A Love Story Collaboration Between Environmental Services (ES) Infection Prevention (IP)

1. A Love StoryCollaboration Between Environmental Services (ES)Infection Prevention (IP) BJ Helton, MT(ASCP), MPH, CIC Manager Patient Safety and Quality Covenant HealthCare Saginaw, Michigan

2. How Did They Meet?They Have Known Each Other for Years ES/IP already had a well established working relationship • ES member of Keystone HAI since the beginning • ES long-time member of the IP Committee • ES active member of SSI Taskforce

3. The Courtship: IP Puts the Moves on ES • Hospital cleanliness is a vital ingredient in the fight against HAI’s • ES is also important in it’s own right as patient’s expect to be cared for in an environment that is clean, safe and fit for purpose.

4. Love HappensIP Shouts it from the Rooftops • Hospital cleanliness is everyone’s responsibility and everyone needs to play their part, not just the ES. • ES is the expert so let’s listen

5. The Proposal:CDC Workgroup In view of the evidence that transmission of many healthcare acquired pathogens (HAPs) is related to contamination of near-patient surfaces and equipment, all hospitals are encouraged to develop programs to optimize the thoroughness of high touch surface cleaning as part of terminal room cleaning at the time of discharge or transfer of patients. (10% Bleach)

6. The Engagement: Clean Spaces, Healthy Patients Clean Spaces, Healthy Patients: Leaders in Infection Prevention (APIC) and Environmental Services (AHE) working together for better patient outcomes

7. The Ceremony:Working Towards Patient Safety • Healthcare Associated Infections (HAIs) occur as a result of health care interventions in any health care setting (doing business) • The environment around the patient influences the incidence of infection. Cleaning and disinfection reduces the numbers of microorganisms in the healthcare environment • The goal of cleaning is to keep the environment safe for patients, staff and visitors therefore… • Environmental Services is an important partner in patient safety

8. Commitment: Safe Patient Environment • Patients shed microorganisms into the healthcare environment • Shedding increased if coughing, sneezing, diarrhea • Organisms survive on surfaces for days to months • The area around the patient is touched by the HCW during care • Many surfaces and non‐critical patient care equipment items have been shown to be contaminated • Cleaning disrupts the transfer of microorganisms to HCW hands and other patients

9. Sharing Space: Transmission • Organisms (e.g. S. aureus, Acinetobacter) present on intact areas of some patients’ skin • Nearly 1 million skin cells containing viable organisms are shed daily from normal skin • Patient environment (bed linen, furniture, equipment) becomes contaminated by patient organisms

10. “Touchy” Areas Everywhere I go… • High Touch Surfaces • Frequent contact with hands • higher likelihood to be a source for transmission • Require more frequent cleaning • at least daily or more frequently if higher contamination • e.g. doorknobs, telephone, call bell, bedrails, keyboards, monitors, etc.

11. My Mom Does it This Way…Hotel vs. Hospital Clean • “Hotel Clean” • A measure of cleanliness based on visual appearance. The basic cleaning that takes place in all areas of the health care setting. • “Hospital Clean” • A measure of cleanliness routinely maintained in patient care areas of the health care setting. • Hospital clean is hotel clean with the addition of disinfection, increased frequency of cleaning, auditing and other infection prevention measures in patient care areas.

12. A Little Give and Take…Measure of Clean- Quality Control Just because it looks clean Doesn’t mean it is clean… • ES looks for ways to Measure Clean • Direct and indirect observation (ES and IP) • Residual bio burden (ATP Monitoring)

13. Marital Woes: A facility outbreak or epidemic can be a costly condition if patients have to be moved, co-horted or isolated

14. Even in the Best of Marriages… • An outbreak of multi-resistant Acinetobacter was observed in the critical care units in October 2009. • Three patients were affected, all ventilator-associated pneumonias. • True Collaboration • Environmental Services /Infection Prevention • Critical Care • Laboratory • Respiratory Care

15. It Takes Work • Challenges and changes • Environmental Hygiene importance • Infection Prevention and Control collaboration • Hospital Cleanliness is everyone’s responsibility • Proactive not reactive

16. Happy Anniversary The collaboration Pays OFF • Not only from the patient care side • It helps keep replacement costs down • It enhances the facility’s reputation • Many more happy years to come!