The NHS Scotland National Cleaning Services Specification: Healthcare Associated Infection Task Force

Guidance to NHSScotland




Healthcare Associated Infection (HAI) is a priority issue for NHSScotland, important both in terms of the safety and well-being of patients and staff, and of the resources consumed by potentially avoidable infections. HAI is equally important for healthcare services in the private, independent and voluntary sectors.

Cleaning services staff are an essential part of the multidisciplinary approach in improving patient, staff and public safety. For prevention and control of infection to work effectively, critical activities such as cleaning and hand hygiene have to be embedded into everyday practice. There must be a culture of "Infection Control is everybody's business" with integration of best practice into routine activities. In other words, simply an understanding and belief that "this is the way we do things round here".

The profile of prevention and control of HAIs has been transformed within the past few years. Significant milestones include:

  • The Carey Report "Managing the risks of healthcare associated infections in NHSScotland" (August 2001);

  • The NHS Quality Improvement Scotland (NHS QIS)/Clinical Standards Board for Scotland (CSBS) HAI Infection Control Standards (December 2001) and Cleaning Services Standards (June 2002);

  • "A framework for national surveillance of healthcare associated infection in Scotland" (July 2001);

  • The Antimicrobial Resistance Strategy and Scottish Action Plan (June 2002);

  • The Ministerial HAI Action Plan "Preventing infections acquired while receiving healthcare" (October 2002);

  • The Audit Scotland review of cleaning services and the NHSQIS review of HAI infection control standards (both published January 2003);

  • The "Champions" educational initiative (April 2002).

A major programme of work to improve the prevention and control of HAI across NHSScotland was laid out in the Scottish Executive Health Department's (SEHD) Ministerial Action Plan on HAI. The Action Plan also detailed the formation of a Scottish HAI Task Force under the chair of the Chief Medical Officer.

One of the immediate priorities for the HAI Task Force was the development of updated technical requirements for cleaning processes to be used in NHS specifications for cleaning services. An HAI Task Force working group was formed in 2003 to develop the National Cleaning Services Specification. This multidisciplinary working group included representation from NHS support and clinical services, the non-NHS care sector including independent hospital representation, members of the public, and staff partners (Full membership at Appendix 1).

The draft National Cleaning Services Specification was issued for widespread consultation in 2003 and the final document takes account of the views expressed. In the interim period before the Cleaning Specification was finalised, NHSScotland was asked to implement this draft guidance. The Cleaning Specification is written to be applicable throughout Scotland wherever healthcare is being delivered (e.g. acute, primary care and independent contractor settings), within the NHS as well as in the private, independent and voluntary sectors. The importance of environmental cleanliness in non-NHS sectors is reflected in the Regulation of Care (Requirement as to Care Services) (Scotland) Regulation 2002 and the National Care Standards.

"Partnership for Care: Scotland's Health White Paper", issued in 2003, contained proposals for changes to the governance arrangements for local NHS systems. This included the dissolution of the remaining Trusts and the development of single-system working where this does not already exist. This is intended to improve service organisation and delivery throughout NHSScotland. Organisational terminology should be interpreted as appropriate to the new unified structures.

The National Cleaning Services Specification

Audit Scotland published "A clean bill of health? A review of domestic services in Scottish Hospitals" in April 2000. This review made a number of recommendations aimed at improving the quality and effectiveness of hospital cleaning.

As a result of growing concern regarding HAI, the SEHD established the Carey Working Group to "address and make recommendations for a comprehensive framework for managing risk in healthcare settings with respect to infection control, decontamination and cleaning services". The Group's report "Managing the Risk of Healthcare Associated Infection in NHSScotland" recommended that NHSScotland adopt a standard approach to risk management in relation to HAI. The Group also developed draft standards for infection control, cleaning services and decontamination. The challenge was to develop realistic standards which were both achievable and stretching, and which would improve performance to meet current statutory, mandatory or good practice requirements. The intention was that the draft standards be passed over to CSBS (now NHS QIS) for development and implementation.

"Our National Health: A Plan for Action, A Plan for Change" launched in December 2000 states: "Every healthcare system will be expected to deliver the service standards established by the CSBS on food, cleanliness, infection control and other matters". Following the Minister for Health and Community Care's acceptance of the recommendations of the Carey Working Group, in June 2001, an HAI Reference Group was established by CSBS to finalise HAI related standards. The final version of the HAI Cleaning Services Standards was published in June 2002.

A follow-up review to assess progress against the recommendations within "A clean bill of health?" was undertaken by Audit Scotland between March and May 2002. The resultant report "Hospital Cleaning - Performance Audit" (published in January 2003), highlighted variations in the levels of observed cleanliness in wards and public areas. The report also looked at the frequency of cleaning tasks, staff input to cleaning and monitoring, recruitment and retention of staff, management arrangements and the application of policies and procedures. The review incorporated a baseline assessment of compliance with the NHS QIS standards for cleaning services and a review of cleanliness levels observed in hospitals, providing the first national snapshot. Local auditors, together with domestic service managers (acting as peer reviewers), visited 74 hospitals throughout Scotland. In summary, a very good or acceptable level of cleanliness was found in more than 70% of wards and 80% of public areas reviewed. Almost half of the hospitals had very good or acceptable levels of cleanliness in all areas reviewed. Over 25% of hospitals, however, demonstrated a clear need for improvement, with the remainder in need of some minor improvement.



2.1 At the outset of the project, agreement was reached with Audit Scotland on utilising the specifications of those organisations which could demonstrate compliance with the majority of the NHS QIS HAI Cleaning Services Standards and in particular, prove their ability, for example, to manage systems and technical specifications. On this basis, the following organisations were identified:

  • NHS Grampian (Acute and Primary)

  • Greater Glasgow Primary Care NHS Organisation

  • Ayrshire and Arran Primary Care NHS Organisation

2.2 Having reviewed the specifications, it was noted that each of these had been based on the Scottish Health Management Efficiency Group's (SCOTMEG) Review of Domestic Services in 1987. The Group agreed that this should be used as the foundation for the new Cleaning Services Specification, with demonstrable links to the NHS QIS HAI Cleaning Services Standards throughout the process. The document reflects the changes in practice since SCOTMEG and also current best practice.

2.3 In accordance with Audit Scotland's Guide for Hospital Domestic Services (1999), the Group recognised that only certain items could be subject to national guidelines while others would be subject to local policy. The Group agreed that a framework should be provided to assist managers, responsible for providing effective cleaning services, develop and define local policies and procedures to ensure a consistent approach to cleanliness. This will help ensure high quality services which are focused on service users and based on sound best practice principles.

2.4 From the outset, the Group agreed that in order to ensure flexibility, the technical specification must be both an input and an output model.

2.5 The SCOTMEG task definitions have been revised and the outcome measures published in August 2003 by NHS Estates Leeds (Standards of Cleanliness in the NHS) have been used.

2.6 Coding of areas and accommodation types have been updated to reflect changes in practice and to highlight particular areas of risk.

2.7 The Cleaning Services Specification addresses the issues necessary to improve performance against the Cleaning Services Standards within all NHS Scotland healthcare premises.

2.8 While this document contains general information on, for example, cleaning of fixtures and fittings, another HAI Task Force working group has produced an NHSScotland Code of Practice for the local management of hygiene and HAI, which includes guidance on environmental cleanliness and the cleaning of basic ward equipment.




3.1.1 Regular monitoring, audit and benchmarking of cleaning services are mechanisms through which Operating Divisions can assess the efficiency and effectiveness of the cleaning service. The outcomes of these processes will also allow staff and service users to form a view of the quality of cleanliness in healthcare premises.

3.1.2 The basis for all monitoring, audit and benchmarking audit activities must be firmly rooted in agreed and common standards which are widely recognised and in the public domain. Within cleaning services in NHS Scotland, the following are 'source' documents containing key standards and examples of good practice against which Operating Divisions can measure their own performance:

  • Audit Scotland - A clean bill of health? (2000)

  • NHS QIS/CSBS Standards - Healthcare Associated Infection (HAI) - Cleaning Services (2002)

  • Audit Scotland- Hospital Cleaning (2003)

3.1.3 The above sources are now complimented by the outcome standards published in this Cleaning Services Specification which includes clear outcomes for each cleaning procedure carried out by cleaning services staff. In addition, it sets out clear task descriptions and frequencies, both of which are key to the achievement of acceptable standards and which can be monitored in an objective manner.

3.2 Service Monitoring

3.2.1 Service monitoring must be an integral part of the day-to-day provision of the cleaning service with responsibility for ensuring an effective monitoring system. This monitoring process should normally be undertaken by the service provider and formally approved by the Operating Division.

3.2.2 Monitoring is the on-going assessment of the outcomes of cleaning processes. It must also assess the extent to which cleaning procedures are being carried out correctly. An effective monitoring system will be properly designed and implemented. It should not only assess overall effectiveness and provide the basis for a continuous improvement approach but will also identify where additional staff training may be required or indicate where existing training regimes can be improved.

3.2.3 Currently, there is almost total reliance on observational evidence in judging the outcome of cleaning processes. Such an approach is necessarily subjective and may be of questionable validity. The Group recommends that specific scientific research into cleaning services effectiveness is progressed as a priority, with the findings used to inform NHSScotland on the efficacy of different cleaning methods and frequencies. Research findings will also help identify appropriate monitoring techniques.

3.2.4 Although the Cleaning Services Specification is not prescriptive in regard to the design, content and operation of a monitoring system, an effective system will display some key characteristics. These include:

  • Monitoring systems must be sufficiently flexible to be able to cope with a wide range of situations and conditions (for example, during outbreaks or building works);

  • Selection of areas to be monitored should (at least in part) be random and unannounced while always respecting patient privacy, clinical need and the practicalities of accessibility;

  • 'High-risk' areas should receive comparatively greater monitoring attention than 'low-risk' areas;

  • All areas should be selected for monitoring at least once annually;

  • Systems should normally attach a 'pass' or 'fail' outcome for each area monitored;

  • Systems should be explicit on the maximum period permitted for rectification of 'failed' areas and subsequent re-inspection;

  • A proportion of monitoring activity should be conducted jointly by cleaning services staff, front-line staff and representatives from Operating Divisions' Infection Control Teams;

  • Detailed monitoring outcomes should be shared with front-line staff while higher level, summarised monitoring outcomes should be shared across the organisation and placed in the public domain;

  • Systems should include mechanisms to gather the views of patients and, where appropriate, their relatives with regard to the standards of cleanliness being attained;

  • Record keeping of monitoring activity should be capable of validation and systematic audit.

3.3 Audit

3.3.1 Audit activity should centre on the review of systems, policies and procedures which organisations have in place to manage their cleaning services operations.

3.3.2 While providers of cleaning services will undertake normally a significant part of the audit activity, good practice requires the involvement of others in periodic audit. For example, NHS QIS HAI Standards for Cleaning Services require the involvement of Operating Divisions' internal auditors to undertake periodic audits. Some organisations may also be subjected to audit by external bodies in the context of accreditation.

3.3.3 Cleaning services' audit processes must be capable of assessing the effectiveness and accuracy of day-to-day monitoring activity. Audit approaches should also be employed to assess other areas of cleaning services activities including:

  • Training and development (content, efficacy, volume against plans, record keeping);

  • Accident/incident reporting;

  • Availability/evidence of risk assessments;

  • Absence statistics; Attainment of national standards.

3.3.4 Audit Scotland has developed an audit tool which was used to assess standards of cleanliness subsequently reported in 'Hospital Cleaning' (January 2003). The Group believe there is merit in this audit tool being developed for on-going use across NHSScotland.

3.3.5 The Group has also considered the 'peer review' approach as an integral part of the cleaning services' audit and, notwithstanding some of the shortcomings of the approach encountered in its operation in the context of Audit Scotland's follow-up audit. 'Hospital Cleaning' (2003), has concluded that periodic peer review should become a feature of organisations' arrangements for assessing the standards of cleanliness being achieved and the reliability of their own monitoring processes. The Group recommends that the peer review audit tool is further refined.

3.4 Benchmarking

3.4.1 Audit Scotland's "A clean bill of health?" identified benchmarking as good practice capable of helping Operating Divisions identify where and how they can do better. Benchmarking is, therefore, consistent with the continuous improvement ethos which the cleaning service within an organisation should display.

3.4.2 In undertaking benchmarking activities, it is important to identify and use both cost and quality information to assess performance. Comparing processes across organisations (e.g. how the job is done, how the service is provided) should also be part of benchmarking activity, as context often enables comprehension of numerical and qualitative data.

3.4.3 'A clean bill of health?"' recommended that organisations must agree core indicators of cost, quality and productivity to allow comparisons of performance. Audit against NHS QIS standards has highlighted the considerable scope which exists to improve performance in this area, leading to agreement across NHSScotland of core benchmarks to be used on a regular basis. The Group recognises that while progress has been made (either by organisations acting unilaterally or working collectively as members of benchmarking groups), coordinated action across Scotland has yet to be achieved. The Group therefore recommends that a renewed focus on benchmarking is established across NHSScotland to produce properly researched benchmarks to be used by all NHSScotland organisations on a regular basis, in line with current practice elsewhere in the NHS.

3.5 Summary

Performance management is an integral part of cleaning service provision and best carried out with full involvement of service providers. A robust framework for performance management now exists across NHSScotland covering all aspects of cleaning services - from the activities of staff carrying out day-to-day cleaning tasks to the strategic responsibilities of managers engaged in the longer term planning of the service. Organisations must ensure the framework is used effectively in the planning and execution of performance management systems, through which effectiveness, efficiency and overall value can be assessed and improved.



4.1 Introduction

4.1.1 Due to the diversity of needs in cleaning and operating healthcare facilities and the requirements of legislation, a structured training programme needs to be developed and implemented for all relevant staff.

4.1.2 Although training arrangements may vary from location-to-location, the training of all grades of staff involved in the cleaning process must include specific training on infection control issues.

4.1.3 NHS QIS HAI Cleaning Services Standards outlines training requirements for healthcare cleaning service managers and staff.

4.2 Training/Staff Competence

4.2.1 Staff training must be an integral component of the management of cleaning services. A planned and documented training programme is therefore required for staff to become fully competent to carry out all tasks required of them. Staff should have the ability and support to do a good job through:

  • A clear and precise training programme, which is regularly reviewed and updated;

  • Up-to-date training records and support throughout the training process;

  • A strategy for the education and training of staff, which takes cognisance of NHSScotland guidance on training and lifelong learning. Personal development plans should also be developed to support the staff training needs.

Organisations may choose to further develop their own training programmes in line with the Scottish Vocational Qualifications (SVQ) framework, which require to be accredited by the Scottish Qualifications Authority and allow staff access to this training.

4.2.2 Staff training levels for managers and staff must be commensurate with their work responsibility/activity. Staff with supervisory responsibilities should be encouraged and supported to undertake appropriate qualifications in supervisory management. Managers should hold an appropriate qualification, preferably at diploma level.

4.2.3 Where managers/appropriate responsible persons are involved in the training of staff, adequate protected time must be made available for these duties.

4.2.4 All new staff must receive an organisational corporate induction programme. This should also be complimented by local induction training whereby the new member of staff is adequately supervised until they reach an appropriate standard. The induction programme for all staff with responsibility for cleaning must be documented and should as a minimum include the following:

  • Customer service/care

  • Hand hygiene/chain of infection

  • Personal hygiene

  • Infection control

  • Basic cleaning techniques

  • Health & Safety policies (including manual handling and Control of Substances Hazardous to Health, COSHH Regulations 2002)

  • Areas of responsibility

  • Use of protective clothing

  • Dealing with spillages

  • Waste disposal

  • Cleaning and storage of equipment

  • Any additional duties, e.g. food handling

4.2.5 It is important that staff involved in training others have sufficient knowledge and expertise to direct and instruct staff on all aspects of the cleaning process. It is therefore essential that these individuals receive training to an appropriate level to ensure that they are competent to undertake this task. Training should include the following:

  • Infection control

  • Legislative change

  • Risk assessment

  • New equipment/technology

  • Approved codes of practice

  • Local policies

  • Training skills

  • Service monitoring

Review of Training Programmes

4.2.6 Refresher training programmes for all grades of staff including managers should be developed and personal development plans produced where appropriate.

4.2.7 A record of all training should be maintained and refresher training provided to all staff on a regular basis.

4.2.8 The content of training programmes must be subject to regular review and updated frequently, so that best practice, new developments and any legislative changes are incorporated.

4.2.9 To further promote and underpin consistency in training, it is recommended that there should be national reference materials/packages available throughout NHSScotland.

4.3 Summary

4.3.1 Staff training and development is a core activity in any department involved in the cleaning service and a structured approach to training should be developed and controlled by an appropriate service manager, with direct input from Infection Control Nurses and other relevant healthcare professionals, where possible.

4.3.2 Organisations should ensure that the method of training delivery is readily accessible to all staff involved in the provision of the service and that training levels and technical competency are standardised throughout shift patterns.

4.3.3 Training programmes should be systematically applied and may well include a variety of training techniques including "classroom" and "on the job" training sessions.

4.3.4 Training programmes should be evaluated regularly to ensure that they meet the needs of the service and that staff are able to readily assimilate the information provided to them.

4.3.5 On-going training should take cognisance of the outcomes of monitoring reports, skills audits or competency reviews by appropriate responsible persons or managers.



5.1 Introduction

This section provides guidance on the interpretation and local application of the Cleaning Services Specification. It should be read in conjunction with the main document (at Section 6, Cleaning Services Specification).

For an input specification, the provision of frequencies is essential. The group considered:

  • The original SCOTMEG frequencies (August 1987) and those published in December 2001;

  • Edition Two in June 2003 by the Association of Domestic Management.

While, in the main, these have been merged into one document, there is one important difference in that recommended frequencies as opposed to minimum frequencies have been provided.


  • These are arranged by surface/category to be cleaned and include all relevant tasks.

  • Each surface/category is allocated a number indicating Task Group number and running from Group 1 - Group 21.



Task Group 1

Hard Floor

Task Group 2

Soft Floor

Task Group 3

Toilet, sinks, basins, baths, taps and fixtures

Task Group 4

Furniture, fixtures, fittings and soft furnishings

Task Group 5

Low level surfaces

Task Group 6

High level surfaces

Task Group 7


Task Group 8

Paintwork - walls and doors

Task Group 9

Glass partitions and panels and ceramic wall tiles

Task Group 10


Task Group 11

Window blinds

Task Group 12

Hand hygiene/consumable products

Task Group 13


Task Group 14


Task Group 15

Kitchen/servery, fixtures, fittings and appliances

Task Group 16

Cleaning equipment

Task Group 17

Clean/check clean

Task Group 18

Patient transport vehicles

Task Group 19

Colour coding

Task Group 20

Mop laundering

Task Group 21

Reporting of faults

  • Within the group, the required tasks are allocated numbers (e.g. Task Group 1 Hard Floors, Task 1.1 - 1.13)

  • At the end of each section, REQUIRED OUTCOME MEASURES relating to these surfaces/categories/task groups are included.

5.3 Index to Activity Codes

Activity codes to be applied to all patient accommodation and transport are defined on the basis of risk categories.

Within each Activity Code, the typical Room Type and Area are listed and codes applied (e.g. A1, D3)

Examples of how patient accommodation is classified is included within the headings.



A Code

In-patient Acute

B Code

High Risk In-patient

C Code

In-patient Continuing Care

D Code

Clinical Departments

E Code

Non Clinical Departments

F Code

Residential Accommodation

G Code

Clinic And Health Centres

H Code

Very High Risk Theatres, Transplant, ICU, CICU, NICU

I Code

Laboratory, Pharmacy, Sterile Fluid Preparation, SSD

J Code

Patient Transport Vehicles

K Code

Daily Clean Isolation Room

L Code

Discharge Clean

M Code

Terminal Clean

NB - Ambulatory Care and Diagnostic Centres (ACAD)
A cleaning services specification for these units was beyond the scope of this document. ACAD services are still themselves at the development stage and therefore an accurate assessment of the service level required is not possible to quantify currently.

5.4 Specification Codes - Frequency Templates

The results of Audit Scotland's survey (in May 2002), indicated that some organisations were not meeting the minimum level of cleanliness required. The Group therefore decided that the approach to frequencies should be more prescriptive, where appropriate, in order to encourage and promote consistent levels of cleanliness throughout healthcare facilities. Recommended frequencies, however, could be subject to a local risk assessment. This would not only take account of local policies but would allow an organisation the opportunity to demonstrate, by reference to risk assessment, the need to deviate from a recommended frequency.

Examples of Risk Assessment

  • A theatre which is in use five out of a possible 10 sessions, could have its frequency reduced to reflect the under-utilisation of the area, in comparison with an emergency theatre, which can be in use 24hrs a day, seven days a week, would require an increase in cleaning frequency to reflect usage.

  • An in-patient ward which closes at the weekend may, after risk assessment, have its cleaning frequencies reduced, in comparison with an in-patient receiving-ward (admitting and discharging large numbers of patients on a daily basis), may require to have its cleaning frequency increased to reflect activity in the area.

  • A ward area could be assessed as low risk, but the admission of a patient with a specific condition could change this risk rating to high. It should be recognised that healthcare environments are dynamic situations requiring ongoing review at local level.

Within this section, there are a number of issues which should also be highlighted:

  • The document is based on a template and as such, some Task Groups and/or areas will not be applicable in all healthcare settings.

  • Where no frequency is specified, it is assumed that these areas will be subject to local policy.

  • No recommendation/frequency is provided for soft flooring in isolation rooms because this type of flooring should not be present in these areas.

  • Local flexibility is required for discharge cleaning in order that the planned daily programmed clean can be reprogrammed/reallocated to avoid the requirement for additional cleaning input.

  • A terminal clean is defined as a procedure required to ensure that an area has been cleaned/decontaminated following discharge of a patient with an infection (i.e. alert organism or communicable disease) in order to ensure a safe environment for the next patient.

5.4.1 Frequency Template detail

X below full (cleans) or check denotes nature of clean

Cleaning frequency is indicated by numeric entry under week, month or year

  • 7 = Monday - Sunday

  • 5 = Monday - Friday

  • 2 = Saturday/Sunday

  • 7/7 = 7 full/7 check

  • 5/2 = 5 full Monday - Friday/2 check Saturday/Sunday

  • 7/14 = 7 full/14 check

  • 7/21 = 7 full/21 check

  • 1/4 = 1 full/4 check 1/6 = 1 full/6 check

  • 14/14 = 14 full/14 check

  • 10/4 = 10 full Monday - Friday/4 check Saturday/Sunday












Floors hard









Remove Debris









Mop sweep or suction


















Suction clean or sweep









Damp mop









Spot mop











































As required


Manual Scrub









Suction dry








5.5 Sample Templates

5.5.1 Template 1: Locations at which Services are to be Provided

A sample template to evidence that the Cleaning Service Provider is aware of all locations, operating norms and has developed a cleaning specification in conjunction with the Infection Control Team.

5.5.2 Template 2: Specification Details

A sample template to evidence that the Cleaning Service Provider is including all elements of the specification and the following is a guide to completing this particular template.

As per location and room identification. Reference floor plans.

Room function / activity

Size of location/room as per scale floor plans.

Example - carpet

Proprietary brand flooring manufacturer's technical maintenance recommendations/instructions should be reviewed to ensure compliance with cleaning methodologies and frequencies detailed in this specification.

Coding symbols for types of floor coverings as follows:




All vinyl floors


Non slip vinyl
















Quarry Tiles


Anti-static Terrazzo


Anti-static Vinyl


Carpet (wool/nylon)


Low Profile Carpet

As defined in Task Groups 1 to 21.

Presence is defined as physical presence in the area when work must be scheduled at the time(s) specified.

Defined as the time(s) when the Cleaning Service Provider is permitted to carry out the work as specified in the schedule and is required to have a member of staff available, possibly working elsewhere, to deal with unpredictable contingencies e.g. response to outbreak control plan, discharge cleaning, terminal cleaning.

Defined as the period when the cleaning service provider is denied access to the specified location.

Remarks defined as additional information relating to the specified location as detailed.

Sample Template 3: Specification of local requirements

A sample template to enable the cleaning service provider to identify local variations as required.

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