Role of cleaners in establishing and maintaining essential environmental conditions in healthcare facilities in Malawi

Healthcare facility (HCF) cleaners play an important role in preventing healthcare-acquired infections and promoting a safe and clean healthcare environment. There is little evidence describing cleaner roles in HCFs in low-income countries and factors facilitating and constraining their roles and responsibilities. We analyzed qualitative and quantitative data from 57 in-depth interviews with cleaners in 44 government-run HCFs in Malawi. Cleaner constraints included inadequate training on infection prevention and control (IPC), personal protective equipment (PPE), hand hygiene, and waste management; insufficient PPE and hand hygiene resources; assignment of tasks that are unrelated to core responsibilities and their job description; risk of work-related injuries; and disrespect and stigma from medical staff, patients, and guardians. Facilitators included the positive collaboration and communication with medical staff, high job satisfaction, and a positive working attitude. We recommend the provision of more robust IPC, PPE, hand hygiene, and waste management trainings (including orientation and refresher). PPE resources must be made available to ensure HCF cleanliness and to keep cleaners, staff, patients, and guardians safe. Clearly defined job descriptions for cleaners will clarify their roles, describe bounds of their work, and ensure cleaners are viewed as essential frontline workers who ensure the safety of staff and patients.