long-term care infection prevention
long-term care infection prevention
By Buffy Lloyd-Krejci , DrPH , MS , CIC , LTC-CIP
Boost Your Facility ’ s Infection Prevention and Control Program by Implementing These Best Practices
Environmental services ( EVS ) professionals in long-term care facilities are a crucial ( and often overlooked ) part of infection prevention and control ( IP & C ). Indeed , their role in IP & C is as important as that of a facility ’ s nurses — and if a facility has a bacterial or viral outbreak , they may even take precedence over nursing and clinical staff in helping to slow and / or stop its spread .
As I discussed in the May 2023 issue of Healthcare Hygiene magazine , 1 the number of multidrug-resistant organisms ( MDROs ) is growing rapidly . As a result , if a facility ’ s EVS professionals aren ’ t following recommended best practices for environmental cleaning procedures , 2 they can spread these and other dangerous pathogens throughout the facility , inadvertently causing serious complications — or worse — among residents . However , as sobering as this reality is , there is a solution : attract and retain dedicated , effective EVS professionals by paying them a living wage , offering them benefits , and educating them about the critical role they play in keeping your facility ’ s residents safe .
To determine what education your EVS staff needs , your facility ’ s EVS supervisor should first evaluate whether they are adhering to the environmental cleaning best practices outlined by the Centers for Disease Control and Prevention ( CDC ). 3 This is important even if you contract EVS services through a third party , as third-party agencies don ’ t always provide adequate training in best practices .
The EVS supervisor can start the evaluation by asking each EVS staff member to describe the process they follow when cleaning rooms . They should also watch each staff member clean a room , as that can reveal valuable information about potential problems . To give you an example of a common issue my staff and I see , consider that many EVS professionals report always using a fresh towel to clean residents ’ tray tables . However , we frequently observe them using that same towel to clean the tray table ’ s legs ; in the process , the towel often touches the ground — and then is used to clean another place , such as bed rails . Unfortunately , this scenario can lead to cross-contamination , so it must be guarded against .
During the observation period , the EVS supervisor can also review the order in which the staff member cleans each part of the resident ’ s living quarters . Best practice dictates that they start with the cleanest areas ( e . g ., resident rooms ) before moving on to dirtier areas ( e . g ., bathrooms ).
It ’ s also essential for the supervisor to observe when the staff member changes their gloves . This is especially important because many EVS professionals are trained to change their gloves only when they ’ re done cleaning an entire room . To see why this practice is such a problem , imagine this all-too-common scenario : the staff member has just cleaned the restroom , and now they need to clean the floors . So , they grab the mop and / or broom with the same gloves they wore when cleaning the toilet . Imagine someone else holding that mop a few hours later to clean up a spill . If they fail to wear gloves , they may
come into contact with whatever organisms the original EVS professional left behind . You can see how this can quickly spread pathogens throughout the facility .
Once the supervisor has made their observations , they must educate the EVS professional about any shortcomings and get buy-in on implementing best practices . Providing visual examples can be very helpful during this step . For example , my staff and I like to use bright pink or yellow washable paint ; we put it on our gloves , and as we touch various surfaces , the paint left behind clearly shows how easily bacteria and viruses can be transmitted from one place to another . Using this or a similar approach in your facility can help hardwire the importance of following best practices in your EVS staff .
Along with observation and education , your EVS supervisor should also monitor what cleaning products are being used ( this holds whether your facility contracts EVS professionals through an agency or employs them directly ). The CDC offers broad guidance about appropriate cleaning products ; 4 if you are dealing with a specific pathogen , you can refer to the EPA ’ s guidance to find a list of specific cleaners approved to kill that organism . For example , cleaners on the EPA ’ s List N can kill all strains and variants of the coronavirus SARS-CoV-2 ( COVID-19 ) when used according to manufacturer directions . 5
In addition to the best practices described in this article , I recommend EVS supervisors go through the Association for the Health Care Environment ( AHE ) certification training programs 6 and then educate staff and your facility ’ s infection preventionist ( IP ) about the strategies and best practices they learn .
Your facility ’ s EVS professionals are critically important in keeping your environment safe and free from harm , so make it a priority to support them in doing a great job . In other words , help them understand best practices and talk with them about the consequences that can occur if they don ’ t follow them . Remind them , too , that these best practices 7 aren ’ t just about keeping the residents safe — by adhering to them , they also mitigate any risk of introducing dangerous pathogens into their own homes .
Buffy Lloyd-Krejci , DrPH , CIC , LTC-CIP , is a leading authority on infection prevention in the long-term care industry . Her firm , IPCWell , delivers in-person gap analysis , training , and support to nursing homes across the country .
References :
1 . Staying on Top of the Latest Enhanced Barrier Precautions Recommendations for Long-term Care Facilities 2 . Environmental Cleaning Procedures 3 . Best Practices for Environmental Cleaning in Healthcare Facilities : in
Resource-Limited Settings 4 . Best Practices for Environmental Cleaning in Healthcare Facilities : in
Resource-Limited Settings 5 . About List N : Disinfectants for Coronavirus ( COVID-19 ) 6 . Association for the Health Care Environment ( AHE ) 7 . Environmental Cleaning Procedures
september 2024 • www . healthcarehygienemagazine . com •
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