Infection Control Today

SEP 2018

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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14 ICT September 2018 www.infectioncontroltoday.com As Pedersen, et al. (2018) obser ve, "Overall, EVS staff believe themselves to be valuable members of the team. This contrasts previous studies that have shown EVS workers feel unappreciated with a 'me versus them' mentality. Nevertheless, EVS workers do not feel appreciated by physicians and nurses. This underappreciation is to a lesser degree than previously reported. The institutional difference may be due to the culture of appre- ciating and empowering EVS employees that is instilled by EVS leadership, thereby fostering job satisfaction within the department. Despite feeling valued, respondents report feeling rushed to clean patient rooms. At our institution, 15 minutes is allotted for daily room cleaning and approximately 30 minutes is given for terminal disinfection at the time of patient discharge. This time frame is tailored based on factors such as contact precautions and length of stay." T h e r e s e a r c h e r s a d d , "H o s p i t a l s strengthening their EVS program for infection prevention purposes should be knowledgeable of perceptions and barriers of environmental cleaning at their institutions. Subsequent knowledge gaps should be addressed for all levels of experience. Workfl ow effi ciency should be routinely monitored and improved. Finally, the importance of our environmental service colleagues in preventing infection transmission should be recognized at an institution level." Cleaning Interventions Doll, et al. (2018) conducted a review of the literature regarding environmental cleaning in the healthcare setting. As the researchers noted, "Despite evidence of the transmission of infectious organisms from environment to patient, the role of a clean environment in hospital prevention remains controversial. The extent to which environmental contamination contributes to healthcare-associated infections is unclear. Surface cleaning is certainly not a substitute for other infection control practices such as handwashing, limiting medical device usage, and gowning or gloving when indicated. However, routine efforts to decrease the overall bioburden of the hospital environment via cleaning is likely foundational to other efforts; lower levels of infectious organisms on surfaces translates to less contamination of healthcare worker hands and patient care objects as they make contact with the hospital environment. Essentially all literature related to the optimization of environmental cleaning in healthcare systems comes from countries with relatively abundant resources. In resource-limited healthcare settings, additional challenges may exist that contribute to inadequate cleaning. The minimum standards for environmental health reported in the World Health Organization's Essential Environmental Health Standards in Health Care with regard to healthcare centers with limited resources, outline clean water, waste management, and a focus on visible dust and soil as essential temporary measures to protect patients. A comparison of these minimum standards against other published environmental cleaning recommendations highlights a striking disparity in the conditions of the hospital environment between different regions of the world." The researchers add, "The hospital environment can be a source of HAIs, and current cleaning methods are only partially successful in mediating this risk. However, the extent to which the environment contributes to the transmission of infection and the level of cleanliness required to prevent the acqui- sition of organisms from the environment is unknown. There has been substantial interest in improving the cleaning process in recent years, and publications highlight a variety of strategies to accomplish this. Yet, funda- mental issues remain unaddressed. There is an urgent need to overcome the challenges faced by manual cleaners (Bernstein et al., 2016) and to maximize the benefi t of manual cleaning efforts. A tiered approach to cleaning that is tailored to the specifi c needs and resources of healthcare centers would be better defi ned with a wider representation of the global healthcare community in published studies. Human factors will ultimately determine the quality of environmental cleaning in the hospital and will remain the patient's best defense against invisible threats from the hospital environment." Combining Infection Prevention and Implementation Science to Improve Cleaning Allen, et al. (2018) sought to assess the effectiveness of an environmental hygiene bundle in terms of changes to HAI rates, cleaning performance and environmental services (EVS) workers' knowledge and attitudes. A multi-modal bundle was designed and implemented with EVS personnel in eight wards in a 400-bed metropolitan teaching hospital, using a prospective, before-and-after study design. This consisted of a three-month pre -inter vention phase and six-month intervention phase. This research used an implementation science framework to guide the transition from evidence into practice, with data collected in the pre-intervention phase synthesized to design the implemen- tation strategy. The researchers report that signifi cant improvements in cleaning performance were observed, with the average proportion of ultraviolet markers removed during cleaning across the wards increasing from 61.1 percent to 95.4 percent. Results also demonstrate improvements to both the knowledge and attitudes of EVS professionals. By combining infection prevention and implementation science, this bundle was an effective way to engage environmental services staff and improve hospital cleaning. The hospital environmental hygiene bundle included the following components: • Targeted training for environmental hygiene (including addressing cleaning roles and responsibilities, bundle requirements, and local context) • Defi ned and consistent product use • Availability of point of care wipes for medical equipment (nurse-cleaned items) • Defined and consistent cleaning technique: (including addressing sequence, pressure and movement, as well as adherence to manufacturers' instructions for product use, including contact time and dilution) • Regular audits, with results fed back directly to EVS personnel • Enhanced communication between EVS workers and other healthcare personnel • Hospital-wide promotion of environ- mental hygiene The researchers surveyed EVS personnel before and after the bundle was implemented and found that most participants had been professional cleaners for more than a decade, with approximately half the survey participants holding at least one related workplace certifi cation. Infection preven- tion-related knowledge questions scored high in the pre-intervention survey and remained consistent throughout the intervention period. According to the researchers, the major positive shifts in knowledge were related Ò Human factors will ultimately determine the quality of environmental cleaning in the hospital and will remain the patient's best defense against invisible threats from the hospital environment.

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