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Infection Prevention

Preventing HAIs: Tips for training frontline EVS workers

Keep it simple, standardized and routine.

dry mopping procedural technique

It’s no secret that properly cleaning and disinfecting the environment of care—from faucets to floors, bed linens to bed rails, and monitors to medical devices—is one of the most important jobs when it comes to preventing healthcare-associated infections (HAIs).

But it can also be a thankless one, when you consider the challenges Environmental Services (EVS) directors are facing every day. Here are just a few:

EVS room turnover rates

Pressure to expedite room turnover, making it difficult to adequately clean and disinfect the care environment—pressure that’s intensified since COVID.

understaffed EVS department

Understaffed and underbudgeted EVS departments, where staff turnover averages 40 to 50 percent and thus requires continuous training of new hires—many of whom speak English only as a second language.

Environment of Care Education

Lack of staff knowledge about the underappreciated role the care environment plays in cross-contamination and infection transmission—that it’s one of the three zones in the facility where infection is transmitted on surfaces, in the air and water.

Lack of an industry practice standard when it comes to adequate cleaning and disinfection protocols, including the most appropriate technologies and products for usage.

Now add to this the realities of contamination and spread of certain pathogens. Here is what some of the data tell us:

<50%

of healthcare room surfaces are adequately cleaned and disinfected.3

10 to 50%

of the surfaces in rooms where the patient or resident is infected or colonized with C. difficile, MRSA and VRE are contaminated with these pathogens.2

72%

of healthcare floor sites tested positive for C. difficile.1

2.5x

increased risk of contracting C. difficile from a previously infected occupant to the next occupant.4

Yet, even as challenges persist and the stakes for infection prevention get higher, adequately cleaning and disinfecting a patient’s room to prevent HAIs and doing so in a timely manner don’t necessarily have to be incompatible. There are ways to achieve both.

In lieu of a single “blueprint” for the best cleaning and disinfection method, the Centers for Disease Control and Prevention (CDC), working with the Association for the Health Care Environment (AHE), identified six core components that “help establish and sustain a clean, safe environment that supports the safety of patients or residents, healthcare personnel (HCP) and visitors.”5

  1. Integrate environmental services into your facility’s safety culture, which we believe is essential to ensuring shared accountability.
  2. Educate and train all healthcare professionals (HCP) responsible for cleaning and disinfecting patient and resident care areas.
  3. Select appropriate cleaning and disinfection technologies and products.
  4. Standardize setting-specific cleaning and disinfection protocols.
  5. Monitor effectiveness and adherence to cleaning and disinfection protocols.
  6. Provide feedback on adequacy and effectiveness of cleaning and disinfection to staff and stakeholders.

A few practical solutions

Most of the CDC’s core components fall under the EVS director’s responsibility and control, and while some may require extra time, effort and budget, training and education is a reliable way to effect optimal cleaning, enhanced outcomes and reduced throughput times. Here are simple and practical solutions for you to consider:

training frontline EVS staff

Involve EVS frontline staff in the training process to drive consistency and standardization—an approach used successfully in other areas of the healthcare setting to drive compliance in safety protocols, from hand hygiene to bedside care procedures to fire safety. In fact, certify members of your EVS frontline staff to lead peer-to-peer training and education of new hires.

Follow the Tell, Show, Do, Review formula:

  • Tell EVS workers what protocols to follow
  • Show them your facility’s expectations
  • Have them do the work to these expectations
  • Review their work against these expectations

Reiterate and reinforce the 7-step process for disinfecting surfaces:

  1. Dry dusting
  2. Disinfecting horizontal surfaces
  3. Disinfecting vertical surfaces
  4. Restroom cleaning
  5. Dust-mopping the floor
  6. Damp-mopping the floor
  7. Inspecting the work

Use a clean-by-sequence process to effectively address the 17 high-touch surfaces recognized by the CDC that are most vulnerable to the spread of pathogens:

  1. Bed rails
  2. Controls
  3. Tray table
  4. IV pole (grab area)
  5. TV remote call box/button
  6. Telephone
  7. Bedside table handle
  8. Furniture arms
  9. Room sink
  10. Room light switch
  11. Room inner doorknob
  12. Bathroom inner doorknob/plate
  13. Bathroom light switch
  14. Toilet handrails
  15. Toilet seat
  16. Toilet flush handle
  17. Toilet bedpan cleaner
EVS IP posters

Create “7-step” and “17 high-touch surface” posters to drive better protocol adherence. Place these visuals wherever EVS workers regularly spend their time—hallways, rooms, storage closets and break rooms. Create miniature sets, stored on a keyring, for worker carts.

use icons to support communication

Rely on pictures instead of words as much as possible to compensate for language barriers and save precious time.

mock room for EVS training

Have a mock-up of a patient or resident room in the EVS work area that can be used for worker training and observation without the disruptions and distractions that typically occur in an actual department.

Vendor training tools

Take advantage of vendor training tools when switching to new technologies and products or as a special agenda item during team meetings.

validation tools

Use validation tools, such as ATP testing, not only to inspect someone’s work but also teach them ways they can improve.

high tech disinfecting equipment

Demonstrate to EVS workers that their team and the work they do is valued by equipping them with up-to-date technologies and products that not only effectively clean and disinfect but are also safe to use. Also, consider providing EVS workers with uniforms if they don’t already have them.

HAI performance measurement

Share your facility’s HAI performance measurements and other information you receive in IP meetings with supervisors and frontline workers to emphasize the important role they play in infection prevention and empower them to help make a difference.

recognition program icon

Establish a rewards and recognition program for individual and team achievements.

Key takeaway

It is possible to adequately clean and disinfect patient and resident rooms to prevent HAIs without hindering your care facility’s stated goals for reducing throughput times. And it doesn’t necessarily have to be expensive or time-consuming. It simply requires a commitment to:

  • Standardizing cleaning and disinfection protocols, performed routinely
  • Deploying a few practical solutions to train and empower frontline workers
  • Driving consistency through monitoring and feedback

References:

  1. Desphande, A. et al. Are Hospital Floors an Underappreciated Reservoir for Transmission of Clostridium Difficile and Methicillin-Resistant Staphylococcus Aureus? Available at: https://www.researchgate.net/publication/313301242_1647.
  2. Pyrek KM. Environmental Hygiene: A Refresher for IPS and EVS Professionals Infection Control Today. 21016; September: 12-28.
  3. Pyrek KM. Environmental Hygiene: The Importance of Process, Product and Practice. Infection Control Today. August 2014. Available at: http://sd.infectioncontroltoday.com/digita1issues/2014/08/environmental-hygiene.aspx. Accessed July 18, 2016.
  4. Chemaly, RF, Simmons 5, Dale C, et al. The role of the healthcare environment in the spread of multidrug-resistant organisms: update on current best practices for containment. Therapeutic Advances in Infectious Disease. 2014;2(3-4):79-90 doi:10.1177/204993611454328 7. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4250270/.
  5. https://www.cdc.gov/hai/prevent/environment/surfaces.html
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