Implementing and Evaluating Ward Cleanliness in an Acute Care Setting at a Referral Hospital: an Evidence-based Practice Project

Abstract

Introduction
Environmental cleanliness is important for controlling infection. A male medical ward was identified to implement best practice for ward cleaning. The interventions were based on the WHO guidelines and focused on cleaning ward surfaces, sluice room, toilets and equipment.

Methods
A mixed method was conducted using the Plan DO Study Act model. Data were collected through audits, observations, documentary analysis, focus groups and semi-structured interviews. NVivo 12 was used to handle the qualitative data. Quantitative data was managed using Excel.

Results
A baseline audit consisting of 15 criteria for ward cleanliness and the use of protocols demonstrated that no protocols were used. An evidence based ward cleaning protocol was developed and implemented. Following the intervention, ward cleaning was evaluated on 5 separate occasions, using the original audit criteria. Thirteen attributes relating to the presence of protocols and their use scored 100%, two attributes related to the process of escalation if protocols were not followed, and presence of training on ward cleanliness scored 60% respectively. Using the Medical Research Council evaluation framework; we identified three themes from qualitative data:  Changes to practice, boundaries and frameworks; changes to ward ethos and environment; and system challenges.

Conclusion
The implementation of the ward cleaning protocol has provided insight into the complexities of improving care. The intervention proved successful and can be attributed to training, supervision and the involvement of ward cleaners and patient guardians.

Originality
Implementing evidence based change in a country with limited resources is highly complex. This project demonstrates successful change through the involvement of ward cleaners and guardians in the process of achieving ward cleanliness.  It highlights successful collaboration between academics and clinical practitioners and the involvement of stakeholders in implementing evidence based practice.