Cleaning in hospitals: what is at stake and the protocols involved

In a healthcare facility, cleanliness is not a matter of comfort: it is a matter of patient safety. According to the national prevalence surveys carried out by Santé publique France, the French public health agency, around one hospital patient in twenty has a healthcare-associated infection (infection associée aux soins, IAS) on any given day. Cleaning and disinfecting surfaces play a direct role in preventing these infections. Here is what you need to know about the protocols, standards and requirements that govern cleaning in hospitals.

Hygiene requirements like no other

Hospitals impose cleaning constraints that are radically different from those of an office or a shop. Surfaces there are potential vectors for the transmission of pathogenic micro-organisms -- multidrug-resistant bacteria, viruses, fungi -- that can survive for several hours, or even several days, on inert surfaces.

Healthcare facilities generally classify their premises according to the level of infection risk, often on four levels:

• Low risk -- Reception halls, administrative offices, technical rooms. Standard cleaning is sufficient.
• Moderate risk -- Patient rooms, consulting rooms, rehabilitation departments. Daily cleaning and disinfection is required.
• High risk -- Intensive care, critical care, accident and emergency. Bio-cleaning is essential, with strict protocols.
• Very high risk -- Departments caring for the most vulnerable patients (transplants, neonatal care, severe burns). Protocols there are at their most stringent.

Each area has its own cleaning plan, which sets out the frequency of cleaning, the products to be used, the cleaning techniques and the microbiological checks to be carried out.

Bio-cleaning: much more than standard cleaning

The term "bio-cleaning" (bionettoyage) refers to a three-stage process described in the recommendations of the hospital hygiene bodies (the CLIN, or nosocomial infection control committees, and the former CCLIN, now the CPIAS):

1. Cleaning -- Removing visible soiling with a detergent. This mechanical stage removes the organic matter that shields micro-organisms and reduces the effectiveness of disinfectants.
2. Rinsing -- Removing detergent residues. Insufficient rinsing can neutralise the disinfectant applied afterwards.
3. Disinfection -- Applying a disinfectant product whose activity has been tested to European standards (EN 13727 for bacteria, EN 14476 for viruses, EN 13624 for yeasts). The prescribed contact time must be strictly observed.

In practice, many facilities use combined detergent-disinfectant products that carry out the first two stages in a single operation. This time-saving choice must not, however, lead to the mechanical action of cleaning being neglected: scrubbing the surface is still essential to remove biofilms.

The standards that apply to the healthcare sector

The main standards and regulations governing cleaning in healthcare settings include:

• The French Public Health Code (Code de la santé publique) (Articles L.6111-1 et seq.), which requires healthcare facilities to take action against nosocomial infections
• The recommendations of the HAS (Haute Autorité de Santé, the French National Authority for Health), which are built into the criteria for certifying facilities
• The NF EN 14885 standards, which set out the requirements for disinfectant products used in medical settings
• The Ministry of Health's technical guide on the surveillance and prevention of nosocomial infections
• The CPIAS protocols (Centre d'appui pour la Prévention des Infections Associées aux Soins, the support centres for the prevention of healthcare-associated infections), adapted at regional level

HAS certification, renewed every four years, specifically assesses how well infection risk is controlled. Shortcomings in cleaning protocols can lead to reservations, or even to certification being refused.

Staff training: a non-negotiable investment

The quality of cleaning in hospitals depends above all on the competence of the operatives who carry it out. A high-performance product used incorrectly is ineffective. A rigorous protocol that is poorly understood is not applied. Training is not a luxury: it is the essential precondition for patient safety.

Cleaning operatives working in healthcare settings must master:

• The basics of applied microbiology -- understanding what a germ is, how it is transmitted and why protocols are designed the way they are
• Bio-cleaning techniques -- the sequence of steps, observing contact times, handling single-use mop heads and cloths
• Reading and applying technical data sheets -- dosages, dilutions, precautions for use, chemical incompatibilities
• Personal hygiene rules -- hand washing, wearing PPE, the clean/dirty circuit
• Traceability -- filling in cleaning logs, reporting anomalies, recording checks

Quality checks: measuring in order to improve

Where the health stakes are this high, trust is not enough: you have to prove it. Quality checks in hospitals rely on several complementary tools.

Visual inspections remain the first line of verification. Standardised assessment grids make it possible to give each room a score based on objective criteria: no visible soiling, condition of the floors, cleanliness of contact points (handles, switches, grab rails).

Microbiological checks go further. Surface samples taken by swabbing or with contact plates (agar) make it possible to quantify the residual microbial load after cleaning. The results are compared with the thresholds set in the facility's quality plan.

ATP bioluminescence is a rapid testing method that measures the amount of adenosine triphosphate (ATP) on a surface. Since ATP is a marker of living organic matter, a high level after cleaning indicates that the protocol has fallen short. The result is available within seconds, allowing immediate correction.

These checks are not punitive: they are tools for continuous improvement. The results feed into dashboards shared between the cleaning contractor and the facility's infection control team, making it possible to identify weak points and adjust protocols accordingly.

What a healthcare facility should expect from its contractor

Working in a hospital requires flawless organisation. Several points are worth checking when choosing a contractor.

Dedicated teams, trained in the specific features of the site and supervised by a designated lead, ensure continuity and quality of service: the operatives know the premises, the protocols specific to each department and the key contacts.

The cleaning plan should be drawn up with the facility's CLIN or EOH (Équipe Opérationnelle d'Hygiène, the infection control team). It sets out for each area the frequencies, products, techniques and checks to be carried out. This document is reviewed regularly in the light of experience and changes in regulations.

Products should be selected in consultation with the facility's pharmacy, taking into account their spectrum of antimicrobial activity, their compatibility with materials and their toxicological profile for operatives and patients.

It must be possible to trace every cleaning operation -- time, operative, area treated, products used, observations -- using cleaning logs or digital tools.

Cleaning in hospitals is an area where high standards allow no compromise. It is a constant commitment, carried by professionals who are trained, equipped and supervised.