Reducing HAI risk through more effective environmental cleaning

HAIs Affect more than 1.7M Patients and Cost U.S. Hospitals Over $35 Billion Annually

Hospitals should be safe havens for healing, not breeding grounds for infection. Yet, one in 25 patients—that's 1.7 million – contract hospital associated infections (HAIs) every year in the U.S.

Evidence continues to suggest that environmental contamination is a leading cause of HAI transmission. For example, recent outbreaks of deadly superbugs such as methicillin-resistant Staphylococcus aureus (MRSA), Carbapenem-resistant Enterobacteriaceae (CRE), norovirus, and others have been tied to insufficient cleaning of endoscopy scopes.

HAIs, and the almost 98,900 deaths associated with them every year, are a source of tremendous concern for the government. To help minimize pathogen contamination, the CDC redefined the standards for environmental services in the healthcare arena. The new guidelines require stringent infection prevention measures to reduce environmental bio-burden and invisible organism counts on all patient care surfaces. This includes daily cleaning with advanced tools and products, testing that goes far beyond the traditional visual inspections, and more extensive personnel training.

In addition to the threat to public health and safety, HAIs are costing hospitals billions in reduced reimbursements and preventable healthcare expenditures. Under the Affordable Care Act's readmission guidelines, Medicare and Medicaid deny payment for HAIs, significantly cutting hospital reimbursements. And in a world of 'pay for performance,' patient satisfaction is everything. HAIs lower cleanliness and patient safety survey scores, which negatively affect revenue. Hospitals can ill-afford these losses.

These factors have put hospital administrators are under tremendous pressure to improve the effectiveness of their cleaning and sanitizing systems and made providing environmental services (EVS) much more complex. Traditional "hotel clean" is no longer acceptable in the healthcare environment and the title of "housekeeper" is not an accurate description of the advanced role required of today's environmental service worker. Rather, "EVS technician" more clearly defines the special training, mentoring, and supervision required to maintain the safe, comprehensive level of cleaning needed to ward off HAIs and protect patients, visitors, and staff in the healthcare environment.

As healthcare administrators strive to keep up, many are embracing the Institute for Healthcare Improvement's (IHI) Triple Aim. The triple-pronged framework, which is designed to optimize health system performance, focuses on improving the patient experience of care, improving the health of populations, and reducing the per capita cost of care. Additionally, making strides to improve Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores—including those related to cleanliness and patient safety—continues to be a primary focus.

But despite the careful implementation of in-house environmental cleaning programs, policies, and EVS staff training, invisible pathogens continue to lurk on healthcare surfaces. There are new best practices processes and technology being developed and deployed to supplement traditional cleaning and disinfection protocols.

Adenosine triphosphate (ATP) is an enzyme present in all living cells. ATP monitors quickly detect their presence and accurately measure the level of microbial contamination that remains on surfaces, medical devices, and surgical instruments 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 new types of monitoring and measuring more accurately reflect how clean a surface really is and how effective sanitation protocols are, and they are becoming the gold standard in the healthcare industry.

Unfortunately many healthcare EVS decision-makers are finding they simply don't have the resources required to cost-effectively meet the new EVS best practices and are looking to augment their environmental cleaning methods with these cutting-edge technologies and protocols and advanced EVS training.

Some have turned to contracted EVS programs because they are "turnkey," ready for implementation, and have been developed by leading experts who specialize in healthcare environmental services. To be advantageous, such EVS programs should:

• Emphasize effective surface cleaning and disinfection, including providing staff with the proper tools for the specific job such as microfiber technology, fluorescent marking gel, ATP technology and other tools to measure the cleanliness of high-touch surfaces
• Adhere to the recommendations of the CDC's Options for Evaluating Environmental Cleaning, released in 2010
• Build collaborative partnerships between EVS, infection prevention, and control and nursing leadership
• Promote enhanced hand hygiene awareness programs facility-wide for all members of the healthcare team
• Ensure the number one priority remains on patient safety and satisfaction while providing a healthier healing environment

Additionally, a contracted EVS program should be built on a foundation of comprehensive education that moves beyond standard hospital-required training of EVS staff. For example, ABM Healthcare Support Services' EVS training program follows this 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.

Investing in a quality EVS program rooted in advanced training methodology is an important step in the right direction to help reduce HAIs, improve safety and productivity in the healthcare setting, and help lower healthcare costs for everyone.

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 Support Services. 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 ABM standardized WMC's work processes and programs; transformed their cleaning operations; and increased the efficiency, productivity, and cost effectiveness of the departments.

ABM employed cutting-edge ATP testing, and trained personnel on the new tools and processes 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 (RLUs) on the luminometer when tested. A pass rate of 80 percent or above is the recommended target based on 2010 CDC data).

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

HCAHPS scores for cleanliness under ABM's management are 74.32, as compared with previous scores of 61.1, and ABM environmental services was able to reduce the number of full time EVS employees from 42.19 to 40.19 because of increased productivity and efficiency.

"ABM Healthcare Support Services' team has helped provide an environment of which 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.

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Gary Pollack is the senior vice president of operations, environmental services for ABM Healthcare Support Services and is a sought-after industry thought leader with more than 35 years' experience.

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