Providing a clean and safe environment for healthcare is a key priority for the NHS and is a core standard in the Hygiene Code (DH [30]). The role of cleaning has been recognized as a vital and cost‐effective mechanism for ensuring that the risk to patients from HCAIs is reduced to a minimum (Dancer and Kramer [18], Hall et al. [50]). It is also an important confidence marker for patients and the general public, as a ‘dirty’ environment is often seen as being synonymous with risk of infection. Many items in the healthcare environment can become contaminated, but the most likely routes for the spread of infection are inadequately decontaminated items of equipment used for diagnosis or treatment. Transmission can be prevented via effective cleaning and decontamination between each use (Curran et al. [16]). Healthcare providers are obliged under the Hygiene Code to provide reasonable standards of cleanliness with an appropriately staffed and resourced cleaning service.

According to the national standards of cleanliness (NPSA [88]), clinical environments are divided into areas of very high, high, significant and low risk, and cleaning standards and frequencies are determined from this categorization. It can be argued that all clinical areas and equipment will carry some risk and items that are used between patients must be subjected to thorough decontamination (Curran et al. [16]). Regular auditing should be undertaken by the organization, and the nurse in a clinical area may be asked to accompany staff on these audits and verify that cleanliness is at a satisfactory standard. The standards are set out in local cleaning specifications (British Standards Institution [10], NPSA [88]). Some of the key elements a nurse should be looking for include the presence of dust high up or low down on surfaces, and evidence of organic material on surfaces, including residues of blood or body fluids. Particular attention should be paid to the cleanliness of toilets, handwash basins, baths, showers and high‐touch surfaces such as door plates and handles, taps, call bells and light switches. Nurses should also consider auditing the cleanliness of clinical equipment that is not usually cleaned by domestic staff; this may include commodes, drip stands, pulse oximeters, blood pressure equipment and pumps (among others). Decontamination of these items is facilitated by availability of effective and properly used decontamination items at the point of use in the same way that local placement of hand hygiene products facilitates hand hygiene (Curran et al. [16]).

It should be noted, though, that decontamination (which includes cleaning) is an important nursing role, as many pieces of equipment (e.g. blood pressure monitors) are used on multiple patients, meaning that decontamination to an appropriate level should take place between each patient use. Nurses have a duty to ensure high standards of hygiene in the care environment. Particularly, they must ensure that equipment that may be used for multiple patients and that has a high risk of contamination (such as commodes) is safe for use by the next vulnerable patient. Nurses should be trained to decontaminate any equipment that they use in line with local policies and the manufacturer's guidance.