3 key elements of environmental disinfection improvement efforts

Healthcare-associated infections account for anywhere between $28.4 billion and $45 billion a year in healthcare costs, yet up to 70 percent of HAIs are said to be preventable, according a recent webinar presented by Sealed Air Diversey Care.

Healthcare settings of all kinds understand the importance of reducing HAIs for their bottom line and for the safety of their patients, but the question remains: How?

"I have to admit, there is no one easy answer," said Jim Gauthier, the senior clinical advisor of infection prevention for Sealed Air Diversey Care, during a recent webinar hosted by Becker's Hospital Review. "This is definitely multifactorial. There isn't one silver bullet that's actually going to make a difference to what we're seeing in our healthcare settings."

That said, environmental cleaning and disinfection is a great place for any facility looking to reduce HAIs to begin. According to Mr. Gauthier, a successful, integrated approach to environmental cleaning and disinfection should include three elements: Products, procedures and validation.

1. Products

Disinfecting the high-touch surfaces immediately surrounding the patients — including bed rails, tables, call button and telephone — is crucial, as is choosing the right products for the job.

"There are numerous considerations, but you can lump them into about five groups," said Mr. Gauthier. "These considerations are from the paper by Rutala and Weber, Selection of the Ideal Disinfectant that was published in Infection Control and Hospital Epidemiology (Vol. 35, No. 7 (July 2014)."

Disinfectants should be:

  • Able to kill the most prevalent healthcare-associated pathogens
  • Have fast kill times with acceptable wet contact times and proper tools to do the job
  • Safe for use by hospital staff for patient care areas on hospital surfaces
  • Easy-to-use in that they are convenient and accessible when and where needed
  • Meet other considerations, such as manufacturer support and overall cost

2. Procedures

"The important thing with procedures is we need to make sure that everything is addressed in a standardized order," said Mr. Gauthier. "Everyone has to understand what they are supposed to do in terms of cleaning before disinfecting."

For instance, if staff are using an integrated product, such as a cleaner-disinfectant wipe, it's necessary to clean surfaces that are visibly soiled. In such cases, it may be necessary to use two wipes. If the surface isn't visibly soiled, the staff may not need to use two wipes.

It's also essential to have the cleaning processes laid out in clear steps; operational efficiency is key. A lot of these processes can be tied into a functional bundle — similar to what hospitals already use for clinical protocols for line insertions — or a step-by-step checklist.

Responsibilities related to cleaning and disinfection are also very important. Having a clear list of all the equipment in each unit — along with instruction about which items and tools should be cleaned by environmental services, the nursing staff or someone else — is necessary to avoid missing any contaminated objects or surfaces. These lists should also include how frequently each surface needs to be cleaned, what products are used, and instructions for proper use.

"Having training tools is another part of this procedural step that we really need to take a good look at," said Mr. Gauthier. "We know that if we tell people exactly what we want them to do, it makes it easier and fairer to audit performance and provide feedback."

3. Validation

Validation boils down to evaluating whether staff are confident that the job has been done properly. It is a critical part of this three-element bundled approach.

Validation is so important that the CDC issued "Options for Evaluating Environmental Cleaning" back in December 2010. The report recommends every hospital has a procedure in place to ensure all surfaces are cleaned as part of the terminal room cleaning. It's also important enough that Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America have addressed the need to assess the adequacy of cleaning and disinfection practices and the adherence to set protocols.

Some questions Mr. Gauthier suggests hospitals ask themselves include:

  • Are your dilution control systems working properly?
  • Are your cleaning tools compatible with the disinfectant technology used, making sure that quat binding is not an issue?
  • Are all surfaces wiped down properly?
  • Has the staff done more than just visually checked rooms for cleanliness?

Mr. Gauthier also cites research that suggests hospitals consider using a sporicidal aimed at Clostridium difficile only on a case by case need, or if they experience an outbreak or hyperendemic situation with C. difficile.

Hospitals should consider using a validation system that provides actionable intelligence, allowing leaders to offer constructive feedback to employees and drive continuous improvement.

Lastly, Mr. Gauthier said it's critical to note environmental cleaning and disinfection efforts should be accompanied by antibiotic stewardship programs and hand hygiene improvement education for healthcare staff and patients.

To learn more, view the full webinar by clicking here.

Note: View archived webinars by clicking here.

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