Healthcare Hygiene magazine February_2020 | Page 27

The Genesis
of the
Environmental
Services
Optimization
Project ©
By John Scherberger, FAHE
H
ealthcare is ever-changing, never
stagnant, always challenging, and
This article
the confluence of interests, cultures,
is the first
and priorities is constant. However, in
in a year-
the meeting of these often-different
long series
matters, the patient must always be the
describing
focus of healthcare ministering – care,
an Industry
comfort, support.
journey led by
Infection prevention is everyone’s
environmental
responsibility
and goal. It takes a trained
services and
multidisciplinary team implementing
infection
multimodal interventions to fulfill
prevention
the purpose.
toward
A healthcare facility will never be
better patient
germ-free because bacteria, viruses,
outcomes,
molds, and fungi outside the facility
quality and cost
savings.
are always carried inside. Infiltration
into health care facilities is extremely
easy for contaminants and pathogens.
They can be taken by air currents, clothing, supplies, carts,
emergency services stretchers, and, of course, inside and on
the skin of every person entering a facility.
Despite the variety of viruses and bacteria, germs spread
from person to person through everyday interactions.
Therefore, to prevent germ transference, everyone must
work to break the chain of infection. 1
How to identify and break, or interrupt, the six points of
the chain is critical to overall outcomes. At whatever point
the chain breaks, the potential for infection stops.
The six links in the chain include the infectious agent,
reservoir, portal of exit, mode of transmission, the portal of
entry, and susceptible host.
Recently, the Centers for Disease Control and Prevention
(CDC) released a report, “Antibiotic resistance threats in
the United States 2019,” 2 updating the state of infection
prevalence and antibiotic resistance. Most of the attention
focused on the revelation that more people have died from
antibiotic-resistant infections than was previously believed.
The CDC categorizes pathogenic infection threats as
“concerning,” “serious,” and “urgent.” The “urgent”
category is to expand¬ to include the fungus Candida auris
and carbapenem-resistant Acinetobacter. The group is now
Editor’s note
www.healthcarehygienemagazine.com • february 2020
five, having joined C. difficile, the deadliest antibiotic-resistant
germ on the CDC’s urgent list; Carbapenem-resistant En-
terobacteriaceae; and drug-resistant Neisseria gonorrhoeae.
A Pause and Self-examination Were Needed, and
Experts Weighed in
Recognizing this need, the San Francisco Bay Area
(SFBA) Association for Professionals in Infection Control and
Epidemiology (APIC), decided to reflect in 2016-2017 and to
work with their environmental services (EVS) peers and with
allied healthcare professionals to look at the change, and
what is necessary versus what is expedient. It was apparent
that something was amiss with both disciplines in their joint
efforts to reduce healthcare-acquired infections.
Scientific and medical peer-reviewed decision-making
for some infection prevention and environmental services
processes departed from the paths of the patient, varied
in application, fundamental hygienic interests, proven
healthcare culture, and priorities to the way of convenience.
Also, too, was the lack of attention given to this vital frontline
of technicians and the role they play in the environment of
care for best patient outcomes, and that the resources, time,
people, recognition, safety, and tools they use couldn’t be
overlooked or ignored.
The recognition of the divergence from the proper path
resulted in a pause and self-examination of past practices and
the formation of a project designed to support optimization
of the EVS programs in two SFBA hospitals.
Sue Barnes, RN, CIC, FAPIC, who was, at the time,
president of the SFBA, was project manager and SFBA
chapter members were recruited. The two hospital teams
consisted of infection preventionists (IPs), EVS directors
and managers, and nursing representatives. Association
for the Healthcare Environment (AHE) industry champions
committed to the Triple Aim of Cost, Quality, and Outcome
provided project sponsorship. Because of the scope of the
project, AHE executive director Patti Costello and the entire
AHE education staff were intricately involved. The goal was
to design a playbook of best practices that would bring
scientifically recognized, evidence-based, and peer-reviewed
practice guidance to the forefront, while at the same time
providing the vetted resources to the teams that need it the
most. The Playbook is designed as a “DIY” (do-it-yourself)
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