The Other NHS Audits: What Are the Efficacy and External Audits?

The National Standards of Healthcare Cleanliness introduced three auditing systems for NHS Trusts, but we’ve heard enough about the technical audit and its 50-point check; so what are the other two? Dan Teare, Sector Director at mpro5, explains all…

What is the efficacy Audit?

In short, the efficacy audit is designed to measure how you clean, as opposed to what you clean and how frequently. Efficaciousness is determined using evidence-based, scientific methods. This will include:

• Checking that the cleaner is using the right colour coding, following all correct cleaning procedures
• Wearing appropriate uniform and personal protective equipment (PPE)
• Using gloves and chemicals safely and adhering to safe ways of working
• Safely moving furniture and equipment in order to clean
• Rectifying actions are being taken in a timely manner

There are many more metrics to be measured on, and all these questions are rated on a simple scale, it’s either a 1 or a 0.

When should I do an efficacy audit?

While trusts have the freedom to determine audit frequency, patient and visitor-facing areas must be audited for cleaning effectiveness at least once a year. But I’d say once a year is a low bar: your operations will benefit from doing these audits more often, possibly even on a monthly basis.

Unfortunately, you can’t only audit your shiniest areas. With one exception, you will need to select areas at random.

That exception is areas specifically targeted for performance review as they have not achieved safe standards consistently, or because they have high rates of infection. For areas that score 80% or less the audit findings should be used to create an improvement plan with support such as further training, investment in new equipment and materials, increased supervision, more resources and changing cleaning times.

The external audit

Then there’s the External Audit that involves collaborating with neighbouring facilities (also known as “auditing your mates”). Teaming up is a quick and easy way to find suitably qualified staff to act as auditors, often on a reciprocal basis.

This third-party audit performs a vital role. There are no scores involved: it’s all about the systems you have in place. Are your functional risk areas divided sensibly? Have you got a system to identify low-performing areas and how effective is your remediation process?

Admittedly, this audit is entirely subjective but it’s no less valuable for that. It’s a way of learning from others’ experiences and sharing best practice.

Like the Efficacy Audit, this check is purely advisory but, recognising how powerful a fresh pair of eyes can be, switched-on trusts will perform this independent assessment anyway for the often-eye-opening insights it can reveal.

How can a digital solution help?

I’d be remiss not to point out that all three of these audits are enhanced drastically with a digital solution. You can turn your audit from a fixed event to a continuous process: cleaners can gather data as they work via a works management app, and send this data straight to the cloud.

Such systems enable managers to see which areas of the healthcare facility are cleaned well and which not so well by viewing dashboard reports – and these comparisons can provide valuable insight.

For example, if you’re getting a low score for your Technical Audit but a high score for your Efficacy Audit, the mismatch tells you your cleaners are doing their jobs properly but they’re simply stretched too thin. Conversely, if you score highly on your Technical Audit but poorly on the Efficacy Audit, this could mean the cleaners are not doing their jobs well and you’re overstaffed in that space: they’re all doing half a job.

All audits are created equal

I’ll end by pointing out the obvious. The Standards’ three-audit system has been expressly designed to create a whole greater than the sum of its parts: to give a comprehensive view of all aspects of cleaning performance, from what areas are cleaned to how well they’re cleaned and, lastly, ideas for improvement. If your trust focuses on the Technical Audit to the exclusion of everything else, you really are missing a trick.