Improving HAI prevention and patient safety through effective environmental cleaning

HAIs affect more than 1.7M patients and cost U.S. acute hospitals over $35-$45 billion annually

The High Costs of Healthcare-Associated Infections (HAIs)
Hospitals should be safe havens for healing. Yet every year, one in 25 patients contracts at least one healthcare-associated infection (HAI) while in the hospital. Of these 1.7 million HAI cases, approximately 99,000 end in death.*

In addition to the threat to public health and safety, HAIs are costing U.S. acute hospitals $35 to $45 billion** annually in denied Medicare and Medicaid payments, penalties, and preventable healthcare expenditures. And in a world of "pay for performance," where the patient experience is everything, HAIs lower patient satisfaction survey scores.

So what exactly is an HAI? Simply put, it is an infection that a patient develops from germs entering the body during the course of receiving medical treatment for another condition. There are different kinds of HAIs including catheter-associated urinary tract infections, bloodstream infections, surgical site infections, and pneumonia.

Environmental Contamination Plays a Role in HAIs
While a majority of HAIs are spread via medical devices -- such as catheters and ventilators -- during invasive treatment procedures or during surgery, we are learning that another contributing factor of HAIs may be environmental contamination. Recent studies show patient care surfaces play a much larger role in HAI transmission than previously thought. This is a huge source of concern for patients, hospitals, and the government.

So to help promote better awareness and control efforts of surface related infections, in 2010 the CDC published Options for Evaluating Environmental Cleaning. The guidelines include recommendations for monitoring the effectiveness of environmental cleaning in discharged patient's rooms in hospitals.

Fight HAIs with a Comprehensive EVS Program
The latest CDC recommendations have charged hospitals to put procedures that monitor and improve the efficacy of their environmental cleaning programs into place. To be in alignment with the CDC, as well as other best practice guidelines from other groups, a comprehensive environmental services (EVS) program should:

• Promote infection prevention awareness and education programs facility-wide for all members of the healthcare team. Make sure everyone understands how transmission is related to patient care surfaces, the surfaces most likely to become contaminated, and how to best optimize efforts to combat pathogen transmission.
• Focus on traditional infection control practices such as strict hand hygiene programs. Hand hygiene continues to be one of the most effective weapons to fight the spread of HAIs.
• Adhere to proven surface cleaning and disinfection procedures and techniques, best-in-class equipment and products, a standardized approach to measuring cleanliness, and strict employee supervision. The program should also leverage new technology, processes, and products being developed and deployed to supplement traditional cleaning and disinfection protocols.
• Measure effectiveness of cleaning high-touch surfaces with cutting-edge tools and technology. Adenosine triphosphate (ATP) is an enzyme present in all living cells. ATP monitors quickly detect their presence and accurately measure the level of bioburden that remains on surfaces, after cleaning. Fluorescent marking methods use black lights to instantly test how much invisible, non-toxic solution is left on high-touch surfaces after being cleaned. These cutting edge monitoring and measuring technologies more accurately reflect how clean a surface really is and how effective cleaning protocols are, and they are becoming the gold standard in the healthcare industry.
• Partner with professional infection preventionists who specialize in techniques and tools to boost organizational efforts to reduce the spread of HAIs and ensure collaborative partnerships between EVS, infection prevention and control, and nursing leadership.
• Ensure patient safety and satisfaction, and providing a healthier healing environment, always remains the number one priority.

Additionally, a comprehensive EVS program should be built on a solid foundation of high-level training that goes well beyond standard hospital-required training of EVS staff. For example, ABM Healthcare's EVS training program follows a unique three-step strategy to more effectively train its staff:

1. Training Video – New healthcare EVS staff members are required to view a training video, provided by the contracted EVS specialist, which outlines a comprehensive set of core competencies and specialized cleaning methods necessary to follow advanced EVS cleaning standards.
2. Competency Test – After viewing the training video, associates complete a required competency test to remind them about the key steps in cleaning, followed by the instructor reviewing the test results with them.
3. Replicating the Training – New EVS associates move from the classroom to the patient floor and complete the tasks outlined in the training video with the instructor overseeing to ensure accuracy. Associates repeat the steps as needed to ensure they are comfortable in the new environment.

Augment Infection Prevention Program with Expert Outsourcing
Unfortunately, many healthcare EVS decision-makers simply don't have the resources required to cost-effectively meet the CDC's high standards in-house. To supplement their environmental cleaning and disinfection programs, some have turned to contracted EVS providers for help

Outsourced EVS programs are "turnkey," ready for implementation, and have been developed by leading experts who specialize in healthcare environmental services. They can be deployed with minimal resources and disruption.

Environmental services professionals such as ABM Healthcare are also able to advise and help design, implement, and manage an effective solution that has been customized for a facility's specific needs and goals. And by letting experts "own" the EVS program, healthcare facilities can remain focused on providing the best possible patient care.

Investing in a quality EVS program rooted in training, best practices, and the latest technology is an important step in the right direction to help reduce HAIs; improve patient care, safety, and satisfaction, and lower healthcare delivery costs for everyone.

And the good news is that through intensive infection prevention and control efforts of healthcare facilities, care teams, and individual doctors and nurses, some targeted HAIs rates are being decreased by more than 70 percent***.

Best Practice EVS in Action: Wyoming Medical Center
Located in the heart of Wyoming, Wyoming Medical Center (WMC) has offered the state's most complete healthcare services for more than 100 years. The 195-bed facility is continually seeking to enhance its service offering and level of care. However, in 2011, the administration was concerned about cleanliness and the affect it was having on overall patient safety and satisfaction. Their goals were to enhance cleaning management processes and improve stability within the staff.

To meet these goals, WMC contracted ABM Healthcare. The hospital took advantage of ABM's expertise in advanced EVS technologies and tasked them with implementing an environmental cleaning and monitoring program to benchmark cleanliness practices in patient rooms and increase the efficiency of its environmental services and laundry programs.

Leveraging new best practice tools, technology, and processes, WMC standardized its work processes and programs; transformed cleaning operations; and increased the efficiency, productivity, and cost effectiveness of the departments.

ABM introduced cutting-edge ATP testing and trained personnel on the new measurement tool without major turnover or disruption. During 2014, more than 1,400 ATP tests were performed and the overall data showed a passing rate of 89 percent -- continually exceeding the threshold target (A passing ATP score is defined as a surface area that had an ATP reading of less than 500 relative light units on the luminometer when tested. A pass rate of 80 percent or above is the recommended target based on CDC data).

The new ATP technology gave the hospital a cleanliness 'grade' for the first time, which helped the hospital further reduce the risk of HAIs and ultimately increased patient safety and satisfaction.

WMC's HCAHPS score for cleanliness is 74.32, as compared with a previous score of 61.1. Improved cleaning processes reduced the number of full time EVS employees from 42.19 to 40.19 because of increased productivity and efficiency.

"ABM Healthcare's team has helped provide an environment our hospital staff can be proud, and one that is providing world-class services for each of our patients," said Julie Cann-Taylor, former COO & Sr. Vice President of Patient Care Services.

James Tesorero – Senior Vice President, Operations, Patient Experience
Jim Tesorero joined ABM Healthcare in May 2016 as the Senior Vice President, Operations, Patient Experience. Jim has over 30 years' experience in executive leadership roles with industry core competencies in P&L oversight, operations management, customer relationship management, business development, financial management, and talent management.

Jim is responsible for field operations, client service, and new business development activities for the food & nutrition, environmental services, patient transportation, and laundry services accounts across the United States. He also supports our parking, valet, guest services, and patient sitter/companion teams.

Before joining ABM, Jim worked as a Senior Vice President of Operations for Cross County Healthcare's Optimal Workforce Solutions, one of the nation's leading providers of healthcare staffing and workforce solutions.

Prior to this, Jim had a 28 year career with Aramark Healthcare where he served as Region Vice President Operations over the North Region. He had complete P&L responsibility for a $300 million hospitality and clinical support services group which included 80 healthcare partners in a 12 state region with a management team of over 250. Jim managed the relationships and growth at many of Aramark's key accounts in the region including: Cleveland Clinic; Cincinnati Children's Hospital; St. Vincent Health System in Indianapolis, Indiana; KentuckyOne Health in Louisville, Kentucky; Henry Ford Hospital in Detroit, Michigan; Albany Medical Center in Albany, New York; Tufts Medical Center in Boston, Massachusetts; Ohio Health in Columbus, Ohio; and St. Jude's Children's Research Hospital in Memphis, Tennessee.

In his tenure at Aramark, Jim worked in multiple roles as his career advanced. He began his tenure in 1986 in business dining as a Director and General Manager at client locations at Phillip Morris, Blue Cross Blue Shield, of Kentucky, and Lincoln Life. He progressed to District Manager overseeing corporate dining customers in the Kentucky market including Yum! Brands, Toyota, Cummins Engine and in Detroit with General Motors. Jim then transitioned to healthcare where he became Vice President Operations in the North Central Region overseeing multiple accounts in the Midwest. His career continued to progress where he served as Vice President Business Development East and Vice President Operations in the Southwest and Midwest.

Jim has a BA in food systems, economics and management from Michigan State University in Lansing, Michigan. He is a member of American College of Executives (ACHE). Jim and his wife Diana live in Novi, Michigan and are proud parents of two adult sons. Jim is an avid Spartan alum, enjoys golf, boating, and football.

# # #

* CDC at Work
**The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention, R. Douglas Scott II, March 2009
***CDC.gov

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