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Perception Of Cleanliness Toolbox Launches


The Center is happy to announce the launch of the new topic toolbox: The Perception of Cleanliness. Each toolbox contains a library of newly-created and Center staff-curated content - research findings, expert insights, strategies, tools, and other useful resources. 

Environmental cleanliness affects the patient experience, patient satisfaction, perceived service quality, and actual quality in terms of infection prevention. Successfully achieving certain levels of cleanliness requires an interdisciplinary approach that involves the building design, operational and policy changes, education of personnel, and cultural changes to the organization. 

The New Perception of Cleanliness Toolbox Contains:


An Issue Brief and Executive Summary:

"Clean Matters: Assessing and Maintaining Environmental Cleanliness in Healthcare Settings" illustrates how to identify the significant impact of environmental cleanliness on multiple healthcare outcomes, different measurement methods of cleanliness, and provides a summary of key methods to improve cleanliness through environmental design, operational and policy changes, and education of personnel.

Five Interviews:

  • ​"Perception is Reality When it Comes to Cleanliness", an interview with Cindy Barr, RN, EDAC, describes the frustrations associated with maintaining clean spaces, the ways designers and architects can set the state for maintaining clean spaces, and the importance of training staff to observe patient behavior.
  • "Building Sustainability Into Hospital Design", an interview with Janet Howard, provides insight into using green cleaners to improve patient satisfaction scores around the perception of cleanliness, the negative health impacts associated with traditional cleaning products, and the healthier interiors challenge to reduce the use of harmful chemicals.
  • "Cleanliness: Where Do We Go From Here?" an interview with Roger Ulrich, PhD, EDAC, discusses the importance of considering patients’ perceptions of cleanliness, the ways to look beyond patient perception of cleanliness to create a truly clean environment, and things architects and designs can do to help create clean spaces.
  • "Cleanliness: Time for a Change", an interview with Gary Vance and Terry Thurston  provides insight into the key cleanliness issues facing the healthcare industry today, the issues that drive patient perceptions about cleanliness, and the ways architects and designers can help improve perceptions of cleanliness.
  • "Strategic Design Can Improve Patient Perception of Cleanliness and Quality", an interview wtih Jaynelle Stichler, DNS, RN, EDAC, NEA-BC, FACHE, FAAN, delves into what patients really judge when evaluating a facility's cleanliness, why patient perceptions of cleanliness directly impact reimbursements, and ways hospitals can improve patients’ views of cleanliness, quality, and safety. 

Two Case Studies: 

  • "MedStar Washington Hospital Center’s ER One Incorporates Cleanliness Best Practices", aimed to design its new “all risks ready” Emergency Room for easier and more efficient cleaning.
  • "New Floors in Hospital Rebuild Project Help to Improve Perception of Cleanliness Ratings", WellStar Paulding Hospital wanted to select a flooring surface for the patient care areas of its new facility that would be easy to care for and provide a clean look and feel.

Design Strategies: 

"Top Design Strategies for Environmental Cleanliness" provides a list of design strategies that are part of a systems approach to keeping the healthcare environment clean.


"Environmental Cleanliness Evaluation Checklist" is a tool that can be used to evaluate the implementation of design strategies for improving environmental cleanliness. Mark relevant environmental, operational, and people measures that have been implemented.

Three Blogs:

  • "Coming Clean on the Link Between Perception of Cleanliness and Patient Satisfaction" The healthcare community has recently come clean on an important fact: patient perception of your hospital’s cleanliness may impact their overall view of your facility much more than you’d think.
  • "When Visible Cleanliness and High Levels of Bacteria Co-Exist" Your HCAHPS scores reflect your patients’ views of the cleanliness of your facility. Yet their visual perceptions might not match the reality of your environment.
  • "Applying the “Broken Windows” Theory to Healthcare" It’s the little things that matter when it comes to the message you are sending your patients and their facilities.

Lessons Learned: 

Eight key takeaways from expert interviews.

Related Resources: 

View of organizations that are working to improve cleanliness.


Click here to view Perception of Cleanliness Toolbox resources that are free to all

Click here to view Perception of Cleanliness Toolbox resources available only to A+ members*

* Want to learn how to become an Affiliate+ member?  Contact Lynn Kenney, lkenney@healthdesign.org