An environmental cleaning training package for health facility cleaners
TEACH CLEAN helps address a lack of formal training for those who clean and promotes IPC and WASH standards for a safer environment. It underpins quality health for all.
Obtain a copy of the TEACH CLEAN package
TEACH CLEAN was developed by The Soapbox Collaborative from 2014-2019, and then maintained and advanced by the London School of Hygiene & Tropical Medicine. In 2021, TEACH CLEAN was approved as the basis for a new WHO training package for cleaners. Further details on the history of TEACH CLEAN and how it lives on through WHO’s package can be read below.
Key publications on environmental cleaning produced by The Soapbox Collaborative, LSHTM and partners can be found in the drop down menu below.
- TEACH CLEAN publications
Cross S, Afsana K, Banu M, et al. Hygiene on maternity units: lessons from a needs assessment in Bangladesh and India. Glob Health Action 2016; 9. DOI:10.3402/gha.v9.32541.
Cross S, Gon G, Morrison E, et al. An invisible workforce: the neglected role of cleaners in patient safety on maternity units. Glob Health Action 2019; 12. DOI:10.1080/16549716.2018.1480085.
Gon G, Ali SM, Towriss C, et al. Unpacking the enabling factors for hand, cord and birth-surface hygiene in Zanzibar maternity units. Health Policy Plan 2017; published online Aug 22. DOI:10.1093/heapol/czx081.
Gon G, Kabanywanyi AM, Blinkhoff P, et al. The Clean pilot study: evaluation of an environmental hygiene intervention bundle in three Tanzanian hospitals. Antimicrob Resist Infect Control 2021; 10. DOI:10.1186/s13756-020-00866-8.
Gon G, Dansero L, Aiken AM, et al. A Better Disinfectant for Low-Resourced Hospitals? A Multi-Period Cluster Randomised Trial Comparing Hypochlorous Acid with Sodium Hypochlorite in Nigerian Hospitals: The EWASH Trial. Microorganisms 2022; 10: 910. https://doi.org/10.3390/microorganisms10050910
Gon G, Dramowski A, Hornsey E, et al. Research priorities to strengthen environmental cleaning in healthcare facilities: the CLEAN Group Consensus. Antimicrob Resist Infect Control 2024; 13: 112. (2024). https://doi.org/10.1186/s13756-024-01463-9
Gon G, Ma S, Aiken A M et al., Impact of a multi-component training intervention (Clean Frontline) on microbiological cleanliness in Cambodian referral hospitals: a stepped wedge, cluster-randomised, trial. Lancet Microbe 2025. https://doi.org/10.1016/j.lanmic.2025.101262
Graham WJ, Okomo U, Gon G, Aiken AM. Cleaning Neonatal Units in Low-resource Settings: A Hot-topic in Waiting? Pediatr Infect Dis J. 2021 May 1;40(5S):S1-S4. doi: 10.1097/INF.0000000000002927. PMID: 34042903.
Okomo U, Gon G, Darboe S, et al. Assessing the impact of a cleaning programme on environmental hygiene in labour and neonatal wards: an exploratory study in The Gambia. Antimicrob Resist Infect Control 2024; 13: 36.
- Patrick, M., Kilpatrick, C., Storr, J. et al. Environmental cleaning barriers and mitigation measures identified through two initiatives in four countries, 2018–2023: a commentary. Antimicrob Resist Infect Control 13, 134 (2024). https://doi.org/10.1186/s13756-024-01491-5
Health workers who clean are environmental health champions
Environmental cleaning is known to play a key role in reducing the global burden of healthcare associated infections and antimicrobial resistance. In line with WHO and UNICEF recommendations, system wide changes are necessary to establish improvements in environmental hygiene to strengthen IPC and achieve global goals. The TEACH CLEAN package is a resource designed to address the training of health facility cleaning staff in low- and middle-income countries.
TEACH CLEAN presents information and materials required to deliver comprehensive, participatory training on safe environmental cleaning, applying aspects of essential IPC for these tasks. The package is tailored towards use with cleaning staff with limited literacy skills but can be applied to wider facility staff.
Tailored towards use within low-resource settings, TEACH CLEAN is a freely available, evidence and best practice based resource which is:
- Intended for use by organisations & individuals who want to improve knowledge & practices of those who clean
- Accessible for staff with limited literacy skills through its participatory approach to training
- Adaptable to the local context
- Suitable for a cascade approach to training (Training of Trainers, ToT)
The TEACH CLEAN package
The TEACH CLEAN package contains:
- A ‘How to Train’ instruction document and ToT modules on Supportive Supervision & Quality Improvement
- Seven essential Clean Box training modules addressing IPC and environmental hygiene
- Competency Assessment Checklists
- Written and Illustrated Cleaning Procedure Guidelines
- An Advocacy & Communications Resource Pack
Soapbox’s Professor Wendy Graham, Emma Morrison and Claire Kilpatrick were invited by the WASH in Healthcare Facilities Initiative to present a webinar on The Role of Cleaners: Neglected Frontline WASH Workers in Healthcare Facilities.
Watch a recording of the seminar for a comprehensive overview of the TECH CLEAN package below.
Piloting, evaluating and implementing TEACH CLEAN
Use the following links to learn more about the TEACH CLEAN pilot conducted in The Gambia in 2016, the first formal evaluation of the training package in Tanzania in 2019, and a pilot implementation of TEACH CLEAN was undertaken in Myanmar in collaboration with WaterAid and the Ministry of Health from 2019-2023.
A stepped wedge, cluster-randomised trial of WHO's cleaner’s training package, based on TEACH CLEAN, across 13 Cambodian referral hospitals was conducted in 2022-2024. The results have been published in Lancet Microbe in December 2025, and showed not only the feasibility of the training package for use with low-literacy cadres but also that microbiological cleanliness of surfaces can be improved in low-resource referral hospitals.
Global dissemination of the TEACH CLEAN package
TEACH CLEAN features in a number of global documents released in 2019 which aim to reduce the burden of healthcare associated infections:
WHO and UNICEF have released two companion reports which provide baselines for WASH in healthcare facilities (the Joint Monitoring Programme report) and outline a set of eight practical actions that countries can take to improve WASH services – providing some inspiring practical case studies including TEACH CLEAN training in Tanzania. (Published April 2019).
WHO’s implementation manual to prevent and control the spread of carbapenem-resistant organisms (CROs) at the national and health care facility level highlights TEACH CLEAN as an example of a tool that supports the implementation of environmental cleaning and strengthens a facility’s approach to the prevention and control of CROs (published May 2019).
Soapbox also had the pleasure of working with colleagues in the Infection Control Africa Network (ICAN) and the US Centers for Disease Control and Prevention (CDC) who are currently developing a comprehensive manual outlining the Best Practices for Environmental Cleaning in Healthcare Facilities for Limited-Resource Settings. The purpose of this new manual is to improve & standardize the implementation of environmental cleaning procedures and programs in patient care areas in all healthcare facilities in limited resource settings. (Official launch planned for September 2019 - visit the Infection Control Africa Network pages for more information).
In 2023, the TEACH CLEAN package, was used as the basis for the development of a WHO Trainer’s Guide and the Modules and Resources for the document Environmental cleaning and infection prevention and control in health care facilities in low- and middle-income countries.
- The Trainer’s Guide takes the user through how to prepare, deliver and sustain an effective training for those who clean.
- The Modules and Resources provides instructions, definitions, photographs, posters and specific illustrations of recommended practices