Healthcare Hygiene magazine January 2020 | Page 18

pieces of equipment and
surfaces that need to be
cleaned and referencing
This model of
the manufacturer’s IFUs

shared
was the first step. Next
accountability
step was to identify
which employees were
promoted enhanced awareness
for clean-
amongst all hospital employees responsible
ing what. Once those
regarding the importance of a decisions were made,
the team developed a
clean environment.”
highly visible algorithm
— Betty Ann Boczar, MS, BSN
for communicating the
cleaning requirements
for medical equipment in all inpatient units. This algorithm
was widely communicated in the form of a professionally
designed and colorful cleaning grid. The columns in the
grid use the scrub uniform colors as key to reflecting each
employee’s role in cleaning. For example, nurses wear a navy
scrub and the nurses’ column on the grid was a light navy
color. Using the grid, employees easily identify their column
and their own responsibilities as well as other employees’
responsibilities. In many instances, responsibility is shared.
For example, if a nurse, nursing assistant, or physical therapist
use a portable vital sign machine in a patient room it is
their responsibility to clean it after use. Employees gave us
feedback that visualizing and referencing the grid was an
extremely effective communication tool. The visibility of this
grid made it simple to convey the plan to surveyors during
their recent visit; many surveyors took pictures of our grid
citing us for having a “best practice.”
Since the launch of
the pilot study, additional
work has continued,
The most
including ensuring the
sustainability of ‘Who
identifiable goal
Cleans What,’ which
is reducing the
was a key imperative
chance of transmission
for eventually forming
the secondary, higher
of infections.”
level steering commit-
— Diane Leichter
tee, according to Boczar.
“Steering committee
efforts to ensure sustainability included leadership role
modeling, frequent scheduled rounding on the patient care
units, engaging frontline staff and widely sharing positive
feedback, and positive outcomes,” she explains. “During
the summer of 2019, there was a deliberate and focused
approach by the steering committee to visit every inpatient
unit and measure the compliance with the ‘Who Cleans
What’ plan. Unit visits, or rounding, consisted of education
and support for all staff. Surveillance included an audit tool
which captured the key components of the initiative, such
as visibility of the ‘Who Cleans What’ posters, appropriate
utilization of green bags to identify clean equipment, verifica-
tion of approved hospital wipes in patients’ rooms and staff
questions about the cleaning process. Simultaneously, there
was adenosine triphosphate (ATP) testing done on specific
equipment to validate cleaning effectiveness. ATP tests the
level of bioburden left on equipment after cleaning. Overall
18
the results were extremely positive, and it was a great way for
staff to see the success of their work and the impact to patient
safety. Additional strategies include embedding the language
into ongoing Environment of Care (EOC) rounds, employee
orientation programs, and widespread communication in
existing organizational forums and meetings. The team
incorporated ATP testing into EOC rounds as a continued
monitoring process. We invite the unit employees s to join
us as we make the rounds. At the end of rounds, we share
the results of the ATP tests. The stakeholders are eager to
hear the results to see how successful they are in keeping
the environment clean.”
Successful collaboration is a main driver of accountability,
and Haggerty describes how stakeholders came together to
support the accountability efforts.
“There are multiple healthcare disciplines required to
maintain hospital environments that are clean and safe
for patients and employees,” Haggerty explains. “The’
Who Cleans What’ team brought these groups together to
negotiate solutions that reflect this widespread accountability.
One unique supporting resource the ‘Who Cleans What’ team
had was an expert project manager assigned and committed
to facilitate committee structure. The expert project manager
taught the team to utilize project management tools, focus
scope and direction, develop educational tools and increase
productivity. The team developed a project charter that
was iterative, dynamic and inclusive. We decided upon a
cleaning philosophy that guided all future project decisions.
We met weekly for a year, in order to keep the team on
track and moving forward. All disciplines were required
to be active participants, and all disciplines were required
to identify areas of increased accountability for their own
department and suggest changes that other departments
might be required to make.”
Leichter reports that the ‘Who Cleans What’ approach was
successful for the inpatient units and the patient equipment
in these areas. “The initiative has since been rolled out to
several specific procedural areas including apheresis and
dialysis,” she adds. “In the coming year, the approach will
focus on other areas of the organization and across the
health system. The goal will be to develop a customized
grid delineating the specific plan for cleaning all equipment
in every department of the organization.”
The take-away from this pilot study – that every facility
can establish better lines of communication around cleaning
and disinfection responsibilities – must become ingrained
in institutional policy for it to have sustained momentum.
“The philosophy and mission initially developed by the
committee has proven to be the most essential aspect
of sustainability and alignment,” Leichter says. “Every
question that arises is reviewed by every team member
using that cleaning philosophy as a lens. The philosophy and
mission are embedded into the fabric of each department;
every department is proud to share in the successes we
have achieved.
Reference:
Dumigan DG, et al. Who is Really Caring for Your Environment of Care?
Developing Standardized Cleaning Procedures and Effective Monitoring
Techniques. Am J Infect Control. Vol. 36, No. 5, Pages E63–E64. June 2008.
january 2020 • www.healthcarehygienemagazine.com