Don't get taken by the cleaners!

These days, cleanliness means far more than a facility that merely appears clean. Regulations must be followed, biological and physical hazards must be averted, and costs need to be kept in check.

The nursing home that opts to subcontract its cleaning out to a cleaning service needs to consider a range of issues before making a final decision. To help in that decisionmaking process, this article will review some of the possible hazards of poorly cleaned facilities as well as some useful preventive strategies

Hazards to Avoid

1) Possible infection/illness from poorly cleaned facilities. In every room of every facility -- but especially in the restrooms -- sanitation is the key to proper cleaning. But almost four years after OSHA's Bloodborne Pathogen Regulations were first put into the Federal register, only slightly more than half (64%) of contract cleaning services provides their employees with some type of training on Bloodborne Pathogen regulations.[*] This is especially troubling in longterm care facilities, where the largest of them may have literally hundreds of restrooms, as well as examination rooms with sharps and biohazardous waste.

It's important to remember that a nursing facility places itself at risk by contracting with an outside company that can't, or won't, do the job thoroughly and effectively. With proper training and cleaning techniques, the risk of cleaning-related infection or illness in the nursing home should be no greater than it is in the standard office building.

2) Fines levied by government agencies: As a number of nursing homes have learned, noncompliance with regulations related to cleanliness, safety and infection control can cost dearly. OSHA fines, for example, can be particularly nasty. This is serious business, and your cleaning service should help you to develop a site-specific plan to prevent deficiencies and, if deficiencies have already been tagged as violations, to correct them immediately.

OSHA exists to protect the worker on-premises, regardless of who the employer may be -- the nursing home or a contract cleaning service. This is another reason why the nursing home needs to be certain that all subcontractors meet OSHA requirements. Otherwise, the facility may be held responsible for everything from the cleaning service worker using glass cleaner to clean a toilet, to the worker who carelessly places your residents, staff or him or herself in direct danger. Again, awareness is the key.

3) Infections/allergy symptoms due to poor indoor air quality: Indoor air quality is a hot topic these days. Those of us in the cleaning community had expected OSHA to come out with stringent Indoor Air Quality (IAQ) regulations by now, but these have apparently been delayed, due, possibly, to the Congressional majority's stance on new regulations. New regulations or not, poor air quality from biopollutants remains a concern, especially in health care facilities. And biopollutants need to be removed from the facility, rather than simply moved around. This is accomplished by minimizing dusting and making more extensive use of vacuuming.

More long-term care facilities are using carpeting, and while manufacturers are producing a higher-quality, easier-to-clean product, carpeting still needs to be kept clean and dry to prevent mold and mildew build-up contributing to allergic reactions. To clean carpets effectively without having to cordon off an area for an extended period of time, it's important to use cleaning methods that avoid putting a great deal of moisture into the carpeting.

Dry carpet cleaning methods, such as dry foam extraction, clean just as well as wet cleaning methods. They also greatly reduce drying time since the dry foam contains only 7% moisture. At times, bringing in ah air mover to supplement the building's ventilation can help to ensure that drying occurs within a reasonable amount of time.

4) Allergic reaction from overuse/misuse of chemicals: OSHA's hazard communication standard is designed to protect employees using chemicals, as well as the employees and residents of the facility in which the chemicals are used. Cleaning service workers should therefore be knowledgeable about the chemicals they use, and their specific knowledge and training in chemical safety issues should be inquired about.

5) Slip and fall injuries: The need to prevent falls should be as much of a priority to cleaning personnel as it is to the nursing home staff. Cleaning service workers should be trained to keep equipment out of the path of residents, staff and visitors, and should be instructed not to "save time" with methods that lead to overuse of annoying chemicals or to inadequate drying periods, leading to slipperly surfaces.

6) Premature wear-out of flooring materials, If you care for your flooring by calling the cleaning contractor only when it gets dirty, there may already be damage to the flooring surface by the time you make the call. The key to making any type of flooring last as long as possible is to work with your cleaning service contractor to develop a routine maintenance program to prevent problems before they occur. This may be a little more costly over the short term, but will produce big savings in replacement costs.

7) Cross-contamination of work areas: The thought of cleaning an office or lounge area with the same cloth that's been used to clean the bathroom is, to say the least, disturbing. It does happen, though; especially since most cleaning is done after hours or at other times when there is little supervision, these types of practices may go unnoticed. Your cleaning contractor should, of course, make sure its personnel understands the concept of cross-contamination. One result should be that you will notice cleaning personnel isolating and using cleaning equipment and materials designated for specific areas. This isn't always easy to pick up on, but keep your eyes open.

8) Breach of security: Unfortunately, some cleaning services send their workers out on a job with little or no supervision. This increases the likelihood that doors will be left unlocked or alarm systems won't be properly set. The best solution to this potential problem is an on-site supervisor employed by the service who personally oversees the work and makes certain that unoccupied areas of the facility are secure during the cleaning and after the workers have left.

9) Hidden costs: While we'd like to think that all our colleagues conduct business completely ethically and professionally, a small number of services may advise their customers to pay for a service they don't need. A case in point: Recently, a health care facility asked us what we would charge to strip and refinish their floors every two weeks. This indicated that this facility had been misinformed, since floor stripping -- the most expensive procedure performed on floors -- should be done every six months, at most. With proper routine maintenance, stripping may not be required for years at a time.

Carpet shampooing, one of the most frequently requested services, serves as another example of this concern. Shampooing is a very aggressive, "last resort" attempt to restore the carpeting to its original condition after it's been neglected. Again, with a good maintence program in place, less aggressive, less costly methods will usually suffice.

Asking the Right Questions

With all this in mind, how do you go about selecting a cleaning contractor that will provide the needed services in a safe, effective, efficient manner? Like anyone wanting to hire a service provider, nursing home administrators typically ask for references. The problem is that references usually only show the outcome, and while outcomes are clearly important, there are other, more relevant questions to be asked: What types of cleaning tools and chemical systems do you use? How is the cleaning staff trained: do they receive ongoing instruction after the initial training? What type of program do you have with respect to chemical safety, bloodborne pathogens and other safety issues? Is Your staff up to date on all safety regulations? Are your workers supervised?

As you meet with representatives from various services, keep in mind that the recommendations they give you with respect to a maintenance plan for your facility should not vary significantly in their basics from one service to another. The "rules of thumb" discussed in this article apply to all facilities.

[*]1993 Contract Cleaners Statistical Survey. Cleaning Management Magazine

Joe Fairley is Director of Franchise Development for Coverall North America, a cleaning franchisor with regional offices throughout the us, Canada, Asia, Africa and Europe.