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