Step into any of the washrooms at Tata Memorial Hospital and the next moment you would jump out with the suffocating smell of uric acid. Walk into the men’s toilet in the outpatient area of AIIMS Trauma Centre, New Delhi, you will be greeted with urine flowing out of the broken pot and people walking in and out of the same toilet, carrying uric acid in their shoes all over the place. The maintenance, which is mostly handled inhouse, includes a soap wash of the toilets at least twice a day and intermittent spraying of anti-septic solution to keep the odour under control. Many a time the safaiwalas do not turn up to clean the toilets and the authorities are either not aware or are too busy handling patients that the clean factor takes a back seat.
T o ilet s are a major issue even in private hospitals. Except that since housekeeping services are being outsourc ed, the toilets get cleaned more often. In spite of having systems in place and the facility outsourced to qualified service providers, CIJ observed serious lacunae at Fortis Mulund.
CIJ spotted outsour ced women janitors in washrooms doing exactly what an untrained staff would do. The mops used to clean the passageway inside the washroom were being used all over and kept aside with the mop end on the floor. Excess water in the passageway was being pushed into the toilets using the same squeegee in and out and that too a wrong one. The supervisor claimed that the janitor was new and that she would learn in time. But this mode of handling cleaning tools was happening at all levels of the hospital.
While, a common man may not comprehend the repercussions of this practice, any expert would agree that this wrong practice could be a major cause of contamination, spread of germs to other parts of the hospital and a major health scare.
The toilets otherwise are cleaned periodically through the day using all-purpose cleaning solution, wet mop and squeegee. Sani cubes are used in the toilets for odour control besides other toilet accessories of hand wash, etc. Ironically, the hospital is planning to “upgrade” the cleaning processes by replacing Sani cubes with Naphthalene balls!! Naphthalene balls have chemicals like naphthalene and pradichlorobenzen which are dangerous. Prolonged exposure can kill red blood cells, causing hemolytic anemia till the body is able to replace them. Symptoms include fatigue, loss of appetite, restlessness, fever, or jaundice, and severe cases
can result in kidney or liver damage. Eco-friendly sani cubes are available in the market for use especially in the toilets.
Outsourcing housekeeping services is yet to catch up but, in some hospitals outsourced janitors are being used to perform many other activities besides cleaning. They also do the work of hospital attendants! A janitor who is engaged in cleaning or even washing toilets is involved in attending to patient’s needs! This is true of not just private set ups but many government hospitals have in-house cleaners doing multiple tasks. Time and again doctors and nurses have been confronted for unhygienic hand hygiene practices leading to cross contamination but hospital authorities seem “oblivious” about disease spreading through janitors working as attendants. These janitors may have also handled hazardous waste! “At Fortis, we are already working on recruiting new staff as hospital attendants,” said the Executive Housekeeper.
From the primary observations at both private and government hospitals, apparently a common man’s initial lookout of any facility is the medical expertise. Ironically, the cleanliness and hygiene factor probably comes to fore only during the consecutive post-treatment visits.
From the industry perspective, it is quite clear that clinical care takes priority and cleanliness & hygiene forms a complementing factor in the healthcare business. Even though hospitals are implementing the clean factor and also engaging professional cleaning systems, they are not as hygienic as it should be. Hygiene definitely cannot be compromised either on the part of the housekeeping professionals or the hospital when it comes to dealing with lives.
With more and more housekeeping service providers bidding for hospital cleaning contract, it is time to ponder if they are actually qualified to take up the job. Further, are the hospital authorities well-versed in cleaning & hygiene practices and are they keeping regular checks on the implementation ensuring cleaning standards at all times? Well, there is always scope to learn a lot more.
Many government hospitals are attempting to keep clean but given the nature of the people visiting these places, it calls for high level trained staff to firstly educate the people on hospital hygiene. In a maiden attempt, the Government of Puducherry has set up a state-of-the-art hospital and has outsourced the cleaning function to professional integrated housekeeping service providers. In the following pages, CIJ reports on the systems adopted by Fortis Hospital, Mulund, and the standards set at the Puducherry government hospital.