Up until about eight years ago , we didn ’ t have a lot of evidence that the healthcare environment can actually have a real impact on HAIs and patient safety . A decade or so ago a systematic review didn ’ t find sufficient evidence and didn ’ t provide much prescriptive recommendations for environmental hygiene either .” constructive feedback ; other institutions either usually gave punitive or no feedback . Twenty-three percent of healthcare facilities always had EVS staff managers on-site , and 49 percent were on-site less than once per week or not at all .
As Peters , et al . ( 2022 ) report , “ There were indicators of major issues with management and quality control as half of EVS staff managers were reported as being on-site either less than once per week or not at all . Sometimes , EVS staff and nursing staff did not speak the same language and therefore could not communicate adequately , which would directly impact the facility ’ s institutional safety climate . Most healthcare facilities surveyed did not provide EVS staff access to certification programs , although these could foster career development , recognition and reduce turnover .”
The lack of proper protocol and supervision is being attributed to an overall deficit in global recommendations and standards . In the U . S ., there are a number of EVS-directed guidelines and recommendations , so it ’ s easy to forget this is not true in much of the world . Peters reminds us that until recently , there was a dearth of studies indicating the importance of environmental hygiene in the fight against healthcare-acquired infections ( HAIs ).
“ Up until about eight years ago , we didn ’ t have a lot of evidence that the healthcare environment can actually have a real impact on HAIs and patient safety ,” she says . “ A decade or so ago a systematic review didn ’ t find sufficient evidence and didn ’ t provide much prescriptive recommendations for environmental hygiene either . So , this is all a little bit like the Wild West for many countries , still . Obviously , it makes sense to keep high-touch surfaces clean . It also makes sense for patients to have clean facilities , but people didn ’ t really know how important it was , scientifically speaking . Some countries have decided that environmental hygiene wasn ’ t important at all , and then other countries were disinfecting non-critical surfaces . Healthcare facilities have been operating according to the way that they thought it made sense , but now that we are starting to get some real evidence , that may change . There are some recommendations , but again , everyone is still performing environmental hygiene the way that they want , with no real international guidelines .”
Peters says critical information is still lacking regarding evidence pertaining to different interventions that can be performed in the healthcare environment . “ My guess is that we never will because it ’ s so challenging to set up these expensive randomized controlled trials , as well as actually fund these interventions in the healthcare environment as a driver for lowering colonization risk or fighting HAIs .”
Peters points to the success of bundled or multimodal strategies which are increasingly accepted as essential for optimizing successful implementation of HEH strategies . “ In these bundles you have hand hygiene , you have all the other IP & C interventions that you know are based on evidence . So , I think we see the biggest impact when we do bundled interventions . I think this is common sense to a certain extent , acknowledging to ourselves that , OK , we ’ re bundling training and it ’ s increasing compliance , so we ’ re guessing that ’ s part of the reason why our intervention is working , for example .”
Some healthcare facilities use ATP in their programs to check bioburden levels , but an all-consuming focus on using this tool , as an example , could also present problems .
“ ATP is going to measure colony-forming units ( CFUs ) to indicate protein residue on surfaces , but it ’ s really only a proxy ,” Peters says . “ I think what needs to happen is the focus placed on cleaning and disinfection processes . In some facilities , the level of cleaning is so bad that I don ’ t know if we need to get bogged down in how clean that cleaning can get , when it ’ s not even happening in a lot of places . I ’ ve been in hospitals where a mop and bucket with some bleach water was the only cleaning tools used . I ’ ve seen EVS personnel using two sponges , with one being used for things like toilets and the other sponge used on other areas . They took these two sponges to all patient rooms and the dirty-task sponge was sitting on top of the ‘ clean ’ sponge and dripping water down onto it . So , when we see things like that happening in real life , I think what ’ s most important is to go back to basics and to realize that you can do a lot with very little if you have a good process and you have a good detergent and you have a good disinfectant and you know what you ’ re doing -- you can already do quite a bit , at least in the normal-care areas .”
Peters says she believes elevating the overall profession of healthcare environmental services is key to improving practices . “ We need to let these workers know that they ’ re not housekeepers , and they ’ re not cleaners , they are respected professionals who have a critical role within the hospital , and they need to be trained as such and treated as such . It ’ s not just the kind of a job you get because there weren ’ t any openings at a fast-food restaurant . So , I think that ’ s probably the first thing that one should focus on , and then greater efforts driven at achieving standardization is good . But it ’ s always challenging to get guidelines and standards developed , and then when the technology advances , half the time you can ’ t use it if it ’ s not in the guidance . Therefore , in many cases you have people throwing technology at a problem and missing the big picture because they may be using an automated disinfection robot , but they are not performing mechanical cleaning before use of the robot . Instead of an additional step after cleaning that would have been useful , you ’ re actually reducing the quality and effectiveness of your cleaning because you ’ re skipping the critical step of the physical removal