One of the most pertinent observations from the 2023 paper is that both the bundle as well as the training and the educational approach used “ should be tailored to meet local needs and reflect the context of the respective healthcare setting , including current cleaning approaches ( and products ), as well as the cleaning schedules .” the context of environmental cleaning , core education should include content on cleaning roles and responsibilities and the effect of environmental cleaning on reducing healthcare-associated infections . Training should include the cleaning technique and sequence , correct product use and adherence to manufacturers ’ instructions as described above .”
➍ Audit and feedback
As the researchers explain , “ The use of audit and feedback to drive and sustain improvements in infection control practices , including cleaning , has been well documented in many studies . In the context of environmental cleaning , the use of fluorescent technology to identify the thoroughness of cleaning and provide feedback to environmental services staff is common and is shown to be effective at improving cleaning , as well as reducing HAIs .”
➎ Communication
As the researchers explain , “ Communication is a critical component of commencing and sustaining facility wide infection control initiatives . Environmental services staff are often an ‘ invisible workforce ’ that are the lowest paid for the service they provide and the importance of their role in the wider context of patient safety . Communication strategies are key to engage staff , support an organizational culture shift and raise the profile of cleaning and environmental services staff . Strategies to achieve this include recognition and reward schemes , facilitating daily contact between cleaning staff and clinical staff , as well as reports to appropriate governance committees , leaders and managers .”
One of the most pertinent observations from the 2023 paper is that both the bundle as well as the training and the educational approach used “ should be tailored to meet local needs and reflect the context of the respective healthcare setting , including current cleaning approaches ( and products ), as well as the cleaning schedules . Understanding baseline levels of knowledge and attitude of environmental services staff also allows for the tailoring of training and may be useful in monitoring future changes .”
Mitchell says he and his co-author kept several factors in mind when they made this key point in their paper . As they state , “ It is essential that these initiatives are subject to a risk-based assessment … In different healthcare facilities , there is considerable variation in products used , frequency of cleaning , baseline and ongoing training received , staffing models for environmental services staff , ability and readiness to accept change and organizational culture across healthcare facilities . Understanding these and using an implementation framework to guide changes in cleaning practices may be useful .”
“ At a local level , things can be very different between healthcare institutions and organizations , and even within departments ,” Mitchell emphasizes . “ An example would be the epidemiology of certain pathogens that you ’ re facing within your healthcare organization , which will vary . There will be some organizations that may have problems with particular pathogens and others that don ’ t . Selecting your approach depends on that risk assessment and your local epidemiology around pathogens of concern . You must pay attention to the products you use , as there ’ s no point using a product that ’ s not going to be effective against pathogens that you ’ re specifically targeting . If you ’ re in an outbreak setting , your approach and the products that you use may also be different . There are also workforce challenges that differ across hospitals , such as with contract cleaners versus cleaners who are part of the paid staff within the organization . If it ’ s contract cleaners that you are using , you need to think about how to approach cleaning and disinfection practices that are relevant to the workforce and the service-delivery contract . The education background and literacy levels of cleaning staff would be another factor , so , you would need to ensure appropriate communication around cleaning practices . A multi-faceted program must be flexible enough to be modified according to local needs . I also think that approach produces better outcomes to meet the organization ’ s needs .”
Another imperative addressed in the paper by Browne and Mitchell ( 2023 ) are the costs of any infection prevention and control initiative . Evidence from the REACH trial demonstrated that implementing a cleaning bundle does generate some additional costs , but also results in cost savings . As the researchers reported , there was an 86 percent chance that implementing the cleaning bundle was cost effective , compared with existing hospital cleaning practices , and this resulted in an incremental cost-effectiveness ratio of $ 4,684 per quality adjust life year gained . For hospitals , a reduction in HAI rates also reduces patient bed days and antibiotic use .
“ I think cleaning technicians are probably always the first ones to feel the pinch when it comes to hospitals trying to save money ,” Mitchell says . “ I think it ’ s a bit of a false dichotomy , because as a profession , they ’ re not paid very well , and that needs to be addressed . Further budget cuts to their department create poor outcomes . It ’ s important to consider the overall cost-effectiveness of cleaning practices as well as infection control-related interventions in general and the impact they can have on HAI rates that justifies them .”
References :
Browne K and Mitchell BG . Multi-modal environmental cleaning strategies to prevent healthcare-associated infections . Antimicrobial Resistance & Infection Control . 12:83 ( 2023 ). https :// doi . org / 10.1186 / s13756-023-01274-4
Mitchell BG , Hall L , White N , Barnett AG , Halton K , Paterson DL , et al . An environmental cleaning bundle and healthcare-associated infections in hospitals ( REACH ): a multi-center , randomized trial . Lancet Infect Dis . 2019 ; 19 ( 4 ): 410-8 . www . healthcarehygienemagazine . com • october 2023
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