environmental hygiene
environmental hygiene
By Richard Dixon
Call to Action : A Team-Based HAI Response
The bottom line is that the typical healthcare system of silos does not function properly to the benefit of patient care . However , the first clue is that when an outbreak occurs , the entire group of departments gets together to work through the cause , effect , and resolution issues to a successful conclusion , and hopefully put into future processes of the lessons learned .”
A good risk management question to ask in a healthcare facility is : Who is responsible for safety ? The most likely response would be “ everybody .” Great answer ! What about : Who is responsible for reducing healthcare-acquired infections ( HAIs )? Answers typically are infection prevention and control ( IP & C ), environmental services ( EVS ), or nurses and doctors . Let ’ s take a closer look at the clinical and environmental issues and answer this important question properly .
IP & C staff monitor antibiotic use , assist in the policies for EVS and chemical selection , monitor HAI statistics with a watchful eye on outbreaks , provide education on prevention on many typical issues , guide contractors through the difficult process of renovations in the facility , conduct product review and evaluation , manage HAI outbreaks , and more .
EVS is clearly responsible for the cleaning and disinfection in most healthcare facilities , with daily attention to horizonal and vertical surfaces , and special attention to high-touch surfaces plus a variety of waste management and recycling functions , pest management , laundry , and a wide variety of other areas .
Specialized cleaning and disinfection also take place in the food service department ( food preparation , storage , serving , waste management ), and in facilities management ( ducts , cooling towers , HVAC equipment , and more ).
Medical device reprocessing plays an important role in the operating and procedure rooms , as cleaning , disinfection , and sterilization of the many pieces of equipment and instruments – some of which are extremely difficult to achieve 100 percent efficacy , such as endoscopes .
Nurses do their best to clean up blood and other fluid spills in medical and surgical inpatient units plus in ambulatory departments such as endoscopy units .
Laboratory personnel , especially microbiology staff , identify bacteria , virus and fungal pathogens with incredible accuracy and speed but seldom are involved in the outcomes and trends of the patients that these tests are concerning .
A healthcare facility is therefore a complex web of different departments within an environment of multi-factorial issues that inevitably causes HAIs .
Let ’ s take the example of a patient in an older-style double room . Patient A is recovering from a respiratory illness and patient B is recovering from an abdominal issue who will test positive two days later for Clostridioides difficile ( C . diff ) from an endoscopy procedure . In the meantime , Patient A starts off with a mild diarrhea , uses the ensuite bathroom with the door partly open , and to complicate this issue , the bathroom ’ s negative-pressure vent is hardly drawing in any air , so the flushing of the toilet results in a plume of air containing fecal particles with C . diff bacteria to be distributed to Patient A whose bed is adjacent to the bathroom door . In the meantime , EVS staff try to clean and disinfect the room and bathroom , although both patients have personal items on the sink , overbed and bedside tables , so those surfaces don ’ t get any attention – it ’ s the same with the bedside rails because both patients are sleeping or have frequent visitors . As you can see , a perfect circumstance for Patients A and B to both contract as HAI , with further potential transmission beyond that patient room .
So , you can see in this over-simplified example , that HAIs are multi-factorial , and a different approach is required by all the separate departments who reside in their own silos . Here is just a sampling of these multi-factorial issues :
● Patient acuity
● Hand hygiene practices and auditing with consideration of the Hawthorne Effect
● Antibiotic stewardship programs
● Clinical practices
● Fecal waste management
● Environmental cleaning and disinfection practices , plus education
● Patient and visitor education
● Visitor restrictions
● HAI statistics availability and future predictions
● Personal protective equipment ( PPE )
● Auditing of routine and specialized practices
● Recognition of transmission routes and challenges
● Facility design
● Facility audit of positive and negative pressures , water temperatures
● Clinical glove use policy
● Training and education
● Budgets to maintain within only a focus on initial control , not long-term prevention , and risk adverse interventions .
The bottom line is that the typical healthcare system of silos does not function properly to the benefit of patient care . However , the first clue is that when an outbreak occurs , the entire group of departments gets together to work through the cause , effect ,
26 july 2023 • www . healthcarehygienemagazine . com