Special Edition on Operating Room Imperatives Special Edition- Operating Room Imperatives | Page 8

Cleaning Turnover
Times: Efficiencies
Must be Balanced
With Effectiveness
By Kelly M. Pyrek
I
nvestigators have expressed concerns over a consistently
poor standard of cleaning and disinfection in some
hospitals, with significant shortcomings in the cleanliness of
patient-care areas as well as patient-care equipment. While
guidelines and recommendations emphasize that healthcare
institutions should give environmental services (EVS) personnel
adequate time to clean and disinfect properly, the reality is
that corners are cut under immense time pressures.
In 2009, the Association for the Healthcare Environment
(AHE) published recommended guidelines for environmental
cleaning in healthcare, suggesting that effective patient room
cleaning upon discharge should range from 40 to 45 minutes.
However, AHE cautions that room size, degree of isolation,
number of surfaces, and other factors can increase this time.
“To its credit, AHE has affirmed its Minimal Time Guidelines
for Patient Room Occupied and Terminal (Discharge or
Transfer) Cleaning and Disinfecting, published in 2009,” says
John Scherberger, principal of consulting firm Healthcare
Risk Mitigation. “They have even refined the guideline times
by releasing studies that address partial minutes. Many
hospitals and healthcare facilities have embraced the AHE
guidelines and stand prepared to defend the guidelines in
the face of opposition from surgeons, physicians, nurses, and
administrations bend on rushing room-processing times.”
What healthcare facility leadership must recognize is
the myriad factors impacting turnover times, including the
competency of EVS personnel, outbreak scenarios, suspected
or confirmed presence of pathogens of concern, availability
of the right tools for the job as well as the availability of
adequate numbers of staff members.
“Much has changed in the past 10 years,” Scherberger
says, “including emerging pathogens and the complexity of
animal-to-human and human-to-human complexities they
pose. Thus far, U.S. healthcare has stayed ahead of the curve
the pathogens pose. And, yes, challenges to keeping the
cleaning times realistic are constant. However, the recognition
of constraints faced by environmental services departments to
ensure that maintaining a hygienic healthcare environment is
slowly recognized and accepted by healthcare professionals,
particularly infection preventionists (IPs). They are partnering
with EVS to advocate for more time to ensure patient rooms
and other patient treatment areas are hygienic. With the
collaboration of IPs, perioperative nurses, and EVS, there is
a recognition that time is one constant constraint that no
discipline can reduce, while still providing patients with the
most hygienic atmosphere for recovery and improvement.”
Scherberger continues, “The push for a quick turnover of
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patient rooms is usually, but not always, for the convenience
of incoming patients, usually post-operative patients or
post-emergency room patients. Prolonging time in a post-op-
erative location is better, dare one say ‘safer,’ than putting
a patient in a room that has not been rendered hygienic.
Communication between post-op and unit secretaries is
essential to alleviate much of the ‘stat clean’ requirements
foisted upon EVS technicians. Indeed, emergent situations
occur, such as a patient ‘crashing,’ thus instigating the need
for ‘stat cleaning,’ but that is not the typical reason. However,
in emergency or ‘stat’ situations, sufficient time must be
allowed for processes and dwell times to be followed.”
He acknowledges the ever-present fiscal imperatives.
“Unfortunately, many EVS departments, including contract
departments, look to reduce turnover times to reduce payroll
costs, and patient admissions or transfers have nothing to
do with the reduced time allocation,” Scherberger says.
“This position is often detrimental to patient outcomes
and hobbles the effectiveness of technicians in their job of
providing hygienic patient rooms.”
An investment must be made in environmental services
departments as a frontline defense against HAIs. Peters, et
al. (2018) confirms the existing struggle: “Although the
available literature is limited, there is now enough evidence
to demonstrate that maintaining the hygiene of the hospital
environment helps prevent infections. Still, good interventional
studies are rare, the quality of products and methods available
is heterogeneous, and environmental hygiene personnel is
often relatively untrained, unmotivated, under-paid, and
under-appreciated by other actors in the hospital. Coupled
with understaffed environmental hygiene service departments,
this creates lasting issues regarding patient and healthcare
worker safety … Ultimately, what is needed is a reevaluation
of how hospitals view environmental hygiene: not just as an
area from which to cut costs, but one that can add value.
Hospitals and key stakeholders must work together to change
how we maintain the hospital environment in order to better
protect patients.”
Regarding the cost of environmental hygiene versus the
value of hospital cleaning and disinfection, Peters, et al. (2018)
observe, “It is imperative to develop a new and efficient model
for hospital environmental hygiene maintenance. The return
on investment for successful hand hygiene promotion has
been shown to up to 23 times the initial amount invested.
In order to have similar figures for hospital environmental
hygiene, we need to first understand what the cost of
maintaining a clean hospital environment is, and what its
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