I’m sorry that I have been inconsistent, or non-existent in updating this website over the past few months. I’m working on so many things I’ve put my time in other areas. Soon I will be adding new content, longer posts that have greater emphasis in learning, team building, and inspiring your staff to greatness.
Remember you can still use the search function to look for information that you need.
John
Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives. ~Willa A Foster
All hospital environmental service departments have some form of quality assurance process. However often the cleaning inspections are done when it is slow, and are given up when the department gets busy.
The message given to our staff is that we are only concerned about quality when we do not have other work to do.
When the real truth is that the delivery of consistent quality service is what we must deliver and needs to be consistently measure and acted upon.
Here are four reasons to measure quality (more…)
Here are five things that environmental service leaders should do to improve relationships with staff.
Be Visible with Rounding
Rounding should include one-on-one rounds with your staff. Ask what is working well and what they need from you to do a better job.
Appoint a department champion
Identify a department champion who is well respected and works well with other staff. This team member can help with manager meetings and quality inspections. Try to make this a quarterly appointment and have at least one on each shift.
Credit Staff for Success
Frequently show appreciation both privately and publicly. Remember, you can’t overdue praise so get out there and let them know.
Be Transparent
Share and post HCAHPS and other survey scores. Talk about budget and supply costs. Have an open door policy and share as much as you can. Your staff will appreciate open communication. Some hospitals use a stoplight report to show improvements. Green means completed or meeting goals. Yellow means in-progress and red means it does not line up with goals.
Align Incentives
The annual evaluation is an important tool to get staff back on track. Define their goals with weighted, objective and measurable expected results.
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Another great question and answer:
Q. Which disinfectant should I use when disinfecting environmental surfaces?
A. Your facility will specify the EPA approved hospital grade disinfectant to use. A good rule is to only use disinfectants registered with the U.S. Environmental Protection Agency (EPA). See https://www.epa.gov/oppad001/active-hospital-disinf.pdf. Remember to always follow the instructions on the product label. Pay close attention to the purposes indicated on the product label, the proper dilution rates (if provided), the contact time required, the product shelf-life, and all safety instructions for handling and use. Do not mix cleaners and disinfectants unless the product label says that it is safe to do so.
Another Question and Answer
Q. When should the environment be cleaned and disinfected?
A. Housekeeping surfaces (e.g., floors, table tops) and other environmental surfaces should be cleaned and disinfected regularly, when spills occur, and when these surfaces are visibly dirty. Follow your facility’s schedules for routine cleaning and disinfection and for terminal cleaning of rooms when preparing the room for the next resident. Medical equipment that is shared between residents (e.g., blood pressure cuffs) should be disinfected between residents.
Another good question and answer:
Q. What is the difference between cleaning, disinfection, and sterilization?
A. There is a big difference among these terms.
Cleaning refers to the removal of visible soil and organic material (i.e., dirt, body fluids) from objects by washing or scrubbing with water and detergents or soaps and rinsing with water. Thorough cleaning is needed before disinfection or sterilization because organic material can decrease the effectiveness of those processes. A detergent is a cleaning agent that does not claim to kill microorganisms.
Disinfection refers to process of removing many or all microorganisms that can cause disease, except bacterial spores. There are three levels of disinfection, depending on how many organisms are removed: high, intermediate, and low. A disinfectant is a chemical or a physical agent (e.g. ultraviolet radiation) that kills microorganisms, but not bacterial spores. Disinfectants are also classified as high-level, intermediate-level, and low-level.
Sterilization refers to the complete elimination of all forms of microbial life including bacterial spores. Objects can be sterilized by physical processes (i.e., intense steam and pressure or dry heat) or by using certain chemicals.
Another question and answer:
Q. Does environmental cleaning and disinfection really work in preventing the spread of harmful microorganisms?
A. Yes. But how well is works depends on many things, including the nature of the object, the type, number, and location of microorganisms, how well the organisms resist the physical processes or disinfectants, the presence of organic and inorganic matter, the concentration and potency of disinfectant, other physical and chemical properties (i.e., temperature, pH), and the duration of exposure and the contact time. Remember that environmental cleaning and disinfection is just one of several steps needed to prevent the spread of germs.
Another question and answer:
Q. Why is it important to clean the environment?
A. Microorganisms (bacteria, fungi, viruses) are present throughout our environment and can cause infection. The environment can serve as a breeding ground for these organisms. Cleaning and disinfecting housekeeping surfaces and medical equipment, especially those that are frequently touched, is important to decrease or prevent the spread of these organisms to people.
Another Question and Answer:
Q. In the healthcare or residential setting, what does the “environment” or “environmental surface” mean?
A. The environment refers to the patient or resident’s surroundings. When we talk about cleaning the environment, typically we are referring to cleaning and disinfecting objects, like housekeeping surfaces (e.g., floors, tabletops) and medical equipment. It is particularly important to focus on cleaning and disinfecting frequently touched items, such as bed rails, tray tables, IV poles, call button, monitor screens and controls and cables, pump controls, bedside tables, telephones, carts, toilets, bedpans, sinks, door knobs and levers, light switches, and faucet handles.
The most important staff related task we have in Environmental Services is in training. Almost every challenge or difficulty we face can be reduced or eliminated with training. To help you I’m going to list steps that will help you conduct successful training. This is not meant to be a perfect or complete list, just use this as your starting point and customize if for your needs.
ACTION STEPS:
1. Organize the Approach for Training
a. Decide the amount of skill you expect the trainee to acquire and by what dates.
b. Prepare a schedule to follow
1. Have the employee ready for training.
2. Decide what area will be used for training.
3. Decide items to be covered in each training session.
2. Organize the Work
a. Decide how the area to be covered will be separated into segments that can be learned.
b. Arrange for the proper supplies.
c. Be sure the necessary equipment is available and in good condition.
3. Orient the Employee
a. Put the person at ease. Make them feel comfortable with you.
b. Explain the task to be learned and find out how much the employee knows about it. Depending on the environment and the employee’s knowledge, the starting point for learning will vary.
c. Stress the importance of the task, the reason it must be done, and the results of doing it well. The employee must become interested in learning the work.
d. Explain and show the employee each step of the task, one step at a time. Going too rapidly will cause the employee to become frustrated and have to repeat the task.
e. Stress each step clearly, completely, and with patience to make sure the employee understands.
4. Hands on Training
a. Have the employee attempt the task, and correct any errors while he or she does the task.
b. Have the employee do the task again, and explain each step as the employee does the tasks.
c. Repeat the procedure until you are certain that the task is being done properly and the employee fully understands.
5. Follow Up
a. Allow the employee to perform the task on their own. Be sure they know that they should contact their supervisor if assistance is needed.
b. Check on the employee frequently until they are thoroughly comfortable in the performance of their duties. Always encourage the employee to ask questions.
6. Evaluation Employee Performance
a. What are the areas of poor performance?
b. Should they be retrained?
c. If retraining is required, when should it be started, and how long should it last?
d. Is the schedule being met? If not, why?
e. What changes may be anticipated in a job?
f. What changes in personnel may be anticipated? Who will be trained as replacement and by what date?
5 practical reasons to get up early everyday:
It was more than five years ago that we changed from cotton towels and mops to microfiber towels and mops. The difference has been dramatic. Fresh mops for each patient rooms instead of going to the closet and dumping your big bucket every three rooms. Towels that clean better and don’t deactivate the disinfectant. Less weight on the cleaning cart, the list of benefits goes on and on.
Here I want to give you a video of the mopping system we have been using. While there are several different types on the market today, this model from 3M has been good for us. Enjoy!
Inpatient infection rates are down, but there is still more work to be done. In a report released Friday, the Pennsylvania Health Care Cost Containment Council said 21,319 of the 1.89 million patients admitted to Pennsylvania hospitals in 2010 acquired an infection. That is a rate of 1.13 percent, down from 1.20 percent the previous year.
Though only a small percentage of hospitalizations, the patients’ outcomes were sobering. Infected patients stayed in the hospital three times longer than patients without infections. They also were far more likely to be readmitted up to a month after their hospital stay and were more than five times likely to die than patients without infections.
Re admissions represent both challenges and opportunities for hospitals seeking to improve, according to Pennsylvania Health Care Cost Containment Council Executive Director Joe Martin. “Patients with a healthcare-associated infection continue to be readmitted at higher rates than those whose cases were not associated with an infection,” he said in a Sentinel Article. “Those readmission’s remain an important opportunity for quality improvement and cost control. And with public-sector health programs like Medicaid and Medicare facing serious cost challenges, it behooves us to redouble our efforts to prevent these infections from occurring.”
The healthcare-acquired infections detailed in the Pennsylvania report come from four major sources: patients’ surgical sites, urinary tract infections, gastrointestinal infections and pneumonia. These infection sites largely correspond with what other studies have found to be the most common.
Other states also have been releasing their own data in recent weeks or will be soon. For example, the Raleigh (N.C.) News-Observer reported that, under a new North Carolina law, state health officials have begun collecting data on infections that patients get while in the hospital and plan to begin making it public this fall.
And earlier this month, the Atlanta Journal-Constitution raised eyebrows when it reported that seven Georgia hospitals, including several prestigious medical centers, scored worse than the national benchmark for cases of potentially deadly bloodstream infections. This article, in which the newspaper based its reporting on recently released CMS data, is typical of a slew from around the country that spotlighted relatively higher infection rates at teaching hospitals.
As the CMS blood infection data show, the trend is clearly toward more transparency. Public reporting of hospital-acquired infections of all kinds is now required in 27 states, and more have laws in the works, according to the Committee to Reduce Infection Deaths, a nationwide advocacy group that lobbies for techniques for reducing such infections, according to the News-Observer.
“Don’t join an easy crowd. Go where the challenge is great and the emotions are high. Go where the expectations are so strong that they provoke you, push you, and urgently insist that you not remain in one place. That way, you will grow and change.” -Jim Rohn
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:
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.