Healthcare Hygiene magazine September 2020 September 2020 | Page 29

When questions remain about what will be done by EVS as part
of the multidisciplinary team (MDT) or how to fulfill swim lanes or
the responsibility matrix, unrealized expectations, disappointment,
and frequent anger arises. Stressed partners on an MDT often
pressure the technicians to turn the rooms faster for them, which
causes a demoralizing effect, a sense of not being understood or
appreciated. There are times when an OR theater may have just
been used for a joint replacement or a very messy trauma case.
There needs to be time allowed for proper processing of these
surfaces, often involving significant scrubbing. Turning over a
room also requires sufficient disinfectant dwell-time for bacteria
and potential pathogens to be destroyed. Disinfectants need a
clean surface to be effective, and there is no short-cut. EVS cannot
make time go faster. To ask EVS to reduce dwell time to speed up
a process can be equated to asking a surgeon to close an incision
with three stitches rather than the requisite 10 stitches; it is not
appropriate or safe to do so; the patient will suffer.
All of this equates to a successful recipe, one in which each
ingredient or step is essential. The human element
of the formula is just as necessary to ensure the
message of quality, cost and outcome (CQO) must
always factor into decisions made and actions taken
for the best possible patient outcome. Communicating
this importance of each member’s role and mutual
respect for the individuals and their responsibilities
on the MDT is vital.
Every year, the Association for the Healthcare Environment
(AHE) conducts a trends and data survey to
keep a finger on the industry’s metaphorical pulse. And
each year, most facilities included in this survey allocate
between 30 and 44 minutes for discharge cleaning of
rooms, with the minority allotting 60 minutes. The
timeframes reflect the individuality of each hospital
and the size of their “football fields.” Occupied rooms
are more likely to be given about half that time for
cleaning, but this is not a hard and fast rule. There are
multiple factors each facility and MDT must consider.
Slightly less than 50 percent of the respondents say
they do not disinfect floors for occupied or terminal
(discharge) cleaning of patient rooms.
Almost all sites allocate 30 minutes or more for
the end of the day or terminal cleaning of each OR.
Between cases, the OR is more likely to be given 10 to 20
minutes. These time limits should give a pause for reflection,
especially if remembering the football field analogy. EVS must
receive information regarding the type of surgery conducted
and the potential bioburden level in each OR, mainly if it was a
messy procedure or a patient on isolation required surgery. This
essential information can only come from OR MDT members
when handing ORs over to EVS for processing.
Now more than ever, awareness of the opportunities to
deliver industry best practices for OR between-case cleaning
such as zone cleaning and implementing the training, along
with a substantial responsibility matrix. Organizations like
AHE offer a Train-the-Trainer program for the perioperative
areas called CSCT – Certified Surgical Cleaning Technician
to help in this endeavor, for the rest of EVS CHEST – Certified
Healthcare Environmental Services Technician. Programs
like these offer rock-solid advice and ensure everyone is in
harmony, efficient and effective in conducting their duties.
View OR
Zone
Cleaning
View OR
Zone
Checklist
View Zone
Cleaning
Checklist
Between
Cases
Other things to factor in are computer workstations on
wheels, respiratory and anesthesiology equipment, and others
processed (cleaned and disinfected) by those who typically use
them. Those users have the training, tools, and proper resources
to follow manufacturers’ instructions for use (IFU). When a MDT
ensures the equipment in the room is cleaned by the designated
professional, this ensures that the place is ready as soon as possible.
However, if any one of these vital components is disrupted,
missed, completed out of order, or late, it may fall to EVS to
pick up the slack. The disruption causes an already strapped
and burdened EVS department to get the job done with limited
resources and often limited success. We must distinguish between
room turnaround time (wheels out to wheels in), a phrase that
typically means the time a patient leaves the space, and another
arrives. This time frame incorporates all activities and disciplines
involved in cleaning and disinfecting the environment, which
encompasses the physical surfaces and the assets or equipment
in the room. This is not to be confused with room turnover time
(when EVS receives the call and begins processing the space to
the time the room is completed by EVS, which may or may not
include bed make-up).
Variables that may impact standard benchmark times:
● Room type and size
● Age of the facility
● Facility design
● Weather and other elements
● Activity in the room
● Clutter
Seeking Volunteers!
Join a growing group of individuals leading
the charge in addressing HAIs
• Help create educational resources
• Identify educational programs
• Work with other professionals in creating,
planning, and implementing
• 2-3 hours/month
• Reduced membership fee
healthcaresurfacesinstitute.org/volunteer
www.healthcarehygienemagazine.com • september 2020
29