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seeking to replicate their performance
across all member of the EVS team.
Equally importantly, this galvanizing
study also continues to encourage
dialogue around room turnover times
and taking into consideration the
multiple factors impacting real-world
results on the local level. Although
this study may not be generalizable in
Our study
all healthcare institutions, Rupp, et al.
lends support
(2014) explain, “… three diverse areas
to and may
of the hospital, including critical care
and routine care units, were studied,
explain earlier
and it is likely that other institutions
studies that
have similar opportunities to improve ef-
have shown
fectiveness and efficiency of cleaning.”
that improved
The adequacy of the benchmark
cleaning
time of 25 to 30 minutes
cleaning
depends on numerous factors such as
performance
the presence of pathogens of concern,
can be achieved
suspected/confirmed colonization, insti-
tutional policy, and available resources.
without
“In general, I think around 30
substantial
minutes should be adequate in most
additional
situations,” Rupp says. “However, it
also depends on a variety of variables
cost. ”
– whether there is equipment in the
— Mark Rupp,
room that needs to be cleaned, or
MD
are EVS personnel assigned to clean
monitors and keyboards, etc. Also,
the degree of contamination needs to be considered. For
example, a room that housed a longer-term patient who
suffered from fecal incontinence due to C. difficile will
require greater care and a longer period of time to clean
than the room of a short-term patient that was relatively
healthy, not colonized or infected with a multidrug-resistant
organism (MDRO), and who was in the hospital for a short,
elective procedure. I doubt whether most EVS departments
have the sophistication to stratify cleaning needs in many
situations. Many departments probably stratify to some
degree based on the type of unit (for example, rooms in our
ICUs or transplant units require greater cleaning disinfection
procedures and time taken than a routine discharge from
the med/surg ward) and many departments give a bit of
extra time to clean an isolation room.”
The infection prevention community reacted to the
findings of Rupp, et al. (2013) with surprise and dismay,
as it seemingly gave a green light to continue with speedy
turnarounds, since the extra time investment wasn’t
paying dividends.
“That study, along with numerous others, pointed to
the shortcomings and challenges faced by healthcare,
primarily that the healthcare environment is the primary
source of contaminants that contribute to healthcare-related
infections and poor patient outcomes,” says Scherberger.
“This study, and many of the referenced studies virtually
burst the balloon of many healthcare professionals who
believed their ways of doing things were, without question,
‘best practices.’ With balloons burst, others were asking
how to move forward. Many organizations had to take a
14
step back from their established protocols and silo (sandbox)
mentality and reach out for help. To their great credit, AHE,
APIC and AORN stepped forward to provide vitally needed
education and training.”
Scherberger points to improved education and training
as a response to some of the resulting confusion.
“The AHE now offers formal training to hospital staff
that leads to Certified Environmental Services Technician
(CHEST) and Certified Surgical Cleaning Technician (CSCT)
designations,” he says. “The demand for certified training
opportunities has also seen the rise of certifications from
much of the allied healthcare industry. Many hospitals are
recognizing the importance of certification of their EVS staff
and recognize certificate holders with advancement and
financial reward recognition.”
Supporting better training is improved communication
and collaboration.
“EVS professionals and IPs are collaborating more
than they ever have, for EVS is tasked with maintaining
care environments that are free of environmental surface
contamination and that support safety, service, and efficient
and effective operations,” he says. “IPs have both a vision and
mission to fulfill; their vision is healthcare without infection,
and their mission is to create a safer world through the
prevention of infection. Both disciplines use and promote
tools such as checklists, fluorescent markers, adenosine
triphosphate (ATP) meters, and periodic culture swabbing of
environmental surfaces. They are collaborating on processes,
education, training, tools, and chemical selections.”
Scherberger points to an example to be found when the
San Francisco Bay Area (SFBA) Association for Professionals
in Infection Control and Epidemiology (APIC) begin a col-
laborative project in 2017 to work with their EVS peers at
two hospitals, the goal being allied healthcare professionals
examining what was necessary versus what was expedient
to performing their jobs.
“Out of this collaboration came the Environmental Services
Optimization Playbook (ESOP) project,” Scherberger explains.
“The ESOP project is an ongoing, non-commercial collabo-
rative effort that provides EVS departments excellent ideas
and insight into developing and maintaining a cutting-edge
department.”
Despite the ongoing debate around thoroughness of
cleaning correlation, it is hoped by many that ongoing research
could still provide EVS professionals with more time to clean
if it could still be proven that additional time, resources and
FTEs equate into improved hygiene, decreased infection rates,
and other measurable outcomes.
“Studies continue to focus on the healthcare environment
as a primary need to improve patient outcomes,” Scherberger
says. “Those findings and the continuing accumulation of per-
tinent data for the need to continually address the healthcare
environment have resulted in positive outcomes for patients.
Focus on the clinical aspects, not just the aesthetics, is now
recognized as an essential and vital need. EVS departments
are collecting data, establishing data-driven dashboards,
incorporating patient outcomes into departmental goals,
and measurable infection prevention protocols into their
profession. These steps have proven the need for additional
time, resources, FTEs, and education resources. Studies by
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