The process of physical cleaning of environmental surfaces using detergent (soap), water, and friction is the critical step required prior to surface disinfection. The combination of the cleaning and disinfection processes is designed to remove and kill vegetative microorganisms on surfaces. Disinfection will not be effective in the presence of dirt, blood, or other bio burden. The  goal of the cleaning step is to remove bio burden and with it, the majority of pathogens. Disinfection is designed to be a synergistic and somewhat redundant step to ensure comprehensive removal/kill of pathogens on surfaces.

The CDC’s Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, states that, “noncritical surfaces (e.g., dialysis bed or chair, countertops, external surfaces of dialysis machines) should be disinfected with an EPA-registered disinfectant unless the item is visibly contaminated with blood. In that case, an EPA registered tuberculocidal agent with specific label claims for HBV and HIV should be used.”1 the commonly used disinfectant for blood contaminated environmental surfaces is a 1:100 dilution of bleach (500–600 parts per million [ppm] free chlorine).

The environmental surfaces in HD settings at highest risk of transmitting germs are described using different terms. From the perspective of the patient, the term “patient zone” is used to refer to the surfaces which the patient can touch, or can touch the patient, including the chair, armrests, bedside table top/counter, and drawer/cupboard handles. From the HCW or dialysis staff perspective, the term “high touch surfaces” is used to describe surfaces which are frequently touched by HCWs. These include the same surfaces in the patient zone in addition to others such as the exterior surfaces of the HD machine, computer screens, and keyboards. Cleaning and disinfection of these surfaces (patient zone/high touch surfaces) should be performed between all patient treatments, no matter what the patient diagnosis is, in order to prevent spread of environmentally transmitted pathogens including MDROs (e.g., MRSA, VRE, C. difficile) and bloodborne pathogens (e.g., HBV, HCV). Of note, microorganisms can live for varying periods of time in the environment. MRSA has been documented as viable at 38 weeks on external sterile packaging and VRE at 6 months on a wheelchair. HBV can survive for 7 days in dried blood.

There are certain products and principles which are recommended in order to optimize environmental cleaning in healthcare settings, including HD facilities. These include the following tasks which are typically performed by the dialysis nurse or technician.

• Store cleaner/disinfectant separately from skin antiseptics/patient supplies (separate shelves and below patient supplies to avoid potential contamination).

• Perform hand hygiene before and after cleaning the patient station.

• Don gloves when using cleaner/disinfectants.

• Use one set of cleaning cloths or disposable germicidal wipes for each patient station.

• Use microfiber cloths and mops if possible (more effective cleaning products than regular cotton cleaning cloths).

• Clean all frequently touched or “high touch” surfaces in the “patient zone” between patient treatments (chair, armrests, counters, drawer/cupboard handles, exterior surface of the HD machine)—please note that some of these high touch surfaces may be right outside the patient zone (e.g., computer stations), and must also be cleaned between patient treatments.

• Clean the top of an object first and work down to avoid soiling surfaces just cleaned.

• If using cleaning cloths instead of disposable germicidal wipes:

• When using a disinfectant cleaner, wet the surface, use friction to clean, and allow to air dry.

• Fold the cleaning cloth in a series of squares to provide a number of potential cleaning surfaces. A wadded cloth does not clean efficiently.

• Replace cloth as needed. More than one cloth may be required for a patient station.

• Never use the same cleaning cloth for more than one patient unit.

• Never re-dip used cloth into clean disinfectant solution.

Additional cleaning functions, typically performed by housekeeping staff in HD facilities, should include:

• At the end of the day:

• Wet mop the floor

• Clean patient/staff bathrooms and restock paper products/hand hygiene supplies

• Check and refill all hand hygiene product dispensers in nursing stations and at patient stations (soap, paper towels, lotion, alcohol-based hand sanitizer)

• On a routine basis, walls and high dusting should be performed.

Multi Drug Resistant Organisms Cleaning and Disinfection

Many healthcare workers believe the environment of patients with MDROs require special cleaning. Healthcare workers in HD facilities should clean the environment of the MDRO patient as they would for any patient, as many more patients than are known are colonized/infected with an MDRO. Cleaning involves the use of friction on environmental surfaces to physically remove the soil and germs. The wet contact time of the germicide on the surface helps kill or inactivate any remaining microorganisms. The exception is C. difficile, which requires removal by friction and is not inactivated by any surface disinfectant except bleach.

The key is that sanitation, safety, and quality cannot be assured for items – particularly paper, textile products such as mops and cloths, and chemicals – that are kept in janitor/housekeeping, soiled utility, and other such areas.  When it comes to soiled utility rooms, it might be good for the EVS profession to stop using the term "Soiled Utility Room" and change it to "Contaminated Utility Room."  If it’s soiled, it should be considered contaminated and treated/handled accordingly.  When thinking of sanitation, safety, and quality our profession must consider broader aspects of each word. 

EVS is a proud and honorable profession and as such it must always insist on doing the best and taking the extra steps to ensure that everyone and everything associated with it is held to the highest standards and goals.  If our professionals do not do so, we will see other disciplines encroaching upon and annexing what is currently EVS. 

I would suggest that you look for the following on-line: State Operations Manual, Appendix A – Survey Protocol, Regulations, and Interpretive Guidelines for Hospitals or go to this link to download a PDF document that you may find invaluable:

www.hcmarketplace.com/supplemental/8987_browse.pdf

For assistance in reasoning out the excluding of the rooms in question, I refer everyone to the following.  They are two typical CMS Guidelines cited.  I’ve also provided an OSHA Website that might interest you.

Interpretive Guidelines §482.41(c)(2) – Facilities, supplies, and equipment must be maintained to ensure an acceptable level of safety and quality. Interpretive Guidelines §482.42 Condition of Participation: Infection Control.

http://www.osha.gov/SLTC/etools/hospital/housekeeping/housekeeping.html#ContaminatedWorkEnvironments

I had a great question last Friday… How would you review a housekeeping operation?

Here are some of the steps I said would be important in reviewing their existing housekeeping operations or developing new outsourcing initiatives.

Two key phases of review include:

Analysis

• Interviews with administration/housekeeping/staff
• Facility inspection
• FTE analysis
• Existing support contracts
• Departmental policies & procedures
• Review of housekeeping requirements
• Budget review
• Review of supplies & equipment

Scope

• Physical auditing process
• FTE determination
• Training requirements
• Contractor performance expectations
• Quantifiable & measurable performance requirements
• Quality control processes
• Benchmarking
• Selection of qualified contractors and contract type
• Work loading

These are first steps, and make a great start. Contact me if you want to discuss this further.

Here is the two step cleaning training video I participated in as a technical consultant. We filmed this video at the new beautiful Mercy Medical Center in Merced California. The purpose of this video is to help Environmental Services staff save lives. We believe it is not enough to simply clean with a disinfectant anymore. Microfiber, two step cleaning, and a move away from “quat” based cleaners is long overdue.

As part of the proposed changes to healthcare, reimbursement for hospital care and post-acute care will be bundled; patient readmission’s will be at a lower rate in some cases; hospital reimbursement and performance will be directly linked; and physician self-referral will be more closely regulated. Out of those four important items, environmental services has a direct impact on two—readmission rates and performance-based reimbursements. A sufficiently staffed environmental services department plays a major role in minimizing patient readmission’s. The proliferation of microorganisms affecting our communities and the patient population demands a properly cleaned and disinfected care environment. It is my belief that investing in the environmental services department and assuring proper funding, staffing, training, and consistent cleaning procedures and protocols will have a positive impact on lowering the infection rates, lowering the rate of “never” events like patient falls and improving patient satisfaction rates. Each of these examples provides a direct link between our departments and performance-based reimbursements.

So what does this all mean to the environmental services department? This is an opportunity to position the department as the front-line quality assurance and infection control team able to facilitate cost containment for the health care facility and ensure a proper setting for care delivery throughout the continuum of care. Speak up and make sure your senior leaders know the value you and the departmental staff bring to the health care facility. Make the business case for what you do and the big-picture impact on finances, patient readmission and performance-based reimbursement.

I want to share this news story because it really explains a common, recurring situation that occurs when custodian, housekeepers and other service workers really love their jobs and the people they serve. 

MUSKOGEE, OK — Everyone remembers Pete Robbins’ characteristic greeting to the children as they came into the building at the start of the school day, according to the Muskogee Phoenix.

"Every morning he stood at the door and gave every child a high-five, a smile and a ‘good morning’ as they came through that door," said Carolyn Stach, a teacher at Fort Gibson for 43 years.

Robbins died on Sept. 27 at the age of 89, the article noted.

"Pete was the kind of guy who never met a stranger," said Roger Shaw, long-time principal at Fort Gibson School while Robbins worked there.

"He knew every child in school. Every one of them had a nickname," Shaw added.

"Sometimes it is the people who seem to have a small part in our lives that make the biggest impact, and Pete was certainly one of those people," said Cheryl Todd, a 1989 graduate of Fort Gibson High School.

"He would still recognize you 30 years after you were in school. For many of us, he was our parents’ custodian, then ours, then our kids’," Todd stated.

Click here to read the complete article.

We had our “long awaited” Joint Commission Survey the beginning of this week. It seemed like forever, waiting for them to arrive… not really. While it might have seemed like a long time, it really was just another week for a hospital that prides itself on being the best possible caregiver to meet the physical, and spiritual needs of the community.

Environmental Services is the department that cleans, disinfects, and fights infection in every hospital. ES for short, is a department that touches every aspect of a healthcare facility, every patient, every staff member and every visitor. My team is no different, but we try to be different in one aspect; we don’t “get ready” for survey’s like The Joint Commission, or CMS, we practice survey readiness everyday.

A properly stocked cleaning cart will help prevent wasted trips to supply closets and should be equipped with any of the following items which are necessary for your work:

Read the rest of this entry

Here I continue to list cleaning standards. We use these as a guide to understanding our responsibilities in general cleaning. This is not meant to be a complete list, rather a broad overview. Enjoy your reading:

Read the rest of this entry

Environmental Services (ES) is important to any business because the visible cleaning results create the first impression of a visitor or customer. You’ve probably heard that “the first impression is a lasting one” and there is a great deal of truth in that. Our job is to make that first impression a good one.

In addition to visible cleaning results, impressions are formed by the appearance of you, personally. Some important points to creating a good impression are:

Read the rest of this entry

In Environmental Services, we are aware that first impression of our facility is very important to our clients and other staff, so we strive daily to provide a clean, safe and attractive environment. We also ensure that patient rooms are cleaned to the highest level to prevent cross contamination. The hospital, staff and patient depend on us to do our job with excellence.

Cleanliness is a prime concern to every member of our team because a clean environment successfully keeps bacteria and other germs from multiplying on facility surfaces, and this helps prevent a sick person from being at a greater risk from other diseases and conditions.

Yet as important as it is to remove soil and germs from the physical environment, it is also important to keep all areas neat and organized and in good repair. After all, surroundings with a pleasant appearance help to cheer up patients and send the message that their caregivers are concerned about every detail of service. A clean and attractive facility can actually enhance a patient’s ability to receive care and get well again.

One of the organizations I am a member of, and actually the first that I joined, is the International Executive Housekeeping Association or IEHA.

Since 1930, the International Executive Housekeepers Association (IEHA) has been a non-profit organization committed to raising professionalism in the cleaning industry and providing a cleaner, safer, healthier environment.

IEHA members are Executive Housekeepers—managers who direct housekeeping programs in commercial, industrial or institutional facilities. IEHA provides members with an array of channels through which they can achieve personal and professional growth. Some are: leadership opportunities; resource materials; education program designation; employment referral service; a Technical Question Hotline (1-800-200-6342); networking; an annual convention and trade show, including several educational sessions; and a monthly trade publication, Executive Housekeeping Today.

Take a moment and learn more about our professional organization: