and grease spot removal.
3. Removal of dry and wet waste to prevent cross infection.
4. Cleaning of surfaces such as windows, mirrors, Upholstery, and sanitary fixtures
5. Cleaning of carpets and rugs and window shades and blinds.
6. Cleaning electric light bulbs, shades, and fittings.
7. Prevention of infestation by insects and rodents Sorting of soiled linen.
8. Distribution of cleaning supplies.

 

Rules

1. Housekeeping staff greeting patients but not conversing with them leaving patients’ areas immediately when professional staff attend patients
2. Speaking quietly when in patient’s areas.
3. Prompt cleaning of equipment after use.
4. Electrical equipment not plugged-in with wet hands.
5. Housekeeping equipment not left to obstruct doorways or lift openings.
6. Rinsing water for floors and bathrooms.

 

Functions Of Housekeeping services

The main functions of the house keeping services are:

1. Clean rooms, clean corridors, clean wards, clean floors, roofs, fixtures, curtains, windows and toilets.
2. Hospital waste disposal
3. Sanitation and hygiene.
4. Odour control
5. Control of pests, flies, rodents & stray animals
6. Prevention of fire
7. Hospital equipment maintenance
8. Hospital infection control
9. Replace supplies in utility room
10. Interior decoration
11. Management tasks.

 

Types of Housekeeping Services

The housekeeping services can be broadly divided into:

1. In house services
2. Contractual services or outsourcing

1. In house Services: The staff is recruited by the hospital and the services are maintained by the hospital housekeeping services.

2. Outsourcing: Either the hospital housekeeping services are handed over to the third party for maintenance or the private party on out source is engaged for providing the housekeeping services to the hospital as per the requirement. There are distinct advantages of the outsourcing:

a. Relieves the hospital managements from burden of housekeeping.

b. Expertise in interior decoration or in other areas may be hired as and when required basis, so it will not be a permanent liability of the hospital.

c. Reduction in cost of staffing from recruitment to retirement.

d. Reduction in cost of maintenance of equipment’s and materials.

 

Housekeeping Activities

1. Sanitation

a.Basic Cleaning:

i.  Dusting

ii. Sweeping

iii. Mopping

iv. Polishing

v. Washing

b. Cleaning of the Physical Facilities:

i. Floors

ii. Walls and ceiling

iii.Door and window panel

iv. Furniture and fixtures

v. Equipment’s.

2. Odour Control

3. Hospital Waste Disposal:

a. Collection

b. Transportation

c. Disposal

4. Pest & Rodent Control

5. Control of Stray animals

6. Hospital Linen Supply.

a. Procure from store

b. Storage

c. Maintenance

e. Issue to units

f. Accounting sorting, segregation and sending for cleaning.

7. Housekeeping equipment maintenance

a. Proper placement

b. Dusting

c. Sweeping

d. Mopping

e. Polishing

f. Washing

g. Covering while not in use.

 

8. Management Task (POLICE TASK):

a. Leadership and Liaison

b. Implementation

c. Controlling

d. Evaluation

e. Team work that is “total effort of all members” (TEAM)

f. Attitude

g. Skills

h. Klowledge

 

Cleaning Agents

Following cleaning agents are generally used in hospitals:

1. Washing soda
2. Soda bars
3. Washing powder and soap
4. Abrasives like pumice stone, nylon scourers
5. Emery paper
6. Polishes
7. Bleaching powder phenol
8. Phenyl
9. Acids
10. vinegar.

 

Criteria for Good Cleaning Agent

1. It must have good cleaning property.
2. It should not be toxic to handlers.
3. It should possess good microbicidal property.
4. It should be deodorant.
5. It should be economical.
6. It should not be corrosive to floors.

 

Quality Of A Good Housekeping

A good house keeper has to be a hard task master. Task means, he must possess qualities of working in a team and with positive attitude, with skill and knowledge, what the brain does not know eyes don’t see. It varies from person to person. The house keeper must be a good interior decorator. The abilities of the house keeper should be:

1. Ability to work in team.
2. Leadership qualities.
3. Qualities of establishing good support with all units.
4. Skills of public relationship.
5. Attitude
6. Knowledge of tasks to be performed.
7. Ability to conceptualize things.
8. Active interest in the job.
9. Ability to select team members and assign tasks according to their ability.
10. Technical knowledge of bacteriology and mode of transmission of disease.
11. Record maintenance.
12. Knowledge of accounting and budgeting.
13. Qualities of supervision and control.
14. Manpower planning of the housekeeping services.
15. Knowledge of technological advancements in the field of housekeeping techniques.
16. Concern for quality assurance.
17. Aesthetic sense.

 

 

Personnel

The housekeeping services department is a labour-intensive department. It uses modern, up-to-date equipment, but the job of cleaning the patient rooms, corridors, and lobbies of the hospital falls to the labour force, made up primarily of cleaners (maids and porters). The administrative head of the department may be the housekeeper or chief housekeeper. The maids are assigned light cleaning, dusting, and mopping of the floors. The porters usually do the heavy housekeeping and the furniture moving. By the nature of the cleaning process, the maids have an impact on patients in two ways. The results of their work (that is a clean nursing unit or patient bedroom) have both a public relations and psychological effect. The maids’ approaches, professionalism, attitudes, and personalities directly affect the patients, since they come in constant daily contact with patients while cleaning their rooms. A cheerful, well-informed polite maid can add a great deal to the total image of the hospital.

Organizational Chart by Staff

Records

1. Area and responsibility record
2. Cleaning frequency instructions
3. Standard cleaning times
4. Surface care needs
5. Cleaning procedures
6. Inventory
7. Stock control of consumables
8. Administration department records common to other departments.

 

Interdepartmental Relationship

Housekeeping service unit has interdepartmental relationship with all the areas of the hospital as it renders cleaning service to every nook and corner.

 

Quality of Service

1. Stairs and corridors should be free from dust, litter, and equipment.
2. Floors should be without excessive polish and dazzle which cause slips and falls.
3. Toilet bowels should be stain-free, especially under rims, waste outlets obstruction-free, and bed frames lint-free.
4. Burnt-out light bulbs should be replaced promptly.
5. Mops, brooms, and brushes should be hung to obviate bristle bending.

 

Inter departmental relationships of housekeeping service unit
1	Laundry	Solid linen delivery & clean linen recipients
2	Incinerator	Disposal of combustible waste material
3	Infection Control	Infection control procedures are carried out by housekeeping unit
4	Wards	Cleaning patient room after discharge or transfer of a patient & making it ready for another patient

6. Soiled linens need spot-checking for misuse and stains.

7. Clinical laboratory tests made to identify bacteria on surfaces such as door knobs and handles.

 

 

Communicating

1. Oral communication is used when interpreting policies and rules, explaining new equipment and cleaning agents, and discussing revised procedures and duty schedules.
2. Written procedures for routine tasks guide workers to perform them correctly
3. Posters and exhibits may be used to encourage use of trash-cans.

 

Infectious and Hazardous Waste Removal

Whenever a patient is infectious and has to be moved into isolation, the housekeeping department must properly disinfect the patient’s room and remove infectious and hazardous wastes. The department interfaces directly with the infection control committee’s policies on disinfecting a given area or room, using special bacterial solutions and certain misting or other kinds of techniques that have proven effective in disinfecting accommodations. Usually infectious wastes are placed in specially marked bags and double bagged. Incineration is the most efficient and cost-effective method to dispose of infectious wastes. Legal requirement of hazardous waste removals varies from state to state. The removal of hazardous wastes such as carcinogens and radioactive materials is regulated by local, state, and federal agencies. Many state laws concerning hazardous waste follow the Federal Environmental Protection Agency regulations. The environmental services department must keep informed of changes in the regulations. Hospitals may have on-site removal mechanisms such as incinerators or may contract with firms to provide waste removal services. The hospital as the creator of hazardous and infectious wastes is liable for safe and removal of these products.

 

Linen Control and Distribution

An important factor in linen control, especially in guarding against pilferage, is that hospital linen should be properly marked. Linen marking (that is a hospital name or logo woven or stamped on to the items) is a very effective means of reducing the temptation to people to take linens home with them. In case of the linens and sheets, decals can be affixed to the items. It is common for hospitals to use different coloured linen throughout the hospital. For example, the operating room may use green, and medical-surgical nursing units may use white. There are two methods of distributing linen to the nursing units. Clean for the day should be on the nursing floor ready for use not later than the first shift. The distribution itself is usually handled in a centralized fashion in which one more large linen carts are regularly rotated around the nursing units from floor to floor. Another method of distributing linen, the decentralized way is to provide each nursing unit with its own separate linen cart. With this method, a nursing unit may have a small supply of emergency linen on the floor. But the bulk of linen is kept in the carts usually under lock and key.

 

 

 

Role of Computerization

Having good technologically advanced computerized services in the hospital is useful in many ways to all the departments.

1. Orders regarding the departments to be cleaned can be placed at the respective departments only.
2. The orders are then viewed at the central monitoring station in housekeeping department. Also there will be reminders for cleaning up of rooms which require frequent disinfectation.

Keeping hospital clean is not an easy task. Part of the problem is that a hospital is an active place open 24 hours a day, every day of the year. Frequently the heavy traffic areas need special attention; if they are not cleaned, they can give a negative image to the entire hospital. There is more to cleaning a hospital than simply making sure that each room and floor are cleaned properly under the right standards. Cleanliness for hospital patients, visitors and the staff has two side effects: it creates a public relations image, and it has a psychological effect on the patients and their visitors. A clean hospital is perceived to be a well-organized and well-run hospital and secondly it can reduce the probability, possibility and potentiality of infection.

 

Physical Facilities

The hospital housekeeping services serve all the departments of the hospital, as far as possible, it should be centrally located and close to the vertical transport system of the hospital. The following facilities are required in housekeeping service:

1. Office of housekeeper
2. Office room for clerk.
3. Office room for supervisors.
4. Store room for housekeeping equipment’s.
5. Store room for housekeeping materials like cleaning agents.
6. Janitor’s closet on all floors equipped with sink, shelves for housekeeping equipment’s, supplies, containers, etc.

 

 

 Organization of Housekeeping Services

 

 

Job Description of Housekeeper

It is a real guide to a new recruit as well as to the hospital to train the housekeepers. These parameters not only include duties and responsibilities but also the reporting relationships, authority and control. This will also include how to coordinate with other departments, status within the departmental hierarchy, etc. The hospital administration must hand over the job description to every new recruit to make them aware about the job responsibilities. It has got several advantages:

1. The new recruit knows exactly what is his job.
2. A basic foundation for standards of performance.
3. They know the reporting relationship in the organization.
4. It may act as a legal document on the occasion of disputes.
5. It may protect the subordinates from undue pressure from the superiors.

 

Housekeeping Equipment

Common equipment’s used in housekeeping services are:

1. Scrubbing machines
2. Vacuum cleaner
3. Fumigation machines
4. Ultrasonic fly control device
5. Dust bins, garbage bins, mopping machines for mechanized cleaning.

 

Recent trend in Housekeeping

Due to the increasing need of housekeeping services in the modern hospitals, new advancements are being introduced in respect of technology and techniques. Some of these are being enumerated and discussed below:

1. Mechanized cleaning: With the help of vacuum cleaner and mechanized mopping, the job has become easier and the stigma attached to the sweeping has also been removed.
2. Colour schemes: Attractive colour schemes are available with computerized mixing and coding of colours to give hospital wards, interior, exteriors, corridors an attractive and aesthetic look.
3. Deodorants: Electrical devices, releasing deodorants in time interval is a new introduction.
4. Contractual system: Instead of developing a permanent liability for hospital, now most of the hospitals prefer for out sourcing of the services. The students are advised to consult the chapter on contracting in health care.
5. Control of Hospital infection: The housekeeping services have great role to play in control of hospital infections.
6. Pollution control: Reducing of glare to patients, reduction in noise pollution.
7. Fire safety: Fire prevention by a system of fire detection, and control is an essential part of housekeeping services. The fire detection system, fire alarms, should be conveniently and aesthetically located, so that it does not give a shabby look to the hospital.
8. Provision of concealed wiring: For electricity, telephone cable and AC ducts, so that it does not give a shabby look to the interiors of the hospital.
9. Pneumatic transport system.
10. Quality assurance program through “55” technique. Application of “5S” technique for quality assurance in housekeeping services of the hospital. The housekeeping is an important component of any hospital. It is not only important from the point of view of the patients or their attendants but also from the point of view of the service providers. The work environment improves, the efficiency of the employees, is a proven fact. The “5S” technique is very useful for any health care organization, for improved housekeeping. “5 S” stands for Japanese words – all starting with ‘S’, these can be translated into English words also starting with ‘S’. Therefore it is not necessary to remember “5S” in Japanese, what is important is to understand what it conveys, and practice it, rather than just memorizing the words.

 

 

Japanese in their language call these steps as SEIRI (Sorting), SEITON(Segregating), SEISO (Shine/ sweep), SEIKETSU( Standardize) and SHITSUKE (Sustain/self discipline).

1. SEIRI (Sorting): Sorting is about separating the things which are necessary for the job from those that are not keeping the number of necessary ones as low as possible and at a convenient location.
2. SEITON(Segregating): It is a question of how quickly you can get the things you need and how quickly you can put them away. Just making an arbitrary decision on where things go is not going to make you any faster. Instead, you to analyse why getting things out and putting them away takes so long. You have to study this for both the people using the things frequently and those who seldom use them.
3. SEISO (Shine/Sweep): Everyone is a sweeper. Cleaning should be done by everyone in the organization, from the managing director to the sweeper. This is why in Japan, they do not need street sweepers in residential areas. Every family is responsible for cleaning the pavement in from of their houses. Therefore, what they need are rubbish collectors.
4. SEIKETSU (Standardization): Standardization means continually and repeatedly maintaining organization through neatness and cleaning. As such, it embraces both personal cleanliness and the cleanliness of the environment. The emphasis here is on visual management and “55” standardization.
5. SHITSUKE (Sustain/self discipline): Self discipline means instilling the ability of doing things the way they are supposed to be done. The emphasis here is. On creating a workplace with good habits. By teaching everyone what needs to be done and having everyone practicing it. In industries the “55” has been applied for better housekeeping and it is equally relevant for the health care organizations.

 

Indicators For Quality Services

1. The visual effect.
2. Comments from patients/relatives as ascertained through patient satisfaction survey/complaints/suggestions.
3. Complaints from the staff (especially the doctors/nurses) in the patient care areas.
4. Instances of non compliance of BMW management rules.
5. Increase/decrease in the HAI attributable to the HK services. 6. Extent of pest/rodent nuisance as reported by the dietary/other staff.

 

Summary

Housekeeping is one of those services whose efficiency, or lack of it, can be seen in any area/department of the hospital. Shining floors, clean dust free walls and ceilings always inspire confidence whereas dirty filthy corridors, stinking toilets and insect nuisance not only offend the senses but also discourage the patients/visitors. Apart from the visual effect an unclean environment has a direct effect on the hospital infection rate.

Quality of house keeping service depends largely on the quality of process used. All that it needs is a trained, motivated workforce, standardized cleaning and disinfection procedures (and schedules) and adequate good quality cleaning materials. Modern equipment, if available, may enhance the quality of shine on the floors. However, one must realize that dirty areas are often the areas where machines cannot reach and men won’t care to.