The goal of any Environmental Services Department within a healthcare facility should be to prevent the spread of infectious agents among patients and healthcare workers by meticulous cleaning and appropriate disinfection of environmental surfaces. To reach this goal, the EVS department will need to have a comprehensive training program, the objective of which should be to provide department staff with the information they need to accomplish their jobs safely. The training program should be a part of the big picture of “How to Protect Yourself.” At a minimum the training program should include the following:

1. Identification of occupational risks and hazards associated with handling infectious waste.
2. Sharps safety.
3. Blood borne pathogens.
4. Infection control training – (a) Microbiology and (b) Transmission.
5. Hand hygiene.
6. Personal Protective Equipment (PPE) including donning and doffing.
7. MSDS and hazards associated with using chemicals (cleaning agents, disinfectants, etc.)
8. Product usage training including proper cleaning and disinfection techniques.

The benefit behind breaking the training into sections is two-fold. First, it allows the person responsible for training to involve other departments such as Infection Control or Occupational Health & Safety where specific knowledge and expertise can be called upon. Second, by segmenting the areas into shorter pieces the trainee is not overwhelmed. The individual sections also allow for developing unique methods of delivery. Education should be tailored to the size, topic and needs of the group. Not all programs must be instructor-led in classroom setting. They can also consist of CD programs and/or video-based programs or a series of self-study modules. For example, the product usage training may be better suited to a traditional classroom setting where employees can observe someone performing the task while other sections such as Blood Borne Pathogens can use video-based training. Switching up the method of delivery helps keep the trainee engaged.

A basic understanding of these eight topics doesn’t require a stethoscope or coke-bottle glasses, or even the ability to squint. It takes knowledge, imagination and responsibility. Knowledge… to know basic microbiology, where pathogenic microbes are found, and how they cause disease; to know how cleaning and disinfectant products should be used; to know how to be protected from exposure to blood borne pathogens and sharps injuries; about the proper use of PPE. Imagination… to be able to actually picture the microbes all around us. Responsibility… to take reasonable action to prevent disease.

One person dies every six minutes from hospital-acquired infection. It’s tragic that this is allowed to continue and that an Environmental Services department can be allowed to operate without ongoing, targeted and evolving education.

Time spent properly training staff is an investment that pays dividends for a long time. Training should be a constant process, not just something you do for new employees or to meet the annual requirement. Whenever new products, equipment or procedures are introduced into your department, all staff should be trained on their safe and proper use. Research has shown that adults learn differently than children do, they generally learn more and retain more if they are involved in the training process. Adults learn best by doing, not by listening to lectures or by viewing videos. Lectures and videos have a place in the training process, but trainee involvement needs to be included.

Feel free to share your thoughts and comments.

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.

In view of the evidence that transmission of many healthcare acquired pathogens (HAPs) is related to contamination of near-patient surfaces and equipment, all hospitals are encouraged to develop programs to optimize the thoroughness of high touch surface cleaning as part of terminal room cleaning at the time of discharge or transfer of patients.

Download the Environmental-Cleaning-Checklist-10-6-2010 from this link or go directly to the CDC site.

In the great work presented in Options for Evaluating Environmental Cleaning, December 2010 by Alice Guh, MD, MPH and Philip Carling, MD, objective monitoring of environmental surfaces was studied and presented as a necessary component of training. In view of the evidence that transmission of many healthcare acquired pathogens (HAPs) is related to contamination of near-patient surfaces and equipment, all hospitals are encouraged to develop programs to optimize the thoroughness of high touch surface cleaning as part of terminal room cleaning at the time of discharge or transfer of patients. A two level approach to this is presented and quite well discussed.

For now please draw your attention to the 8 locations above. The importance of targeted cleaning to these surfaces must be taught to your staff and reinforced on a regular basis. While many of our staff have an excellent understanding of the basic policies and procedures involved in terminal room cleaning, most will benefit from focused educational interventions related to our evolving understanding of the role of the environment in healthcare-associated pathogen (HAP) transmission. Specific targeted cleaning will not only reduce HAI’s it will greatly increase the awareness level of your staff.

Some of the basic steps of office cleaning are presented here…

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:

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The major difference between cleaning a medical facility and any other building is the focus on the un-seen enemy, bacteria. Environmental Service’s job is to not only provide good visible results, but to reduce the number of surface bacteria to a safe level in order to control cross infection. This is an extremely important responsibility because it keeps harmful bacteria from infecting the person next door or across the hall. Persons whose bodies are recuperating from surgery, injury or a primary infection are in a weakened condition and therefore, cannot put p their normal fight against harmful bacteria. A secondary infection in these cases can cause very serious illness.

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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:

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I had a request for basic cleaning principles for a doctor’s office. Here is a list for any healthcare facility, and for your home as well.

• Scrubbing is the best way to physically remove dirt, debris and microorganisms.
• Cleaning is required prior to any disinfection process because dirt and debris will decrease the effectiveness of disinfectants.
• Cleaning products should be selected on the basis of their use, efficacy, safety and cost.
• Cleaning should always progress from the least soiled areas to the most soiled areas and from high to low areas, so the the dirtiest areas and debris that falls will be cleaned up last.
• Dry sweeping, mopping and dusting should be avoided to prevent dust and microorganisms from getting into the air and landing on clean surfaces.
• Mixing and dilution instructions must be followed. Too much or too little will reduce the effectiveness of cleaners and disinfectants.
• Cleaning methods and written cleaning schedules (work routines) should be based on the type of surface, amount and type of soil present and the purpose of the area.
• Routine cleaning is necessary to maintain a standard of cleanliness. Work schedules and procedures should be consistent and posted.

There you go, general principles for cleaning hospitals, clinics and other healthcare facilities summarized.

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:

Storage on the floor must be neat and orderly.

No storage within 18 inches of the ceiling, except on shelves against the wall as long as sprinklers are not obstructed.

No evidence of smoking.

All exit signs are illuminated.

No storage of flammables or anything except cleaning items under sinks.

No door stops are allowed.

All equipment must be placed on one side of the hallway. Preferably nothing is in the hallway except crash carts and isolation supply tables.

Abate all trip hazards (secure cords).

Ensure stairwells are clean and no equipment is stored there.

All chemicals are labeled and your chemical list is available.

Do not block fire pull boxes, fire extinguishers or medical gas shut offs.

No evidence of smoking, no butts within 25′ of an entrance.

All gas cylinders in racks.

No visible dust or dirt on surfaces, floors or equipment.

No linen on floor, furniture or window sills; soiled linen in closed bag or covered hamper. All clean linen is covered.

No employee food/drink in patient refrigerators or at nurses stations. No food or drink on or in housekeeping cart or closet.

Check stairwells for trash and storage.

When an agency inspector comes to inspect your hazardous waste storage area, he looks for things like waste manifests, reports, labels, and plans. Why? Because it is easy to find violations in these areas – either you have filled them out properly or you have not. It is straightforward.

The video below is from an inspector at the California Department of Toxic Substances (DTSC). Listen to what the DTSC inspector has to say about what he looks for in your hazardous waste labels.

Here is a short video from California’s DTSC on the training requirements for hazardous waste generators:

One of the four characteristics of a hazardous waste is “reactivity”. The other three are ignitability, toxicity and corrosivity and these three characteristics are pretty easy to define by measuring the flash point, concentration and pH respectively. Reactivity is a bit harder (less objective) to determine.

The California Department of Toxic Substances Control (DTSC) has a short video clip on how to determine reactivity. In general, if something is going to go “boom”, it is likely to be reactive. Or if the MSDS states that a material is reactive with water or unstable, the waste that is derived from that material is likely to be a reactive waste. Enjoy the video.