Environmental Services:
The Nail That Healthcare Depends Upon
By John Scherberger, FAHE
B
enjamin Franklin once said:
“For the want of a nail the shoe was lost,
This article
For the want of a shoe the horse was lost,
is the fourth
For the want of a horse the rider was lost,
in a year-
For the want of a rider the battle was lost,
long series
For the want of a battle the kingdom was lost,
describing
And all for the want of a horse-shoe nail.”
an Industry
Quite an allegory on the importance of envi-
journey led by
ronmental
services. Without the one thing that
environmental
keeps
a
hospital
battle-ready, the war will be lost.
services and
During
the
on-going
COVID-19 pandemic,
infection
much
has
been
made
over
the importance of
prevention
“front-line” staff – physicians, nurses, respiratory
toward
therapists, EMS. They are the face of healthcare,
better patient
the “rider” of the horse. And they are so critical,
outcomes,
quality and cost
but they are the face of hospitals, not the entire
savings.
body. In hospitals and other healthcare facilities,
no department is less important than another.
They all serve the purpose of the hospital body.
The first in this series of articles about the Environmental
Services Optimization Playbook (ESOP) introduced to
Healthcare Hygiene magazine readers the genesis of the
ESOP project. The San Francisco Bay Area (SFBA) Association
for Professionals in Infection Control and Epidemiology
(APIC) decided in 2016-2017 to bring together infection
preventionists, environmental services (EVS), and allied
healthcare professionals. The SFBA APIC Chapter recognized
that the hospital body required improvement. Too many
departments were, if not overtly, then indirectly, essentially
saying: “I don’t need you!”
The lack of essential attention given to EVS and infection
prevention (IP) in roles they play in the hospital body had
diminished over the years; it couldn’t be ignored any longer.
Little did they know that the world would be gripped in
the throes of a pandemic three years later and that their
efforts in developing the ESOP project would be so essential
in bringing coordination and deeper integration of those
departments to the body.
Editor’s note
Prophets of Change
The ESOP program requires that every participating
hospital have a C-suite champion that acts as an advocate
www.healthcarehygienemagazine.com • may 2020
for empowerment, support, and change to the EVS
department. The champion brings to the highest levels of
hospital administration the need for a secure and vital EVS
department. Healthcare EVS professionals have, for years,
recognized that the patient environment plays a significant
role in the transmission of healthcare-associated infections
(HAIs). And for years, they have been the watchmen on the
gates alerting the powerful that there were multiple enemies
at the gates and that the gates were weak. From as early
as Florence Nightingale recognizing the importance of the
healthcare environment during the Crimean War (1854-
18550), those tasked with cleaning and disinfecting the
hospital body. Nightingale showed that with an improvement
of sanitary methods and conditions of a patient environment,
deaths would decrease.
The World Health Organization has been teaching the
roles that patient environmental conditions and sanitary
improvement have in preventing cross-contamination for
years. These are not new revelations by any stretch of the
imagination. Why did it take U.S. medical experts so long
to embrace and stress these two crucial topics? Why have
hospitals taken so long to acknowledge the indispensable
collaborative roles EVS and IP have in infection prevention?
Is the U.S. too dependent upon current scientific,
peer-reviewed studies of healthcare environments to justify
the expenditure of funds to EVS? Are new costly studies
to support the findings of John Snow, “The Father of
Epidemiology,” Ignaz Semmelweiss, “The Father of Infection
Control,” and Joseph Kister, “Pioneer of Antiseptic Surgery”
really necessary for corroboration of their findings? These
pioneers, along with Florence Nightingale, laid the basic,
fundamental, and underlying principles that assisted in
saving millions of lives around the world.
Of course, as new pathogens emerge and humankind
faces more multidrug-resistant organisms (MDROs), studies
are required, but the basic, fundamental principles of cleaning
and disinfection are stable and do not change. Thankfully,
inventors, researchers, and entrepreneurs are continually
working to improve the tools and methods to combat
MDROs, but the principles do not change. Pathogens must
still be killed or trapped, captured, and removed from the
patient care environment.
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