Healthcare Hygiene magazine November 2019 | Page 36

environmental hygiene
By J. Darrel Hicks, BA, MREH, CHESP
From Wheels Up, To Wheels Down
As
I sat buckled into my seat ready for takeoff, one
of the cockpit officers was making his usual
announcements, and then said, “It’ll be three hours and
five minutes from wheels up to wheels down in St. Louis.”
One can’t help but wonder, “How can he be so precise?
How does he know exactly how long it’ll take?”
In the business of cleaning and disinfecting the pa-
tient-care environment, the environmental services (EVS)
department is asked to perform processes that change a
“soiled” room into a “patient-ready” room.
Perhaps the soiled room was a trauma room in the
emergency department that just treated a victim of a car
accident. Or, the 500-square-foot surgical suite that was
used to do a quadruple bypass on person who suffered a
heart attack.
The process has different names depending on where
the soiled room is. Names such as “turnover,” “be-
tween-case-cleaning,” “terminal cleaning,” or “end-of-day
cleaning.” But the most important thing to know about the
“process” is, this is the best opportunity to break the chain
of infection from one patient to the next.
An EVS worker who is educated about infection preven-
tion, equipped with the right products and processes, and
given enough time for the task, will prevent more infections
than a room full of doctors can cure.
The process involves using a clean, micro-denier cloth and
the hospital-approved disinfectant to remove the bioburden
and disinfect the surfaces that are wiped. Do you know how
long the process will take?
The co-pilot seemed to know how long it would take
to travel from San Jose to St. Louis. To process a patient’s
room where the occupant with Clostridium difficile stayed
for 24 days, does it take 35, 45 or 55 minutes? Is the process
the same for an isolation room as the trauma room or the
operating room? Are these processes defined? Are they
the same in every hospital? Are there benchmarks for how
much time to allow for each situation?
Let’s assume for the moment that the national benchmark
states that the terminal process for the isolation room should
take 55 minutes. Is the national benchmark 55 minutes still
in play when the charge nurse says, “This room is a STAT!
Hurry up, the ER patient is on the way”? Would you put
your mother in a STAT room that was improperly processed
by an EVS technician who spent 30 minutes in the room.
When time is placed above patient safety in turnovers,
terminal cleanings, and between-case cleanings, the chain of
infection may remain unbroken. As leaders in environmental
services, risk management and infection prevention, we
need to speak with one voice for the safety of patients who
are undeserving of a healthcare-acquired infection (HAI).
To be sure, we should use the tools at our disposal
to ensure that we are working efficiently. Some of those
tools include:
• Checklists (there are some good ones available, but
some are so long they are unrealistic)
• Team cleaning (identify what needs to be processed,
use color coding so each team member knows what
their responsibility is)
• Observations by leaders (environmental services
or nursing)
• Competency assessments
• Measuring the effectiveness of people, products
and processes
By the way…the co-pilot was right. We landed three hours
and five minutes from wheels up to wheels down.
J. Darrel Hicks, BA, MREH, CHESP, is the owner/principal
of Darrel Hicks, LLC and the author of the book Infection
Prevention for Dummies.
Time Required to Clean Patient-Care Equipment
S
cott, et al. (2017) sought to evaluate the impact
of cleaning duration on nosocomial infection rates
and estimate the time required to clean patient-care
equipment in accordance with national specifications.
A systematic review of the published literature on
cleaning times and an observational study in which
nine healthcare workers cleaned seven items of care
equipment while the duration of time taken to clean
each item was measured.
A limited volume of low-quality evidence indicates
that increased cleaning times in hospitals can reduce
the incidence of healthcare-associated infections (HAIs).
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The mean ‘time to clean’ for care equipment ranged
from 166.3 seconds for a bed frame to 29.0 seconds
for a blood pressure cuff.
The authors note, “‘Time to clean’ estimates suggest
that the most frequently handled items on a hospital
ward offer potential sites for targeted cleaning that could
maximize reduction of pathogen transmission rates at
a relatively minimal expense of time.”
Reference:
Scott D, Kane H, Rankin A. Time to clean: A systematic review and
observational study on the time required to clean items of reusable
communal patient-care equipment. J Infect Prev. 2017 Nov;18(6):289-
294. Epub Jul 4, 2017.
november 2019 • www.healthcarehygienemagazine.com