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Avoid Cleaning in the Dark: Development of Cleaning Standards and Frequencies for Housekeeping Aides and Janitors
www.ajicjournal.org Vol. 39 No. 5
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increase within two months after start of construction. Surveillance efforts revealed that isolation signs were not consistently moved with the patient. Daily surveillance of posted signage by designated staff was instituted to assure that signage was moved with patients and posted appropriately in the new location. Use of bleach was expanded for all decontamination in this area. Hand hygiene compliance was stable as was antibiotic stewardship monitored by Infectious Disease and were not considered to be contributing factors. Construction workers were segregated to the construction area. Results: Surveillance of isolation signage by designated staff and change to ‘‘bleach only’’ decontamination reversed an increasing Clostridium difficile trend during major construction. Clostridium difficile infection decreased from 0.76% in 2007 (240 days of infection for 31,632 days of care) to 0.07% in 2010 (25 days of infection for 36,074 days of care) for an absolute risk reduction of 0.69% and (P ,0.0001). Lessons Learned: Common hospital events, such as construction, can jeopardize infection prevention efforts. Assumption that isolation signage would accompany patients in multiple transfers was inaccurate, threatened to reverse previous gains, and challenged further success. Changing to ‘‘bleach only’’ decontamination may be significant and will be explored further. Success is not achieved through static infection prevention efforts but through clarity of communication, continuous vigilance, and flexibility of thought process. Presentation Number 11-114
Avoid Cleaning in the Dark: Development of Cleaning Standards and Frequencies for Housekeeping Aides and Janitors Natalie Joy Goertz, BScN, Manager of Infection Prevention and Control; Joan Cybulski, RN, Infection Prevention and Control; John Schram, Supervisor of Housekeeping Services; Janis Humeston, BA, Director of Housekeeping/CSR; Woodstock Hospital, Woodstock, ON, Canada Issue: Housekeeping services play a vital role in the delivery of safe care to patients. It has been shown that the healthcare environment can be a significant reservoir for infectious agents. Patients shed microorganisms into the healthcare environment and many of these organisms can survive for weeks or months. The role of the housekeeping aide is complex as cleaning frequencies and standards vary based on the area of the hospital and/or the organism involved. The hospital environment consists of clinical and non-clinical areas, in which the frequency standards would differ based on environmental contamination and risk. Even within the clinical environment, general standards cannot be applied as contamination and risk vary again between inpatient and outpatient settings. Increased prevalence of multidrug resistant organisms, antibiotic resistant organisms and Clostridium difficile add an additional layer of complexity to the role of housekeeping. This requires knowledge in infection prevention and control principals as well as cleaning techniques for removal of these organisms from the environment. Project: Infection Prevention and Control, Environmental Services and Nursing collaborated on developing a guideline for standards and frequencies as a resource for housekeeping aides and janitors. Results: The development of housekeeping guidelines offer clarity to cleaning requirements for these various factors in the hospital setting. Tables, charts and checklists were created to assist housekeeping staff to distinguish differences in cleaning requirements and expectations between clinical areas vs. non-clinical areas and inpatient vs. outpatient areas. Within these areas, frequently touched surfaces were identified and increased frequency of cleaning was indicated. Checklists were created as a tool for the housekeeping staff. In addition, infection control requirements and implications for general cleaning practices, as well as, appropriate hand hygiene and personal protective equipment use were outlined. Finally, cleaning standards and frequencies were provided for various organisms. Lessons Learned: Development of guidelines for environmental cleaning standards and frequencies require collaboration with various stakeholders. Consideration of various factors such as organism and hospital environment requires significant analysis.
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increase within two months after start of construction. Surveillance efforts revealed that isolation signs were not consistently moved with the patient. Daily surveillance of posted signage by designated staff was instituted to assure that signage was moved with patients and posted appropriately in the new location. Use of bleach was expanded for all decontamination in this area. Hand hygiene compliance was stable as was antibiotic stewardship monitored by Infectious Disease and were not considered to be contributing factors. Construction workers were segregated to the construction area. Results: Surveillance of isolation signage by designated staff and change to ‘‘bleach only’’ decontamination reversed an increasing Clostridium difficile trend during major construction. Clostridium difficile infection decreased from 0.76% in 2007 (240 days of infection for 31,632 days of care) to 0.07% in 2010 (25 days of infection for 36,074 days of care) for an absolute risk reduction of 0.69% and (P ,0.0001). Lessons Learned: Common hospital events, such as construction, can jeopardize infection prevention efforts. Assumption that isolation signage would accompany patients in multiple transfers was inaccurate, threatened to reverse previous gains, and challenged further success. Changing to ‘‘bleach only’’ decontamination may be significant and will be explored further. Success is not achieved through static infection prevention efforts but through clarity of communication, continuous vigilance, and flexibility of thought process. Presentation Number 11-114
Avoid Cleaning in the Dark: Development of Cleaning Standards and Frequencies for Housekeeping Aides and Janitors Natalie Joy Goertz, BScN, Manager of Infection Prevention and Control; Joan Cybulski, RN, Infection Prevention and Control; John Schram, Supervisor of Housekeeping Services; Janis Humeston, BA, Director of Housekeeping/CSR; Woodstock Hospital, Woodstock, ON, Canada Issue: Housekeeping services play a vital role in the delivery of safe care to patients. It has been shown that the healthcare environment can be a significant reservoir for infectious agents. Patients shed microorganisms into the healthcare environment and many of these organisms can survive for weeks or months. The role of the housekeeping aide is complex as cleaning frequencies and standards vary based on the area of the hospital and/or the organism involved. The hospital environment consists of clinical and non-clinical areas, in which the frequency standards would differ based on environmental contamination and risk. Even within the clinical environment, general standards cannot be applied as contamination and risk vary again between inpatient and outpatient settings. Increased prevalence of multidrug resistant organisms, antibiotic resistant organisms and Clostridium difficile add an additional layer of complexity to the role of housekeeping. This requires knowledge in infection prevention and control principals as well as cleaning techniques for removal of these organisms from the environment. Project: Infection Prevention and Control, Environmental Services and Nursing collaborated on developing a guideline for standards and frequencies as a resource for housekeeping aides and janitors. Results: The development of housekeeping guidelines offer clarity to cleaning requirements for these various factors in the hospital setting. Tables, charts and checklists were created to assist housekeeping staff to distinguish differences in cleaning requirements and expectations between clinical areas vs. non-clinical areas and inpatient vs. outpatient areas. Within these areas, frequently touched surfaces were identified and increased frequency of cleaning was indicated. Checklists were created as a tool for the housekeeping staff. In addition, infection control requirements and implications for general cleaning practices, as well as, appropriate hand hygiene and personal protective equipment use were outlined. Finally, cleaning standards and frequencies were provided for various organisms. Lessons Learned: Development of guidelines for environmental cleaning standards and frequencies require collaboration with various stakeholders. Consideration of various factors such as organism and hospital environment requires significant analysis.