It’s that time of the year when hospitals – like all other facilities – plan for the year ahead. Amidst hectic budget discussions, Indrani Sanyal, General Manager – Housekeeping, Medica Superspecialty Hospital, Kolkata took the time to discuss how she plans her housekeeping budget, balancing Opex and Capex spends, controlling linen costs, gaps in healthcare housekeeping and the future of this critical segment.
What factors do you take into account while deciding the annual housekeeping budget?
There are two kinds of budgets that the housekeeping manager needs to plan for while preparing the annual budget: the Operational expenses budget or the OPEX budget and the Capital expenses budget or the CAPEX budget. When creating the annual budget, managers need to take into consideration the past performance and combine them with data–driven projections.
Some of the expenses included in the Opex budget in hospital housekeeping include the expenses for linen and uniforms for the entire hospital, gardening, pest control and the biomedical waste management of the facility.
In most hospitals, the housekeeping services are outsourced and in such cases, the largest cost in the housekeeping Opex budget is that of staffing. While planning for manpower expenses, one must consider statutory compliances, overtime hours, potential overstaffing and also a few other forecasted variable costs.
The second largest component of expenses in the hospital housekeeping budget is that of housekeeping cleaning materials and consumables required for patients as well as all the other staff of the hospital. The next largest expense that needs to be managed is the laundry expenses, which may be outsourced. These two expenses are considered as direct costs to the revenue and hence need to be planned as per the business forecast, and also continuously monitored.
While planning the Capex budget, the manager needs to plan carefully and ensure that the proposal for the capital expense will either improve the efficiency of the existing system or bring about cost optimisation or further have a direct impact on the health system’s ability to provide better care to patients. The Capex budgeting is generally related to the hospital or health system’s overall strategic vision for the organisation.
When comparing an Opex budget to a Capex budget, it is important to note that while the two are separate, each influences the other. Funding for the Capex expenses may need to come from the Opex budget. Hence, when planning a hospital budget, leaders must balance the effects of the two budgets.
In the past three years, have you been using any new cleaning/sanitising/sterilising technology, machine or chemical at your facility?
There has not been any significant change in the cleaning protocol in our hospital post the pandemic of the last three years. At our hospital, we have been using a 5th generation quaternary ammonium compound (QACs) for surface disinfection of the facility areas. QACs are highly effective against gram positive bacteria and have good efficacy against gram-negative bacteria, fungi and enveloped viruses. QACs also have some residual effect and they help in keeping surfaces bacteriostatic for some time.
The cleaning frequency and protocols are well defined in our SOP as per risk categorisation of the area. However, it is worthwhile mentioning that there is an increase in the usage of sodium hypochlorite as a disinfectant in some cases, like handling patients suffering from Clostridium Difficile. The surrounding areas of patients who test positive for this organism are cleaned with freshly prepared 1 % sodium hypochlorite as it is most effective in this case.
In your experience, what specific areas of wards, rooms, ICUs and OTs tend to be given less attention by housekeeping personnel?
All the areas in a hospital are categorised into three zones – high risk, medium risk and low risk zones. The cleaning protocols of all these areas have been well defined as per the CDC guidelines and every organisation will have their own SOPs laid down accordingly. However, in spite of it all, there are certain practical challenges which are faced by cleaning staff while executing the cleaning and disinfection program in any hospital.
While the housekeeping staff are carrying out the cleaning tasks as per the schedule, very often, they may be called upon to do some other tasks related to patient care to assist the nursing team, which takes precedence at that point of time. So the cleaning program gets hampered and certain areas may get missed out due to human error.
Also in some cases, particularly in the critical areas, there may be many monitoring devices or other medical devices which may be occupying the surrounding areas of the patient. In such cases, it becomes difficult for the cleaning staff to get access to all the surrounding areas without the support of the technicians and the nursing staff.
Whilst juggling between the various activities of cleaning, assisting with patient care and managing their documentation, following all the steps of the hand hygiene protocol sometimes gets diluted.
What parameters would you use to assess a housekeeping agency that wants to enter the healthcare housekeeping space?
- The service provider must be statutorily compliant in all aspects and would be preferred if they also have good liaison with the required legal entities.
- The agency must have strong training programs followed by regular evaluations.
- The agency must have strong laid down HR policies to manage their staff and at the same time also be focussed on their people management.
How do you balance costs and quality when it comes to providing laundered, hygienic linen to patients and healthcare personnel?
The laundry services can be in house or outsourced. In our organisation, we work with a couple of outsourced laundry vendors. In the case where laundry is outsourced, it is a better idea to work with more than one vendor so that qualitative as well as financial competitiveness may be maintained.
A reliable laundry service is of utmost importance to the hospital as it has a direct impact on patient service and the reputation of the hospital. At the same time, it is also one of the biggest cost parameters in the housekeeping budget.
The factors which are important and have an impact for good quality laundry services are:
- The quality of water: Hardness should not exceed 120 to 170mg/L.
- Quality and brand of chemicals being used: Chemicals used should preferably be eco-friendly in nature.
- Configuration of machines being used: Sufficient quantity of washer–extractors, driers, pressing units
- Type of machines: Whether steam operated, electricity or gas operated.
- Overall layout of the infrastructure: The flow of work should be planned such that it increases the efficiency of output.
However, without an efficient linen inventory process in place, the laundry services are still at risk of spiralling out of control. At the linen room, the following steps must be followed:
- Routine checking of the linen for appearance and hygiene standards
- Checking the daily receipts of fresh linen and soiled linen
- Physical stock taking of linen periodically
- Proper documentation of all processes
- Conducting regular condemnation and plan for timely replacements.
Ensuring the right controls at the laundry and in the linen room will certainly help in increasing the life of the linen and also help in delivering good quality hygienic linen to patients and healthcare personnel.
According to you, what new trends/products/processes can we expect to see in healthcare housekeeping in the coming years?
Today, sustainability, technology and hospital-grade cleanliness are all important trends in the cleaning industry. The Covid environment has necessitated that the earlier housekeeping service standards and protocols need to go through a metamorphosis and must be in synergy with the various stakeholders.
The requirements will be to focus on all components of housekeeping, including training, infrastructure, processes and outcomes. Some aspects which will be the new norm are as follows:
- Sensor based gadgets: wherever there was a need of frequent touch
- Automatic hand sanitisers
- Objective microbiology-based monitoring of surface cleaning standards.
- Selection of furniture and furnishings which are cleanable, easy to maintain, non-porous and resistant to microbial growth
- Creating a ‘menu of audits’ for quality control success
- Introduction of the concept of long acting chemicals
- Introduction of UV disinfection robots: Disinfection robots are a promising tool for surface decontamination in the hospital today, but with even greater potential tomorrow. Presently, they do not replace manual cleaning but can certainly complement it for better results. In the future, they can also provide validated, reproducible and documented disinfection outcomes.