Environmental Cleaning. August 14, 2013

Transcription

1 Environmental Cleaning August 14, 2013

2 Objectives Summarize the literature connecting environmental cleaning and infection transmission risk List the key members to include on an evaluation of EVS cleaning processes Describe the importance of senior leadership support in improvement efforts Describe best practices for environmental cleaning and monitoring

3 Environmental Risk Environmental Contamination - Contaminated surfaces contribute to transmission risk 1 - Patients colonized or infected with resistant organisms such as MRSA, VRE, and C. difficile shed organisms into their immediate environment - Resistant organisms can live in the environment for weeks to months Contaminated surfaces increase crosstransmission ~ Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL. 3 1) Amer Jour of Inf Control 2013; 41(5): S6-11

4 Environment and Infection Transmission Risk Studies suggest increased risk of acquisition for patients in a room where previous occupant was infected/colonized - Increased VRE risk if prior room occupant VRE colonized or VRE colonized occupant in room in previous 2 weeks 1 - Patients more likely to acquire MRSA and VRE when prior occupant was positive 2 Clostridium difficile spores can survive in the environment for several months 1) Clin Infect Dis 2008; 46(5): ) Arch Intern Med 2006; 166(18): ) Clin Infect Dis 1998;26:

5 Cleaning Best Practices Centers for Disease Control and Prevention - Guidelines for Environmental Infection Control in Health-care Facilities - Guidelines for Disinfection and Sterilization in Healthcare Facilities Associated for the Healthcare Environment Association for peri-operative Nurses (AORN) Canadian Provincial Infectious Diseases Advisory Committee (PIDAC) 5

6 Hospital Impact Regulatory - Joint Commission and CMS focus on cleaning standards Patient experience - HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores Financial - Reduced reimbursement for hospital acquired infections and patient experience Public reporting - Certain hospital acquired infection rates 6

7 Partnership Infection Control Focus on C-Diff Reduction Environmental Services Focus on patient experience scores for cleanliness Infection Control Focus on C-Diff Reduction

8 Allina Health Project Recognized gaps/variation in environmental cleaning polices across 11 hospitals - HCAHPS scores not at desired goal - C. difficile infection rates increasing Core group formed to conduct assessment of current process and gap analysis - Operations Director - Environmental Services managers - Infection Preventionists 8

9 Project Plan Conduct gap analysis Establish a planning team - IP - EVS - Operations - Education - Performance Improvement Create Allina Health standard Identify barriers Present Business Case to Senior Leaders 9

10 What We Did Step 1- Customer Service and EVS Role Training We trained over 400 EVS employees in all eleven hospitals on the expectation and perception of the patient, their individual role and responsibility in the reduction of HAI s and the role of the EVS Aide as part of the care team. Not JUST a janitor anymore 10

11 What We Did Step 2- Created a comprehensive four hour instructor led classroom training program. Three hours classroom one hour hands on demonstration in patient room. Curriculum Included: Infection Control Concepts Basic cleaning and disinfection techniques Chemical utilization High Touch Surfaces Room Zoning Isolation and Special Cleaning Procedures Personal Protective Devices Equipment Cleaning Procedures Quality Control Guidelines 11

12 What We Did Step 3- Created an Allina EVS Certification Program for employees who successfully completed the program Certification Awarded when the employee: Completed four hour class room training Successfully passed written post tests Successfully pass a supervised return demonstration of cleaning an occupied daily room and a discharge patient room. Successfully pass two unannounced UV- Gel/Black light test. 12

13 What We Did Competency Statement: Performs patient room cleaning using standardized process, tools and chemicals in order to create a clean and disinfected environment for the safety of our patients. Senior leaders recognized EVS staff for successful completion of certification program - Personal letter sent to their home 13

14 Allina Hospitals & Clinics presents United Hospital Environmental Services Certification to Employee Name for 2012 Allina Environmental Services Patient Room Protocol Training Presenter Name and Title August 7, 2013

15 Allina Standard Room Cleaning Procedure 1. Disinfect bed with minimum of one patient room(color) rag. 2. Starting back at the door, use a fresh(color) rag, begin disinfecting the rest of Patient Room in a clockwise path. Change rags as needed to assure proper saturation and avoid cross contamination(approximately 3-4 rags). 3. Using 2-3 bathroom(color) rags, disinfect the restroom and always finish with the toilet.

16 Room Cleaning Focus Consistent process used every time. - Start with the bed every time Focus on high touch areas Standardization of chemicals and tools Importance of saturation and kill time Separate color rags for cleaning in patient room and bathroom High touch surfaces Use of UV Gel-Black light Testing for QA

17 Evaluated Current Products Inventory of all chemicals and standardization Cleaning tools - String mops - Cotton rags EVS carts 17

18 Evaluated Current Practice and Daily cleaning - Scope - Process Terminal cleaning - Scope Procedures - Process Isolation vs. Standard Room Cleaning Employee education/knowledge gaps 18

19 Research Best Practices/Products Microfiber cloth and mop literature reviews Cleaning chemical assessment and use (water ph, chemical testing for residual) Room cleaning procedures and processes End user evaluation and feedback Evaluation of cleaning - Process - Effectiveness 19

20 Outcome Standardized daily and terminal room cleaning procedure Recommendation to change to microfiber cleaning cloths and mops Standardized cleaning carts and organization of materials on cart Developed educational material and standardized training Implemented cleaning process and effectiveness evaluation 20

21 UV fluorescent gel After patient is discharged, 18 highly touched surfaces are marked with a gel that fluoresces when exposed to ultraviolet light

22 22 Results

23 Allina System Wide HCAHPS "top box" Room Cleanliness How often were your room and bathroom kept clean? YTD Sites include: ANW, Buffalo, Cambridge, Mercy, New Ulm, Owatonna, River Falls, PEI, St. Francis, United and Unity

24 High Touch Surface Passing Rate Toilet Seat Toilet Flush Bath Sink Toilet Hand Rails Bath Door Bath Lt Switch Rm Sink Bedside Table Pt Chair Tray Table Keyboard Telephone Call Box Rm Lt Switch Rm Door Bed Rail 94.2% 94.5% 92.1% 94.4% 90.2% 89.0% 82.8% 94.7% 89.5% 96.0% 82.9% 96.2% 95.6% 88.7% 88.0% 90.6% 0.0% 50.0% 100.0% 24

25 12 Clostridium difficile Rate C. difficile Rate (Jan- June) 25

26 Key Learnings EVS staff must be partners in the process and understand their role in infection prevention Immediate feedback on thoroughness of cleaning improves performance Process is more important than product Right tools Leadership support is essential Consistency improves employee satisfaction, infection rates, and patient satisfaction 26

27 Monitoring and Assessment Infection Prevention - Fluorescent marking- evaluates cleaning process - ATP monitoring- evaluates cleaning effectiveness After 80% success rate for UV monitoring Phase 2- Bringing non-evs staff into the project - Developed assessment of all items in a patient room and unit assigned responsibility for cleaning - Procedural area cleaning standardization (OR, ED, Radiology, Ambulatory Care) 27

28 ATP Monitoring ATP - Measured in Relative Light Units (RLU) - < 250 RLU = PASS = INTERMEDIATE (CAUTION) - > 501 = FAIL - Measurement of organic material, not specific to microorganisms

29 Alternative Room Disinfection Technologies Help reduce environmental contamination after terminal room clean and disinfection with germicide - Ultraviolet irradiation - Hydrogen peroxide vapor - Silver-ion water 29

30 Ultraviolet Irradiation Numerous products on the market Effective disinfection of room surfaces and equipment, including C.diff spores No residual health effects Does not deteriorate surfaces High capital equipment costs Cleaning still must precede disinfection Need to move furniture and UV equipment during cycle No studies of impact on Hospital-acquired infections 30

31 UV-C Published Studies Studies done by leading experts in hospital cleaning and disinfection (Rutala, Weber, and Boyce) show that using UV technology in conjunction with routine cleaning eliminates bacteria (both vegetative and spores) on contaminated surfaces.

32 Hydrogen Peroxide Vapor Effective disinfection of room surfaces and equipment, including C.diff spores No residual health effects Uniform, automated dispersal of HPV HVAC system must be disabled and door gaps sealed with tape High capital equipment costs Cleaning still must precede disinfection Requires hours per cycle Studies support reduction of HAI 32

33 Summary Environmental contamination contributes to transmission of HAI Collaboration between EVS and IP is essential for process improvement Senior leadership support needed for successful implementation Standardization of process, products, and tools builds consistency On-going monitoring of performance provides Quality Assurance Alternate technologies available to augment manual cleaning processes if HAI rates not decreasing 33

34 Thank you Team Members: Laurie McPhee Aaron Freeberg Ben Pries Mike John Michael Roberson Steven Sandeen Mary Braulick Jeff Louks Thomas Paquette Kim Ober Jimly Harris Cindy Larson Mike Wenzel Kim Sorbel Jessica Nerby Thomas Paquette Sue Erdman Megan Steil Colleen Andrews Don Petersen Amy Rasmussen 34