Healthcare Hygiene magazine January 2020 | Page 17

Consistent,

standardized
processes for
cleaning medical equipment
and surfaces in the patient
and unit environments is
critical to maintain a clean
and safe environment,”
performance are a part
of staff annual reviews.”
Lybert continues, “This
program is updated when
policies and procedures
change. Staff can reference
processes and procedures
at any time. If nursing
staff has responsibility this
type of program could be
offered to them as well.
— Caroline Haggerty, RN,
Family members could
MSN, MBA
access information for
simple daily cleaning and
disinfection through something similar and could be part
of a packet of information when patients are admitted.”
Members of the University of Pennsylvania Health System
experienced first-hand what cultivating a shared sense of
accountability can achieve in improving environmental
cleaning in the healthcare environment. The Hospital of
the University of Pennsylvania, 700-bed institution within
this healthcare system, created a multidisciplinary-shared
accountability model for cleaning the patient environment
and equipment, establishing a specific protocol to ensure
environments and equipment were clean, staff could speak
to the cleaning process, and overall cleanliness was improved.
Uncovering vulnerabilities in the cleaning and disinfection
process is often the first step, and as UPHS discovered through
its gap analysis, assumptions can be incorrect.
“The initial motivation for establishing the organization’s
‘Who Cleans What’ Committee was to prepare for a major
regulatory survey in the next calendar year,” says Betty Ann
Boczar, MS, BSN, RN, NEA-BC, nursing director for regulatory
compliance at the Hospital of the University of Pennsylvania.
“This impending regulatory survey prompted the launching
of this program as an organizational survey readiness
strategy. The ‘Who Cleans What’ committee immediately
recognized that they faced a crucial juncture, and the team
could implement a cohesive, far reaching and sustainable
cleaning and disinfecting plan. Team leaders invested time
and resources into changing the culture, and thus moved
the initiative beyond just survey readiness. This was done
by developing a clear mission, attending to all details,
and repeatedly emphasizing the shared accountability of
maintaining a clean and safe patient environment.”
Boczar continues, “This model of shared accountability
promoted enhanced awareness amongst all hospital em-
ployees regarding the importance of a clean environment.
The positive outcomes associated with this initiative included
improving the patient and employee experience. The initiative
correlated with a substantial reduction in hospital-acquired
infections. In addition, staff continue to be able to articulate
their responsibility for the cleaning process. They demonstrate
a clear understanding of the importance of instructions
for use (IFUs) in properly cleaning patient equipment. The
organization achieved successes are widely shared, and thus
support the project throughout the organization and build
on momentum.”
The University of Pennsylvania Health System team
www.healthcarehygienemagazine.com • january 2020
reports that it accomplished several key objectives through
the pilot study.
“Innumerable organizational goals are met by addressing
cleaning and disinfecting in a standard, visible and structured
way,” says Diane Leichter, RN, MSN, BC-NE, CNRN, CIC,
director of infection prevention and control at the Hospital
of the University of Pennsylvania. “The most identifiable
goal is reducing the chance of transmission of infections.
Another goal is to be consistently ready for surveys. Finally,
and overlapping with these two goals is the insight that
maintaining a clean and safe environment is an underlying
precept to reaching the level of a high-reliability organization
in healthcare.”
She continues, “During the years prior to this project,
leadership teams from all departments including nursing,
environmental services, and infection control, to name a
few, had done exemplary work preparing their individual
departments. The efforts had evolved into an effective but
fragmented system that was difficult for employees to speak
to. When the ‘Who Cleans What’ team conducted a formal
gap analysis, the team identified areas wherein a shared
accountability model would better serve key stakeholders
and lead to even more improvements, standardization across
the organization, and increased survey readiness.”
Leichter says their organization achieved a 40 percent
reduction in reportable HAIs. Additionally, it had what she
calls “a resoundingly successful” large-scale survey during
this past year. “In terms of sustainability, the organization
has maintained the initiative for three years at this point.,”
she adds.
Presenting the study findings to a standing-room-only
crowd at a recent annual meeting of APIC, Caroline
Haggerty, RN, MSN, MBA, manager of quality and patient
safety at Chester County Hospital, says that their push for
accountability is resonating with healthcare organizations
across the country, indicating that the struggle is real.
“Organizations work consistently to promote a clean
and safe environment for patients, families and employees,”
Haggerty says. “The challenges are perennial, and the scope
of cleaning all surfaces in a hospital environment is vast. An
initial step in this project was surveying our employees to
measure their knowledge about cleaning and disinfecting
the patient care environment. The survey revealed gaps in
their knowledge. The team identified the need to focus
on standardizing and increasing the visibility of who is
responsible for cleaning specific pieces of equipment. The
team agreed upon a cleaning philosophy early in our project
planning stage; this is essentially a mission statement. The
philosophy is shared on all educational tools and job aids
created for the project.”
The pilot study showed the benefits of clear lines of de-
marcation around cleaning accountability and demonstrates
that other organization can adopt similar strategies based
on their local and global cleaning challenges.
“Consistent, standardized processes for cleaning medical
equipment and surfaces in the patient and unit environments
is critical to maintain a clean and safe environment,” Haggerty
says. “This includes codifying the who, what, when and
how of hospital surfaces are to be cleaned. Identifying the
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