Educating
Environmental Services Personnel
About Infection
Control and Prevention
Derived from a
study by Jennifer Schraag
The Environmental
Services department is possibly the most mobile group of staff in the average
hospital. They can be seen daily in every patient room (even those under
contact precautions), every washroom, every common area, every lunchroom and
cafeteria, every staff lounge, elevator, operating room and laboratory. They
are at the bottom of the hierarchical pecking order, and they often work
without ongoing infection control education. Herein lies a problem.
An infection
control magazine article once proposed that the Environmental Services
Department is second in importance only to hand hygiene in the control of
hospital acquired infections. In subsequent Letters to the Editor, the author
of the article was resoundingly berated. The corporate scientific community
argued that there were so many factors at play that Housekeeping couldn’t
possibly have such a starring role in the hospital infection control
performance. For two reasons, the author of the original article is probably
correct.
Firstly,
Environmental Services workers go EVERYWHERE. If they don’t take proper care,
they could easily transport a potential hospital-wide outbreak on their shoes,
clothing, hands and cleaning tools. Even practices such as vacuuming carpet or
buffing floors can add to the load of infectious organisms in the air and on
above-floor surfaces, particularly true of environmental pathogens like
Clostridium difficile.
Secondly,
Environmental Services plays a huge part in infection prevention. The practice
of environmental cleaning is critical to the removal or destruction of
disease-causing pathogens. Guidelines from Health Canada and the CDC are clear
in the fact that all surfaces (some more so than others) need attention from
Environmental Services staff. The simple act of wiping a railing with a damp
cloth can reduce the microbial load to below infectious levels, forestalling a
potential outbreak.
If at least basic
infection control theory can be taught, and re-taught, and emphasized over and
over during regularly scheduled and mandatory in-services, Environmental
Services workers will have an understanding of how important their job is, why
certain practices are done, and how to make fundamental decisions.
Environmental Services supervisors also should make certain to regularly attend
their facility’s Infection Control meetings. An Environmental Services
department head should be a voting member on their facility’s Infection Control
committee. An infection control manual should be developed with specific
application to the Environmental Services department.
The objectives of
the two departments also need to be aligned with common objectives. This goes
beyond individuals, it speaks about the reporting structures and organizational
alignment. The key is to ensure that the objectives are clear coming from the
top management in order to achieve a balance between the control of risks and
the control of costs, and that at the execution level, bridges are put in place
for communication. Those usually translate on a day-to-day basis into the
implementation of cross-functional teams.
Time is not on our
side.
Hospital cleaning
staff members are inadequately trained in infection control practice and
theory, cleaning budgets had been steadily cut (as much as 15 to 20 per cent
annually), yet hospital buildings and equipment are constantly reshaped and
made more complex. The infections increase.
There is no one
answer to the nosocomial infection problem – several concurrent battle fronts
are necessary. To the extent that, in most cases, all that can be done in the
hand hygiene arena is being done, the next place to look is Environmental
Services. With thoughtful training and a persistent infection control message,
a significant measurable difference can be achieved.
- Material
reprinted from the Fall 2005 issue of Virox Technologies’ Solutions newsletter.
