The Vital Role of the EVS Worker on the Patient Safety Team. David P. Calfee, MD, MS October 19, 2017

Transcription

1 The Vital Role of the EVS Worker on the Patient Safety Team David P. Calfee, MD, MS October 19,

2 What is your main job activity? A. Frontline EVS worker (i.e., housekeeper) B. EVS manager, supervisor, or director C. Infection preventionist or hospital epidemiologist D. Other

3 Where do you work? A. Hospital B. Long-term care facility (nursing home) C. Outpatient facility (clinic) D. Other

4 Do you consider yourself to be a member of the infection prevention and patient safety team at your facility? A.Yes B.No

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6 By the end of this presentation, I want you to believe 3 things. 1. The environment is an important source of germ transmission in health care facilities. 2. Effective cleaning and disinfection of the environment can prevent germ transmission and infection among patients. 3. YOU play an important role in preventing infections in patients admitted to your facility.

7 The environment is an important source of germ transmission in health care facilities.

8 The hospital environment is frequently contaminated with germs. Germ: Acinetobacter Occupied hospital room Non-contaminated hospital room Contaminated hospital room

9 The hospital environment is frequently contaminated with germs. Germ: Acinetobacter Germ: MRSA 42% Non-contaminated hospital room Contaminated hospital room

10 The hospital environment is frequently contaminated with germs. Germ: Acinetobacter Germ: MRSA Germ: C. difficile (C dif) 42% 73% Non-contaminated hospital room Contaminated hospital room

11 The hospital environment is frequently contaminated with germs. Germ: Acinetobacter Germ: MRSA Germ: C. difficile (C dif) 42% 73% 100% Non-contaminated hospital room Contaminated hospital room

12 Germs are frequently found in the hospital environment after cleaning. After daily cleaning Occupied hospital room Non-contaminated hospital room Contaminated hospital room

13 Germs are frequently found in the hospital environment after cleaning. After daily cleaning 34% After discharge cleaning Non-contaminated hospital room Shams AM. Infect Control Hosp Epidemiol 2016; 37: 1426 Contaminated hospital room

14 Germs are frequently found in the hospital environment after cleaning. After daily cleaning 34% After discharge cleaning 18% Non-contaminated hospital room Shams AM. Infect Control Hosp Epidemiol 2016; 37: 1426 Contaminated hospital room

15 Environmental contamination leads to contamination of healthcare workers hands. Hands on bedrail and over-bed table for 5 seconds Bhalla A. Infect Control Hosp Epidemiol 2004;25:164-7.

16 Hand contamination after contact with the environment: OCCUPIED ROOMS 53% Bhalla A. Infect Control Hosp Epidemiol 2004;25:164-7.

17 Hand contamination after contact with the environment: VACANT ROOMS 24% Bhalla A. Infect Control Hosp Epidemiol 2004;25:164-7.

18 1 out of 2 high-touch surfaces in hospital rooms is not cleaned at discharge. 14 High-Touch Surfaces, 36 hospitals 52% Not Cleaned Cleaned (48%) Carling PC. Infect Control Hosp Epidemiol 2008;29:

19 Many pathogens can survive in the environment for long periods of time. Organism Duration of Survival Acinetobacter sp. 3 days-5 months Clostridium difficile spores 5 months E. coli 1.5 hours-16 months Enterococcus (e.g., VRE) 5 days-4 months Klebsiella sp. 2 hours->30 months Proteus vulgaris 1-2 days Pseudomonas aeruginosa 6 hours-16 months Serratia marcescens 3 days-2 months S. aureus (including MRSA) 7 days-7 months Kramer A. BMC Infect Dis 2006;6:130

20 C. difficile is one of the top 3 antibiotic resistance threats in the U.S.

21 Environmental contamination can lead to patient infections. Did the last occupant of the hospital room have C. difficile infection? No Yes 1 in 25 patients gets C. difficile 3 in 25 patients get C. difficile A similar risk occurs with MRSA and other germs. Shaughnessy MK. Infect Control Hosp Epidemiol 2011;32:201-6

22 Environmental contamination can lead to patient infections. 1 out of every 5 hospital patients with C. difficile infection was infected by another hospital patient s germs. Eyre DW. Clin Infect Dis 2017;65:

23 Effective cleaning and disinfection of the environment can prevent germ transmission and infection among patients.

24 Proper cleaning and disinfection prevents infections and deaths. Fewer germs on surfaces Fewer germs on patients and health care workers Fewer infections

25 Improvements in cleaning and disinfection can prevent infections. MRSA infections in ICU patients Before discharge cleaning was improved: After discharge cleaning was improved: 305 infections infections 123 infections prevented! Datta R. Arch Intern Med. 2011; 171 (6):

26 Is this room as clean and safe as it can be?

27 How do we know an elephant is an elephant?

28 How do we know if our health care facilities are optimally clean? Policies, products Visual appearance Patient surveys (HCAHPS scores) Adherence to policies and protocols Objective assessment Patient outcomes

29 Every system is perfectly designed to get the results it gets. -Paul Batalden, MD

30 Are we doing all that we can to make our hospitals and nursing homes clean and safe?

31 Do you think that there is room for improvement in cleaning and disinfection at your facility? A.Yes B.No

32 Maintaining a clean and safe environment is a very complex process. Elbow grease Disinfectant Detergent Teamwork Contact time Communication Other complicating factors Must be done frequently Occupied spaces Differing expectations Competing priorities Human behavior Avoiding recontamination

33 Why do we do what we do? Why don t we do what we don t do? Attitude Behavior What is ok Do we think we can do it?

34 Why do we do what we do? Why don t we do what we don t do? Attitude Acceptance/awareness of responsibility Impact on patient outcomes Impact on the worker Behavior What is ok? Do we think we can do it?

35 Why do we do what we do? Why don t we do what we don t do? Attitude Behavior What is ok? Expectations of supervisor, colleagues Institutional culture Feedback Do we think we can do it?

36 Why do we do what we do? Why don t we do what we don t do? Attitude Behavior What is ok? Do we think we can do it? Training/skills Time, workflow barriers Tools, equipment, supplies

37 We need to identify, understand and eliminate barriers that prevent us from doing the right thing, EVERY TIME. Opportunities for education Expectations and technique Personal safety concerns (cleaning products, patients) Role of the environment in infection transmission and infection prevention strategies Desire/need for constructive feedback Workflow barriers Pushback from patients and residents Clutter Interruptions Lack of clarity regarding cleaning responsibilities Culture Lack of appreciation and respect Concern about disturbing patients

38 Do you feel that you ve been properly trained to perform your job effectively? A. Yes B. No

39 Do you get enough useful feedback about your quality of you work? A.Yes B.No

40 What is your biggest challenge during DAILY cleaning of patient rooms? A. Getting the necessary supplies B. Concern about your own safety (exposure to chemicals, patients) C. Clutter in the patient s room D. Patients refuse to have their room cleaned E. Something else

41 What is your biggest challenge during DISCHARGE cleaning of patient rooms? A. Not enough time B. Interruptions C. Concern about your own safety (exposure to chemicals, patients) D. Uncertainty about what EVS cleans and what others clean E. Something else

42 Make interventions that address facilityspecific needs. Optimize job-specific training Topics: technique, protocols, expectations Methods: hands-on training, return demonstration, assessment of competency Provide constructive feedback Educate Rationale for and importance of the work Eliminate/reduce barriers Make supplies available and easy to use Provide communication tools and skills: patient refusals, clutter Enhance relationships Intradepartmental Interdepartmental

43 We can make a difference. Higher is better Ray AJ. Infect Control Hosp Epidemiol 2017;38:

44 Items Clean (%) We can make a difference. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Daily Cleaning Improvement Initiative Before After Toilet Seat Toilet Flush Overbed Table Bed Rail Call Bell/Remote Visitor Chair Martin E. IDWeek San Diego CA. Abstract 501

45 C difficile Infection Rate Improvements in cleaning and disinfection can prevent infections Before After 85% lower Lower is better Orenstein R. Infect Control Hosp Epidemiol 2011;32:1137-9

46 It is the end of my presentation, do you believe these 3 things? 1. The hospital environment is an important source of germ transmission in hospitals. 2. Effective cleaning and disinfection of the environment can prevent germ transmission and infection among hospital patients. 3. YOU play an important role in preventing infections in patients admitted to your hospital.

47 Do you consider yourself to be a member of the infection prevention and patient safety team at your facility? A.Yes B.No

48 Thank you!