Is there a relationship between the increase in the size
of hospitals and the number of HAIs? Why has EVS become
an afterthought in the fight against HAIs and the saving
of patient lives (excluding the recent spotlight resulting
from COVID-19)? Why do healthcare administrators look
to reduce full-time equivalents (FTE) rather than reducing
overall payroll?
In the military, it is the non-field grade officers, non-com-
missioned officers, enlisted personnel who are out on the
battlefield, and it is those members whose numbers increase
when a surge is needed to attain the victory. You don’t
find a lot of generals on the battlefield engaging in the
actual combat, and you don’t see many C-suite executives
disinfecting and cleaning patient rooms.
Yet, it is the lowest-paid rank and file hospital staff
that are the first to go when a reduction-in-force occurs.
Isn’t there some sort of disconnect in logic there? These
questions ought to provoke questions that deserve answers
from policymakers, healthcare administrators, and public
and private payers.
In an October 2009 presentation titled “Why Environmental
Services Saves Lives,” Dick Zoutman, MD, FRCPC, cited
numerous definitive clinical studies that conclude that proper
and effective environmental cleaning reduces the number of
germs present. Again, the question is asked: “Why is this truth
taking so long to be recognized in U.S. healthcare venues?”
In 2009, Dr. Stephanie Dancer, et al. in the study titled
“Measuring the Effect of Enhanced Cleaning in a UK Hospital:
A Prospective Cross-over Study,” clearly demonstrated a
direct correlation between the number of EVS staff assigned
to patient care areas and the time spent tending to their
duties. There are hundreds of other studies that identify
the importance of maintaining an uncontaminated patient
environment. Yet, they appear to fall on blind eyes and deaf
ears. At the same time, HAIs continue to cost healthcare
systems (and ultimately governments and patients) billions
of dollars each year, more than 100,000 patients contract
HAIs each year, hundreds of patients die, families and lives
are devastated. The numbers do not tell the whole story.
Add to the statistics:
• lost productivity
• lost income
• lost taxes
• family members having to temporarily quit their jobs
to care for loved ones at home
Those statistics do not include the 40 percent of the
population that will become impoverished caring for their
loved ones because they both cannot leave their loved one
and cannot find a job after the death of their loved one.
Please, research this topic on the internet. We are looking
at disaster on a national scale.
In 2013, Marchetti et al., in the Journal of Medical
Economics original research titled “Economic Burden of
Healthcare-Associated Infection in U.S. Acute Care Hospitals
– Societal Perspective,” concluded that “HAIs in U.S. acute-
care hospitals lead to direct and indirect costs totaling $96
billion to $147 billion annually.” Keep in mind that this
study was in 2013, well before the COVID-19 pandemic and
the financial devastation it caused and continues to create.
32
(https://www.researchgate.net/publication/256499741_
Economic_Burden_of_Healthcare-Associated_Infection_in_
US_Acute_Care_Hospitals_-_Societal_Perspective)
If we are to look even further into the immediate and
long-term effects of HAIs on patients, we would see the
psychological effects. Hopelessness, helplessness, loss of
self-esteem, loss of self-worth, loss of identity, despair, dread,
and decline in pursuing one’s purpose of living. All of these
have a detrimental effect on a body’s ability to heal. And
the financial costs continue to spiral upward.
What about the all-important Right of Informed
Consent? Informed consent is the process by which a fully
informed patient can participate in choices about his or her
healthcare. Informed consent is the legal and ethical rights
the patient must direct what happens to and in their body
and from the moral duty of the physician to involve the
patient in their healthcare decisions. Would an informed
patient choose to enter into — much less stay — in a room
that not adequately cleaned and decontaminated and risk
contracting an HAI? Would a patient willingly risk exposure
to an HAI by occupying a place that the staff was allowed
only 12 minutes to clean and decontaminate if they knew
that the 10-minute dwell time of the typical hospital-grade
disinfectant “dwelled” for only two to three minutes? Yet,
that is the reality in many healthcare facilities.
On Sept. 24, 2009, the Association for the Healthcare
Environment – then knows as ASHES – “reaffirmed previously
published Practice Guidance for the minimal time for proper
cleaning and surface disinfection of patient rooms. The
reaffirmation is due to wide variations in cleaning practices.
Over the last several years, the emergence of new microor-
ganisms and the process for removing them from surfaces
has required more time and attention, particularly to high
touch surfaces.” In their Practice Guidance for Healthcare
Environmental Cleaning, the AHE states that an occupied
patient room cleaning will take approximately 25-30 minutes
per room. The terminal cleaning of a discharged-patient
room will take about 40-45 minutes per room.
It takes a collaborative effort by all healthcare disciplines
to overcome the challenges that HAIs and MDROs present
to healthcare organizations and communities. Healthcare
facilities must understand that a clean environment (not
just an attractive and pretty one) is of utmost importance
if patient outcomes are to result. They must also reinvest in
their Environmental Services departments.
Going back to a reference previously made: “On the
contrary, those parts of the body that seem to be weaker
are indispensable, and the parts that we think are less
honorable we treat with special honor.” Something of
great importance may depend on apparently trivial detail.
Environmental Services is neither mundane nor glamorous,
but it is of great importance. Isn’t it time healthcare systems
started paying more time, attention, and money to something
of great importance?
“And all for the want of a horse-shoe nail.”
John Scherberger, FAHE, is the owner of Healthcare Risk
Mitigation in Spartanburg, S.C. He is a subject matter expert
in healthcare environmental services, healthcare linen and
laundry operations, and infection prevention.
may 2020 • www.healthcarehygienemagazine.com