Study Trip to the Netherlands August 28–31, 2023

In the last week of August, an Erasmus+ study trip to the Netherlands took place, led by Puhastusekspert. The study trip was attended by representatives of consortium members SA Tartu University Hospital, AS Rakvere Hospital, SA North Estonia Medical Centre, Valga Hospital AS, OÜ SOL Baltics, Arkaadia Puhastuse OÜ, P.Dussmann OÜ, and Puhastusekspert OÜ, totaling 17 people.

The trainers in the Netherlands were Kristel Rietveldt from Gouda Hospital and Jaap Niezen from SVS.

One of the main objectives of the study trip was to learn from the Dutch experience on whether and how it is possible to ensure sufficient cleanliness and patient safety in a hospital environment by using water-moistened microfiber cloths and mops for cleaning.

Gouda Hospital

Since 2008, Gouda Hospital has been using water-moistened cleaning textiles for cleaning. Disinfectants are used only for removing specific stains and in isolation cases. For daily cleaning, a neutral agent is used for toilets and washrooms, in addition to an acidic agent once a week in toilets and an alkaline agent in washrooms. The hospital has a systematic monitoring system for cleanliness results and processes; in addition to visual assessment, ATP tests are used to identify organic dirt, and microbiological samples are taken. Gouda Hospital’s experience shows that conscious cleaning with water and microfiber is safe and sufficient in a hospital environment, as the infection rates of this hospital were lower compared to the Dutch average, indicating better results.

In 2011, they also switched to cleaning medical devices solely with water-moistened disposable microfiber cloths. Consistent monitoring results also show good outcomes in this regard.

In addition to visiting Gouda Hospital, we studied at the SVS training center in Rotterdam and a hospital in Amsterdam. It is interesting to note that the cleaning performance monitoring systems and standards applied in both hospitals are similar to INSTA800 used in Estonia and Scandinavia, i.e., EVS914:2020 Agreement and Evaluation of Cleaning Work Quality, and EVS944:2023 Cleaning Requirements in Healthcare Facilities.

Our group was very cheerful and eager to learn. During the 3-day training, we experienced an incredible amount and gained new insights and ideas that will help consciously create cleanliness in the hospital environment and contribute to preventing the spread of healthcare-associated infections.

We highlighted the following key points:

To achieve sufficient cleanliness, consistent and systematic monitoring of results and activities, and drawing conclusions from them, are essential.
Cleaning staff had a defined training system – cleaning staff working in the hospital had to complete two 7-day training courses within the first 6 months of employment, one covering cleaning technologies and the other, the specific characteristics of the hospital environment.
Water and microfiber, when properly moistened and with controlled cloth movement paths, are a very powerful tool, removing 99.9% of microbial contamination. These figures were shown to us by the infection control representative of Gouda Hospital.
By acting consciously, we need few disinfectants and other agents.
Thoughtful and correct preparation and use of cleaning tools, trolleys, and textiles are the basis for a good result.
In a hospital environment, one of the biggest enemies is dust, which serves as food for microorganisms. Its daily removal was a top priority in Dutch hospitals.
Wards and similar rooms were cleaned without protective gloves; however, there were strict rules for hand antisepsis – whenever a cleaning trolley or similar item was touched, hand antisepsis was performed immediately afterwards. Their experience shows that acting in this manner results in fewer hand-transmitted infections and less waste from disposable gloves.
In the cleaning rooms, a clear distinction between clean and dirty zones was established to prevent contamination of cleaning tools and cloths.
Cleanliness in a hospital environment is the sum of many contributing factors. If one part is not as it should be, a domino effect occurs, meaning microorganisms can spread, leading to healthcare-associated infections. It is important to see the whole picture and monitor all aspects.
Artikli autor: Helge Alt