When we look at measuring cleaning efforts and the cleanliness of the healthcare facility , there are some general principles that we need to consider , especially examining what are the weaknesses that the different strategies that we use , as each one has a benefit and a weakness . We want to ensure that we ’ re choosing a method that suits our facility .”
— Natalie Bruce
factors you add depends on your capability and your resources to be able to conduct this screening , and that ’ s going to be related to the clinical laboratory resources that you have . Also check with the lab to ensure they can perform the screens efficiently and with the limited resources that they may have , how can you modify your screening protocols to make it easier for the lab ? For example , receiving just one swab instead of four different swabs . Also think about your environmental hygiene and environmental cleaning teams ; sometimes we may think that it ’ s enough to say , ‘ Enhance cleaning in one particular area ,’ but we know that enhanced cleaning in many of the facilities doesn ’ t happen the way we would expect it to happen . It does require closer supervision and review with your environmental services team on the methods as well as the disinfectants used , for the highest level of efficacy .”
• • •
In the third presentation of the Cleaning & Disinfection Symposium at 2023 IPAC Canada , Natalie Bruce , a 22-year infection prevention expert and the associate director in the Infection Prevention and Surveillance Division of the Public Health Agency of Canada , presented on auditing the environmental services department and measuring what matters . She explained that auditing the cleaning and disinfection process can recognize outstanding performance and identify procedural , systemic and other concerns . She reviewed general audit techniques , but also addressed how to use the results to affect behavioral changes and how to message the audits in a positive manner .
“ When we look at measuring cleaning efforts and the cleanliness of the healthcare facility , there are some general principles that we need to consider , especially examining the weaknesses of the different strategies that we use , as each one has a benefit and a weakness . We want to ensure that we ’ re choosing a method that suits our facility . The recommendation is taking a multi-modal approach to auditing methods . And we want to aggregate our data to ensure that we ’ re not pinpointing anyone in particular and also making sure that that there ’ s enough data to make assumptions that are valuable . From our experience at the institution where I worked , it was beneficial to have a cooperative approach . We want to ensure those auditing results are used from a teaching perspective and that training is reflective of the policies of the institution . And we most certainly don ’ t want it to be punitive .”
The first method that Bruce explored was an observational audit method .
“ What has been around forever is visual assessment , something that is probably performed in most facilities . It is still a good method for achieving the level of ‘ hotel clean ’ but the disinfection at the level of ‘ hospital clean ’ is not taking place . With this method there ’ s a standard approach and checklist as well as
means to provide feedback . However , these results do not correlate to the actual cleanliness or disinfection level . We know that if you were to conduct an observational visual assessment and I was to follow , we would probably have different findings . Performing observation is very valuable , as it ’ s an opportunity where environmental services personnel can partner with their supervisor or their manager to identify gaps or practices . During busy days it can be challenging to speak with our supervisors , and this method can be labor-intensive and difficult to standardize . But it is a great way to make that connection within the context of a quality improvement initiative .”
Bruce added that some facilities incorporate surveys into the measurement and auditing process . “ Many institutions , whether it be long-term care or acutecare facilities , conduct surveys to gain the patients ’ perspectives ; we cannot measure cleanliness by this , of course , but it is a good opportunity to learn how patients perceive cleanliness and their expectations for it .”
Another method of measurement that Bruce addressed is fluorescent environmental marking . “ Perhaps many of you are already using this method , where a trained person goes out into the environment and does a marking of surfaces , especially high-touch surfaces ; the fluorescent mark is a surrogate for contamination and bioburden that should be removed during the cleaning process by using friction . Only by using elbow grease can you ensure that the bioburden is removed . Fluorescent environmental marking is easy to implement , is visual , and is a great tool for educating healthcare personnel . The downside of the method is that there are some inter-observer reliability issues , as people mark things differently . From personal experience we had some issues with inconsistent dabbing that impacted our results . This method also requires that an auditor is trained on a standardized process . And if you create your own fluorescent environmental marking fluid , the actual composition of the material matters ; for example , if it is an oil-based substance , it may be more difficult to remove . Also , some of the powders that people use will get dispersed throughout the facility , making it very difficult to track .”
Bruce emphasized another challenge is that there is little consistency regarding what is considered to be a pass or a fail when it comes to removing the fluorescent environmental markings by EVS personnel .
“ Some say that the mark must be fully removed for it to be considered a pass , while others who have studied this say that it can be mostly removed or there could be some residual and that would be a pass . Some facilities measure their markings by percentage of the fluorescent circle that remains ,” she said .
Bruce also addressed environmental culturing . “ Obviously , it ’ s very easy to do , but there are pitfalls . First , we need to rely on our resources in the laboratory and second , there is not a standardized process to
20 july 2023 • www . healthcarehygienemagazine . com