ESOP
program
found its
germination
in the Bay
Area and is
now growing
beyond the
original
boundaries,
and the
program
is now
international.
impact on patient care involved in the
program. Through extensive research
and comparative analysis, AHE training
proved to be the best program available
in the market today for program partic-
ipants. The training delivers thoughtful
and practical solutions that effect the
best patient outcomes possible, as well
as quality and reduced cost of care.
During the ESOP roll-out, participat-
ing study sites were able to be assigned
an advisor with extensive experience
and knowledge to help support
identified gaps or areas agreed upon
to focus on, thereby helping implement
necessary resources to drive long term
sustaining gains. Advisor participation
continues to be a precious resource to
ESOP sites and remains as a benefit to
new program sites.
Quality
Present State
William Rutala said it best: to have
good patient outcomes, one must start with good products
and good processes (training). No one can be gifted with a
Ferrari and become a professional driver without the nec-
essary instruction, training and guidance. Ongoing support
and coaching are also essential. Coaching requires actively
engaged leaders inspecting the expected. Coaching involves
direct observation and effective rounding. Getting out of the
office and observing the principles of the Gemba – otherwise
known as “the place where value is created” — walk.
Too often, EVS departments had inadequate equipment,
broken, misplaced, worn out, or inappropriate materials
and tools for the job at hand. That is akin to expecting a
surgeon to perform heart surgery with a butter knife and
a pair of pliers. EVS’s role in patient care is to promote a
hygienic and healing environment.
This role requires wipes and mops that are appropriate
for the healthcare setting to clean and disinfect and have the
capability to work on the surface intended without adverse
effects on the targeted surfaces or equipment. Wipes and
mops must be compatible with EPA Registered Hospital
Grade Disinfectants, effectively remove bioburden from the
surfaces, and remove the dry surface biofilm (DSB). Wipes
and mops must effectively remove residual endotoxins left
by disinfectants and ineffective or poor-quality, so-called
microfiber. Mops and wipes must also be capable of removing
and not re-depositing residue that typically leaves surfaces
appearing turbid- dirty, cloudy, streaked, and sticky (usually
from certain disinfectant solutions), and that can negatively
impact patient experience scores.
Improved Outcomes
Through the ESOP Project advisory board, leaders in
healthcare regularly convene via teleconferences to discuss
the gaps in industry products, processes and outcomes. One
teleconference highlighted that science-based definitions
were nonexistent for many commonly used terms and
products, thus causing many undesired consequences. For
example, after an extensive search of available products for
34
wiping and mopping, and working with the manufacturers
and distributors to ascertain intended use while looking at
available innovative research and design for future products
under development, a matrix was created to evaluate
performance characteristics as appropriate for a healthcare
setting. These criteria (shown here)
demonstrated missing definitions upon
CLICK
which to assess all products for best
TO VIEW
patient outcomes, efficacy, quality, and
overall costs.
EVS Product
The gap analysis determined incor-
Evaluation Criteria
rect product applications according to
IFUs, proper reprocessing or laundry and care instructions,
life-cycle analysis — that is, when to replace products.
Definitions of what constituted a microfiber product varied
considerably, within both disposable and reusable products,
much like calling all modes of transportation automobiles,
without respect to the desired outcome. Definitions of
research laboratories and facilities varied greatly, and
most testing was done to manufacturer expectations, not
necessarily what was best for clinical outcomes, impact to
the healthcare worker physically or ergonomically, resource
management, expense, and local environmental impact.
The definitions of what constituted proper laundering
and reprocessing to meet CDC and CMS guidelines were not
clear. Additionally, even when aware of the guidelines, they
were often ignored or needed to be clarified and evaluated
by third-party organizations to ensure appropriate adherence
to processing protocols.
Awareness is Essential, and Pride is Not Beneficial
Every journey begins with the first step, and that first
step is crucial to ensure traveling upon the proper and
correct direction. Everyone involved in healthcare knows
of a colleague, a peer, a supervisor, or a person of some
authority that refuses to acknowledge that they don’t know
everything, and that attitude of “It’s my way or the highway.”
Those people are a stumbling-block to progress and quality.
They are obstacles to attaining better patient outcomes.
They are of the ilk that refuses to admit that there may be
a better way to do things.
Fortunately, there were some healthcare professionals
in the San Francisco Bay area who decided, for the sake of
their patients and their communities, to step back and step
up and reflect upon what may be wrong, what was wrong,
and how to change. They were aware that some things were
just not right, that something radical was needed. And they
decided to adopt the adage: “If it’s to be, it’s up to me.” The
idea for a program suitable for all infection preventionists and
environmental services professionals throughout the country
capable of being replicated began. ESOP program found its
germination in the Bay Area and is now growing beyond the
original boundaries, and the program is now international.
For more information, visit: zeroinfections.org
John Scherberger is the owner of Healthcare Risk Miti-
gation of Spartanburg, SC. He is a fellow of the Association
for the Healthcare Environment (AHE) and a subject-matter
expert in environmental services, healthcare laundry/
microfiber, and infection prevention. He may be reached
at [email protected].
march 2020 • www.healthcarehygienemagazine.com