Implementing a risk-based audit system for environmental cleaning… a patient centred approach

Mrs Nicole Sarader1

1Fiona Stanley Hospital, Murdoch, Australia


In 2017 at Fiona Stanley Hospital (FSH), a collaborative working group began reviewing the cleaning inspection regime undertaken by Serco at FSH.

The group undertook a robust review of the cleaning audit process and tools aiming to develop a practical, evidence-based approach to better reflect current infection prevention principles, capturing the importance of high touch points, assessing the criticality of Functional Areas, reducing subjectivity of audit processes, and improving the provision of validated and objective feedback to clinical areas.  Previously, all locations within a functional area were assigned the same risk category which did not provide an accurate risk assessment of patient impact because administrative areas located in proximity to theatres do not present equal risk to patient safety.


A new audit tool was developed, with weighted questions placing greater emphasis on high touch points when the system (TopCat) calculates the audit result.  Auditor education and feedback and a three month trial occurred to ensure site suitability.


Implementation of the revised audit system began in April 2019.  It demonstrated an improvement in staff engagement, measurable actions to identify gaps and quality improvement opportunities, and feedback to relevant cleaning teams and clinical areas.  This contributed to improved environmental cleaning practices, validated through quantitative audit results and trending of data, and observed cleanliness of the patient care setting.


This innovation has provided a robust cleaning audit system that is clear, precise and understandable. It ensures high quality, consistent processes are in place contributing to positive patient outcomes.


As a registered nurse for 15 years and an Infection Prevention practitioner for the last 8 years, I have a passion for safe, patient centred care by everyone working in the healthcare setting.  In my current role as Infection Prevention and Clinical Advisor for Serco at Fiona Stanley Hospital in Perth WA I work with non-clinical services, bringing them on the Infection prevention journey, providing education, support, and promoting the importance of maintaining a clean and safe healthcare environment.

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