sound implausible, but those situations arise much too often
and are a result of a lack of communication, cooperation,
and collaboration.
Coincidentally, two study sites, one new and another with
a significant addition of a 17-story building, did not include a
seat at the table for EVS leaders to discuss the impact these
initiatives would place on cleaning and disinfection. Whether
intentional or a gross oversight due to a proliferation of a
silo mentality is unknown. The new building cited in the
gap analysis did not include consideration or the need for
added dock space, waste-stream support, EVS storage, clean
utility, or soiled utility rooms, or types of surfaces fabrics
and equipment that could exist and function in a healthcare
environment and reasonably cleaned and disinfected.
Additionally, although necessary for clinical staff support,
no allocation of space for scrub-dispensing equipment was
considered nor available after the build, further burdening
the labor budget for non-essential patient-care tasks.
The silo actions had a vital and negative impact on staffing
and resources in EVS. They required significant time and effort
by many departments to find creative ways to work around
diminished space and lack of ready resources such as tools,
equipment, and storage while failing to provide additional
funding to meet the needs of many departments. At the
same time, EVS and other departments experienced labor
issues necessitated by transportation and time requirements
due to the demand for moving both people and assets from
one point to another.
Multiple analysis surveys addressed different impacts on
EVS, and clinical staff directly responsible for patients. A lack
of communication and understanding of task assignments
was cited numerous times in the surveys. Failures to
communicate between discipline responsibilities for what
needed cleaning and who was responsible for cleaning, and
when cleaning was required. Without a definite responsibility
matrix, dirty equipment waited for the responsible party to
clean, disinfect, and remove it. Without a distinct model, EVS
ultimately inherits the responsibility
of ensuring every item, in the room,
is processed.
CLICK
The project advisors assigned
TO VIEW
to the study sites observed two
measurements of time:
Patient Progression
➊ Wheels out to wheels in (a
term to indicate when a patient leaves a room, to when
another can come in), often referred to as room turnover time
➋ A more widely recognized and accepted measurement
relative to EVS, room turnover time, meaning the time it
takes to process a discharged room.
Minimal room turnover time was significantly evident and
emphasized for both patient-room discharge and isolation
room cleaning, as well as OR in-between case cleaning and
end-of-day terminal cleaning in the OR. Numerous surveys
indicated continual pressure to reduce processing time
which resulted in undue influence upon staff to incompletely
fulfill the necessary tasks that provide hygienic spaces for
patients. Infection preventionists recognize the practice is
unsafe and indicated they strive to support the needs of
www.healthcarehygienemagazine.com • march 2020
EVS in adequately fulfilling their duties and responsibilities
to both patients and nursing staff.
Improved Outcomes
Through the implementation of the ESOP program,
executive-level leadership was engaged immediately through
an invitation to join as an executive sponsor. Minimal time
is requested to invest in the overall project, except for
the necessary project kickoff and post-project report. The
executive sponsors participate in the program whenever they
wish and when influence is required, or deemed necessary,
to remove roadblocks encountered or facilitate collaboration
and resource allocation.
Communication within the multidisciplinary team
incorporates a simple template that allows the departments
a method and means to validate effective communication,
report changes, monitor infection rates, and gain collabora-
tion. Value analysis teams, if not already functioning, are set
in place that allow regular and thoughtful communication.
And involvement in projects and
purchasing of products or services
are performed by a team of vested
stakeholders. The value analysis
CLICK
teams ensure that all purchases meet
TO VIEW
the requirements of the facility, as
well as proper infection prevention
Cleaning Accountability
and environmental service cleaning
and disinfection guidelines.
Caroline Haggerty and Sara Townsend, from PennMed-
icine and Children’s Hospital of Philadelphia, respectively,
enacted a “Who Cleans What, How, and When” program.
The program facilitated education and buy-in to ensure
that everyone was clear on the manufacturers’ instructions
for use (IFU). The IFUs, proper cleaning and disinfection,
coupled with a responsibility matrix and utilization of AHE’s
Certified Surgical Cleaning Technician certification training
(CSCT), and Certificate of Mastery of Infection Prevention
(CMIP), along with a capstone project, ensured each item
was adequately cared for to provide the best patient care.
Training – Evidenced Based Certification
Present State
There was a variety of programs in place for both in-house
(hospital managed) and contractor (outsourced) training;
however, standardized resources across facilities lacked the
requisite methods and means to fulfill obligations and the
equipment varied. The content of the existing programs
typically was outdated to current industry standards and the
latest practice guidance by the authorities having jurisdiction.
Policies were outdated, including the training materials and
resources on-hand. In many cases, the passion and desire
to serve were evident, yet the tools, knowledge, availability,
or time, and financial support was lacking.
Improved Outcomes
As introduced last month, the Association Healthcare
Environment (AHE) (https://www.ahe.org) was available
to program participants to provide significant resources.
Resources included instructor-lead train the trainer programs
with world-class content. The AHE was ready to deliver
educational formats for audiences to make an immediate
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