The take-home message from the HEH survey for hospital leadership and EVS managers is that critical issues related to budgeting , resourcing , education and training would be addressed as a means of elevating the profession and ensuring better outcomes . “
of soil and bioburden on surfaces . So , It ’ s complex and there is no one-size-fits-all solution . What ’ s most important is that hospitals start realizing that a lack of environmental hygiene is a problem , and that infection prevention and control efforts have a return on investment for each dollar spent . For quite a low investment you can address many infections , but some hospitals are not making those calculations . Environmental hygiene can often pay for itself when it is perceived as a risk-mitigation strategy .”
The importance of effective environmental hygiene practices comes into focus particularly when considering the criticality of bioburden removal . In another recent paper , Peters and her co-authors ( Peters , Schmid , et al ., 2022 ) reviewed the evidence-base for the ability of interventions in the hospital environment to reduce patient colonization with multidrug-resistant microorganisms ( MDROs ) and other epidemiologically relevant pathogens , and to prevent HAIs . The researchers categorized the interventions by mechanical , chemical , human factors , or bundles , and the effect of HEH interventions on environmental bioburden was studied as a secondary outcome . Most studies ( 81 percent ) analyzed either S . aureus , C . difficile , and / or vancomycin-resistant enterococci . Most studies ( 88 percent ) reported a decrease of MDRO-colonization or HAI for at least one of the tested organisms , while 58 percent reported a significant decrease of MDRO-colonization or HAI for all tested microorganisms .
As the researchers observe , “ Most of the studies that did not show a statistically significant reduction in HAIs or patient colonization nonetheless recommended their interventions for application because they did greatly reduce environmental bioburden .”
“ I think the reduction of HAIs will pretty much always correlate with the reduction in bioburden , but not necessarily the other way around ,” Peters remarks . “ You can reduce bioburden in places like the cafeteria floor . You ’ ve reduced bioburden in your hospital , but that probably wasn ’ t where people were getting their HAIs . On the other hand , if you have interventions that have been proven to be effective , my guess is that if you implement those interventions and you see a reduction in bioburden , they ’ re working . I think bioburden is a nice proxy that ’ s very easy and cheap to measure , and I think it is always better to provide immediate constructive feedback ; that ’ s what I like about using ATP , in that you get a sense of the effectiveness of the cleaning process and can correct what is not being done properly , which is more important than merely saying , ‘ Oh look , you missed this spot .’”
The authors of the survey acknowledge that the sample size is small , but Peters confirms that their findings can be extrapolated to indicate a more pervasive issue globally .
“ This is absolutely the tip of the iceberg ,” Peters says . “ Additionally , the results were probably better than they would be in real life because respondents were people who were interested enough to respond to the survey , plus , the survey was sent to the World Health Organization database of hospitals that had already participated in a previous survey on hand hygiene , so those hospitals that answered were already predisposed to be concerned about environmental hygiene and infection prevention in some way . The survey findings , in some cases , were dismal , and we know it ’ s likely that in real life , it ’ s even worse . So , there is a great deal of room for improvement .”
Peters says they are finishing the next phase of the Healthcare Environmental Hygiene Self-Assessment Framework which will be offered widely as an online assessment tool in 2023 . Currently , the researchers are conducting in-depth testing of this tool with about 10 healthcare facilities that will provide them with feedback so that the tool can be refined further before release early next year .
“ Through some of our public-private partnerships , some industry partners are taking this tool to the healthcare clients that they know really well , sitting down and saying , ‘ Let ’ s look at this tool together in your healthcare facilities and thoroughly vet it .’ Once that ’ s done and we finish the little tweaks that need to be Implemented , then the next step is to make the tool available in English and eventually have it translated into different languages , much like the WHO ’ s hand hygiene self-assessment framework . Hopefully by next March tentatively , we ’ ll have at the very least an English version of the tool that ’ s ready for public use . Then the goal is to be able to allow healthcare facilities to see how they measure up , and hopefully have an on-site manager who can provide constructive feedback about HEH performance to environmental services staff . It is our hope that the tool can provide healthcare facilities with a map of where and how they can improve , benchmarking against themselves and others .”
The take-home message from the HEH survey for hospital leadership and EVS managers is that critical issues related to budgeting , resourcing , education and training would be addressed as a means of elevating the profession and ensuring better outcomes .
“ In an ideal world , that ’ s exactly what would happen ,” says Peters . “ Quality improvement must come from hospital leadership ’ s commitment to providing for their HEH programs . Doing so would allow them to attain and keep proficient environmental hygiene managers and personnel and have the funds to potentially restructure the HEH program in a way that provides potential cost savings and maybe even better results microbiologically , to support infection prevention so that everybody wins . That requires quite a bit of support , but more healthcare institutions are realizing that they can ’ t address this significant problem of poor practices if they don ’ t provide HEH programs with the resources they need .”
“ These findings provide the global IP & C community with a baseline for HEH assessment , and should encourage focus , improvement , and investment in HEH globally to reduce healthcare-associated infections and their implications ,” says 2022 APIC president Linda Dickey , RN , MPH , CIC , FAPIC . “ The final HEHSAF will be an invaluable tool to support this effort .”
Reference : Peters A , Schmid MN , de Kraker MEA , Parneix P and Pittet D . Results of an international pilot survey on health care environmental hygiene at the facility level . Am J Infect Control . May 25 , 2022 . DOI : https :// doi . org / 10.1016 / j . ajic . 2022.02.029