Healthcare Hygiene magazine March 2020 | Page 19

environmental surfaces. They are collaborating on processes, education, training, tools, and chemical selections.” Scherberger points to an example to be found when the San Francisco Bay Area (SFBA) Association for Professionals in Infection Control and Epidemiology (APIC) begin a col- laborative project in 2017 to work with their EVS peers at two hospitals, the goal being allied healthcare professionals examining what was necessary versus what was expedient to performing their jobs. “Out of this collaboration came the Environmental Services Optimization Playbook (ESOP) project,” Scherberger explains. “The ESOP project is an ongoing, non-commercial collaborative effort that provides EVS departments excellent ideas and insight into developing and maintaining a cutting-edge department.” Despite the ongoing debate around thoroughness of cleaning correlation, it is hoped by many that Click here for Environmental ongoing research could still provide EVS professionals Services with more time to clean if it could still be proven Optimization that additional time, resources and FTEs equate into Playbook improved hygiene, decreased infection rates, and other measurable outcomes. “Studies continue to focus on the healthcare environment as a primary need to improve patient outcomes,” Scherberger says. “Those findings and the continuing accumulation of per- tinent data for the need to continually address the healthcare environment have resulted in positive outcomes for patients. Focus on the clinical aspects, not just the aesthetics, is now recognized as an essential and vital need. EVS departments are collecting data, establishing data-driven dashboards, incorporating patient outcomes into departmental goals, and measurable infection prevention protocols into their profession. These steps have proven the need for additional time, resources, FTEs, and education resources. Studies by Rupp, et al. (2013) and other researchers disrupted EVS and IP disciplines by bursting isolation balloons; however, they also helped shine a light on the needs of both disciplines.” So, the question remains, how long does it take to actually clean various objects in the patient-care environment? As Peters, et al. (2018) remind us, “Hospital environmental hygiene is complex because it is dependent on the pathogen present and the product used to remove it. There are five main variables to cleaning, whether removing soil or disinfecting and cleaning on a microbiological level. These elements are: What product or intervention is applied, the technique and equipment used to apply the product, the type of surface, the level of contamination of the environment, and last but not least, the environmental hygiene personnel doing the cleaning. If any one of these elements is lacking, the cleaning will, by definition, be suboptimal. Because of this, changing cleaning practices in hospitals must be implemented through a multimodal strategy that takes these variables into account. The best cleaning substance in the world is useless if not applied correctly, and the best-trained personnel are useless if the product they are using is not effective against the particular pathogen that needs to be removed or killed.” Two studies (Saito, et al., 2015; Zoutman, et al., 2015) estimated the time currently being spent by healthcare workers on cleaning shared patient-care equipment and three articles (Dancer et al., 2009; Rampling, et al., 2001; www.healthcarehygienemagazine.com • march 2020 Wilson et al., 2011) evaluated interventions which increased the time spent on cleaning. Saito, et al. (2015) observed the frequency of cleaning and disinfecting tasks (recorded at 5-min intervals) as a proportion of shifts (percentage of total shifts) and observed time spent performing cleaning and disinfecting tasks per shift (minutes/ shift). The researchers concluded from their observational study that healthcare workers undertaking multiple roles as a part of their job (e.g. registered nurses) tended to perform cleaning and disinfection tasks with a lower frequency and for a shorter duration. In particular, housekeepers spent almost twice as long on equipment cleaning (23 minutes per shift) than registered nurses (13 minutes per shift). The average duration of time spent cleaning fixed surfaces (e.g. beds and chairs) was more than nine times as long for housekeepers (94 minutes per shift) as it was for registered nurses (10 minutes per shift). Zoutman, et al. (2015) estimated the time required to perform routine cleaning and terminal cleaning of private, semi-private and ward rooms. The researchers used a questionnaire distributed to senior managers to ascertain that routine cleaning of a private room required nearly half as long a mean time (17.3 minutes) as that needed to clean a ward room (34.2 minutes) with an unspecified number of beds. Likewise, terminal cleaning of a private room took almost twice as much time (30.4 minutes) as routine cleaning, mainly due to additional tasks (e.g. replacement of privacy curtains). This observation implies that higher room turnover, resulting from a shorter length of stay, would further increase the amount of time required to keep patient rooms clean. Regarding studies that evaluated increased cleaning times, Wilson, et al. (2011) found that twice-daily cleaning, in addition to usual once-daily cleaning for three two-month periods resulted in a statistically significant reduction in environmental MRSA per bed-area day from 14.6 percent to 9.1 percent, when sampling from five randomly selected sites around the bed areas, staff hands and communal sites. Dancer, et al. (2009) studied the impact of adding a member of the cleaning staff for a period of six months; the researchers found a statistically significant reduction in levels of environmental contamination of 32.5 percent by weekly sampling of 10 hand-touch sites and a borderline statistically significant reduction in new MRSA infections of 26.6 percent. Rampling, et al. (2001) studied the impact of an increase in routine domestic cleaning time from 66.5 hours to 123.5 hours per week for a period of six months. They found a reduction in patient acquisition of an outbreak strain of MRSA from 30 cases in the six months prior to the intervention to three cases over the following six months. In a more recent study, Scott, et al. (2017) evaluated the impact of cleaning duration on HAI rates and estimated the time required to clean care equipment in accordance with national specifications. The researchers conducted a systematic review of the published literature on cleaning times as well as an observational study in which nine healthcare workers cleaned seven items of patient-care equipment while the duration of time taken to clean each item was measured. They reported that a limited amount of low-quality evidence indicated increased cleaning times in hospitals can reduce the incidence of infections. They found the interventional 19