When EVS cannot clean a surface , it should be excluded from use with barriers or completely removed .” It also advises , “ Ensure cleaning staff receives training on the proper use of cleaning and disinfecting products .”
The principles of cleaning and disinfecting environmental services must consider the intended use of the surface or item used in caring for a patient . The physical action of scrubbing with detergents and surfactants ( wetting agents found in cleaning chemicals and some disinfecting chemicals ) and rinsing with water removes large numbers of microorganisms from surfaces . If a surface is overlooked or not cleaned before the terminal or final processing procedures are started , the success of the disinfection process is highly doubtful , if not completely negated . It ’ s not enough to scrub a surface to loosen bioburden ; the process must include tools that can trap , capture , and remove the bioburden residue from the intended surface . In partnership with the physical efforts — or elbow grease — needed to loosen and detach bioburden from a surface , healthcare grade ultra-microfiber ( HGUM ©) traps , captures , and removes the loosened bioburden from the surface . The CDC retains the Spaulding Classification for patient-care items and equipment . It outlines three
To View CDC categories based on the potential for the instrument Cleaning & to transmit infection if the device is microbiologically Disinfecting contaminated before use . These categories are “ critical ,”
Environmental
Surfaces “ semi-critical ,” and “ noncritical .” In 1991 , the CDC proposed an additional class designated “ environmental
surfaces ” to Spaulding ’ s original classification to represent surfaces that generally do not directly contact patients during care . The CDC found that environmental surfaces carried the least risk of disease transmission and decontamination using less rigorous methods than those used on medical instruments and devices was appropriate Environmental surfaces were further divided into medical equipment surfaces ( e . g ., knobs or handles on hemodialysis machines , X-ray machines , instrument carts , and dental units ) and housekeeping surfaces ( e . g ., floors , walls , and tabletops ).
The following factors influence the choice of disinfection procedure for environmental surfaces :
● the nature of the item subjected to disinfection
● the number of microorganisms expected to be present based upon the location , condition , and previous use of the environmental surface
● the innate resistance of those microorganisms to the inactivating effects of the germicide
● the amount of organic soil present
● the type and concentration of germicide used
● duration and temperature of germicide contact
● if using a proprietary product , other specific indications and directions for use
Spaulding ’ s Classification is so clear and logical that it is successfully used by infection preventionists and other professionals , including EVS personnel , preparing patient-care areas . The EVS task is to render “ noncritical ” surfaces hygienically clean . Here ’ s a look at the Spaulding Classification :
Click to view the Spaulding Classification
Unfortunately , even healthcare workers , regardless of their primary discipline , must be reminded that the disinfection of surfaces cannot occur and is not effective until all potential contaminants are removed from the surfaces indicated to be disinfected .
Cleaning is a separate activity from disinfection . Cleaning must include scrubbing with the trapping , capturing , and removing of all potential contaminants . Surfaces must be free of contaminants before disinfection steps commence , or the disinfection solution may not be effective . If using a one-step cleaner and disinfectant , it is best to choose a substrate or textile that can trap , capture , and remove the bioburden / biofilm , including dry-surface biofilm , and deliver the disinfectant at the appropriate concentration for the required dwell or contact time as per the manufacturer ’ s master label .
Processing is the preferred all-inclusive term that includes cleaning with detergents and surfactants , using HGUM © infection prevention textiles to trap , capture and remove any surface contaminants , plus an approved EPA-registered disinfectant or an EPA-approved hospital-grade cleaner / disinfectant combination solution .
In considering CQO , one must factor in all the aforementioned factors , which are not an ounce-by-ounce comparison of a disinfectant cost , nor is it a unit rate per textile , but rather a combination of all elements , e . g ., efficacy in cleaning and disinfecting , delivery of the disinfectant , quantity or consumption of the product used to achieve an optimal outcome . It also includes staff labor , Lean strategies in reduced steps and efforts , impacts on the patient and healthcare worker safety ; the waste stream and environmental considerations , and of course , patient throughput or progression ; the time it takes to appropriately process a particular area or space , including all fixed and mobile medical equipment , as well as a clear responsibility matrix , as to who cleans , what , when and how .
Implementation science consists of “ Interventions and evidence-based practices that are poorly implemented – or not implemented at all – do not produce expected health benefits . Even when effectively implemented , interventions and practice changes still might not produce expected health benefits if effectiveness is lost during implementation , or if the intervention or practice was never effective in the first place .”
Implementation science is the scientific study of methods and strategies that facilitate the uptake of evidence-based practice and research into regular use by practitioners and policymakers .
Implementation science seeks to systematically close the gap between what we know and what we do ( often referred to as the know-do gap ) by identifying and addressing the barriers that slow or halt the uptake of proven health interventions and evidence-based practices .
How do we get “ what works ” to the people who need it , with greater speed , fidelity , efficiency , quality , and relevant coverage ? Just as infection preventionists have embraced implementation science in their practices , EVS professionals must enthusiastically embrace implementation science to produce science-based and value-based cost , quality and outcomes . EVS professionals must embrace , immerse themselves into , and incorporate implementation science into their departments ’ culture , or others will leave them in the dust of progress .