Healthcare Hygiene magazine January 2020 | Page 16

Shared Accountability
in Cleaning and
Disinfection Can Help
Reduce Infection Risk,
Boost Outcomes
By Kelly M. Pyrek
A
division of labor in the hospital that is often fuzzy is that
of cleaning and disinfection, particularly when it comes
to electronic patient-care equipment and surfaces that are
not subjected to a clear policy and procedure outlined by the
healthcare institution in its environmental hygiene program.
As Dumigan (2008) reminds us, “All healthcare facilities
have procedures for cleaning the patient care environment,
but in the ‘real world’ experience there is often confusion
about the division of labor when it comes to cleaning busy
patient-care units and patient-care equipment. With the
environment playing an ever-greater role in transmission of
multidrug-resistant organisms and gastrointestinal illnesses, it
is important to have clear lines of responsibilities for a variety
of types of cleaning, along with consistent procedures, and
a verification system to monitor effectiveness.”
As a consultant,
Linda Lybert, founder
and executive director of
the Healthcare Surfaces
I have had
Institute, has observed
many discussions the confusion that exists
with nursing
as facilities grapple with
ownership of cleaning
professionals and EVS
professionals that, when asked and “It disinfection.
is important to
directly, they express confusion recognize we are depen-
dent on human behavior,
over who is responsible
which is something we
for what.”
don’t have complete
— Linda Lybert
control over,” Lybert says.
“Assumptions are quickly
made that someone else is responsible for, and critical areas
are missed.”
“I have had many discussions with nursing professionals
and EVS professionals that, when asked directly, they express
confusion over who is responsible for what,” Lybert confirms.
“When a problem arises, fingers point in many directions.
Training programs for EVS workers provide training and in-
struction for efficient and effective cleaning and disinfection.
Nursing professionals do not receive this training, yet they
are often expected to turn over rooms in the emergency
department (ED) or perhaps to clean areas of the patient
room. It is crucial to note that nursing professionals have
primary responsibility for patient care, and the last I checked,
the curriculum for nursing school did not also include cleaning
and disinfection of rooms, equipment, or furniture. Nurses
16
will focus on patient care and will tell you that comes first,
and often time any cleaning and disinfection requests are
usually not done.”
Room turnover causes particular consternation, and Lybert
recalls conversing with a clinician who confirmed that it is
fraught with difficulties.
“I will never forget the conversation I had with an
ED nurse who shared with me her frustration when the
responsibility for room turnover between patients was their
responsibility,” Lybert says. “This was a daunting and often
impossible request, which I understood when she told me
what she focuses on. When a patient arrives, there is a set
amount of time for the patient to be seen, treated, admitted,
or discharge. Penalties may apply if patients are not treated
promptly. If the ED is busy such as during flu season or if
there are several trauma patients at a time, there is no time
for a nurse who is focused on patient care to efficiently and
effectively clean and disinfect between patients.”
According to the ED clinician Lybert talked to, the ED is
considered to be turned over by someone grabbing wipes
and wiping down the railings on the gurneys, and then
flipping the sheets over and moving the next patient in.
“In defense of the nurse, she was never trained to turn
over the rooms,” Lybert says. “She wasn’t sure which wipe
to use and used the one that is in the room. Her focus is
on patient care.”
Lybert continues, “It is vital to note that EVS professionals
came in once a day to do a terminal clean and disinfection,
and while there are EVS professionals on staff, they are
limited. If there is heavy contamination such as trauma,
nursing staff may request help from EVS. In an occupied
patient room, EVS professionals are reluctant to touch
anything close to the patient. IV poles, medical equipment,
monitors, walkers, bed rails, overbed tables, bedside tables,
arms of the chairs next to the bed, are all often missed in
daily cleaning and disinfection. EVS professionals will tell you
those are the responsibility of nursing professionals. Ask a
critical care nurse about this responsibility, and they will tell
you the focus is on patient care. If something needs to be
taken care of, they do it when there is time. I have asked if
they receive any training ever for cleaning and disinfection.
They may be shown how something is cleaned but no clear
directions. They use whatever is available to clean. What is
interesting is the instinctual desire of a family to help keep
a patient room clean. Are we missing an opportunity here?
I am aware of a few healthcare facilities that educate and
engage family members in the daily cleaning process. This,
however, requires training as well.”
While the best solution is for healthcare institutions to
establish and implement evidence-based environmental
hygiene programs, additional interventions include awareness
campaigns, education and training efforts, and improved
communication.
“It is important again to note we are talking about human
behavior,” Lybert emphasizes. “I am familiar with a few
healthcare facilities that have created in-house educational
training programs that are accessed online. EVS staff must
complete this program which includes quizzes and hands
on training. Completion of this program as well as ongoing
january 2020 • www.healthcarehygienemagazine.com