Becker's Clinical Quality & Infection Control

54 Executive Briefing Sponsored by: Reducing the risk in the environment — Striving for zero infections Healthcare-associated infections are a primary source of illness and death among hospitalized patients, and the fifth leading cause of death in U.S. acute care hospitals. Each year, approximately 1.7 million HAIs occur in U.S. hospitals, resulting in 99,000 deaths and an estimated $20 billion in healthcare costs. To reduce risk, cleaning and disinfection of hands, surfaces and equipment is critical. Although there has been much focus on improving hand hygiene for decades, it is still estimated that only 50 percent of healthcare workers follow basic hand hygiene measures. Even if the hand hygiene compliance rate were higher, there is still the risk that hands can become re-contaminated by touching contaminated surfaces, which is why hand hygiene and surface cleaning, and disinfection are both important factors to reduce infection. Studies have shown that the environment can act as a reservoir in healthcare settings. Pathogens can live on surfaces for days, weeks and even months. Unfortunately, data has also shown that cleaning and disinfection of patient rooms, operating rooms and shared patient equipment is suboptimal. Previous studies have demonstrated that less than 50 percent of patient room surfaces and less than 25 percent of operating room surfaces are properly cleaned and disinfected during terminal cleaning. It has been demonstrated that a patient entering a room that was previously occupied by a colonized or infected patient has significantly higher odds of contracting that illness. Consumerism of healthcare Another aspect for consideration is the evolving consumerism of healthcare. Ensuring the healthcare consumer is a core focus of an organization's strategy is key to improving outcomes, saving costs, improving satisfaction levels and ensuring consumers return or recommend a provider for a future experience. In a recent survey of 1000 patients conducted by Health Industry Distributors Association, patients revealed that a "visible commitment to infection prevention" was the leading factor that drove their satisfaction level with providers. Satisfaction levels also impact reimbursement and brand. HCAHPS is a patient satisfaction survey required by CMS for most hospitals in the United States. The survey results affect reimbursement levels and are publicly reported on the internet for all to see; directly impacting a healthcare organization's finances and reputation. Creating a safer environment of care To create a safe environment for patients, it is important to reduce risk of environmental contamination during stays and to ensure the environment is effectively cleaned and disinfected before the next patient enters the room. A three-pronged approach should be considered to help reduce the risk while demonstrating a "visible commitment to preventing infection." This article addresses these in detail. 1. Ensuring daily cleaning is optimal 2. Deploying Targeted Moments of Environmental Disinfection™ (TMED™) 3. Adding assurance at every discharge with UV–UVCqDC™ 1. Ensuring daily cleaning is optimal Both thoroughness and frequency of cleaning are key to outcomes. There are many considerations to ensure optimization including: a. Clearly defined roles and responsibilities. A checklist of all surfaces, equipment and areas to be cleaned and disinfected, along with who, when and how often these tasks are to be performed is key to ensuring staff members understand their role. It is important for staff to understand not just what to do, but also why these tasks are so important for the safety of staff, patients and visitors. Well-defined procedures need to be in place outlining how to effectively complete these tasks along with tools to reinforce learning. b. Having the right tools to do the job, drives compliance and efficiency. Labor represents the largest cost in healthcare, so it is critical to provide staff with the right products and tools to streamline activities, reducing labor and turnover time. Products and tools that get the job done faster (quicker dwell times, fewer steps) can drive efficiency. To ensure cleaning compliance of high touch surfaces, products selected should be non-irritating to patients and staff to ensure that key activities, such as disinfecting surfaces near the patient, are pleasant for the patient, and also safe for use by staff. c. Deploying a validation program with ongoing training to address areas of opportunity. If cleaning and disinfection compliance is important, it needs to be measured. A measurement program to ensure the job is getting done correctly will improve the odds of success. The data generated through the program can be used to recognize great performance and address areas of opportunity with constructive feedback and increased training. 2. Deploying Targeted Moments of Environmental Disinfection (TMED™) Every human is covered in microorganisms, which can be shed into the environment by patients, staff and visitors entering a patient room. To address this, healthcare settings typically incorporate a daily cleaning regime. Typically, environmental services staff members spend 15 minutes on a daily clean (Source: AHE 2018 Trends Survey). Every patient deserves a safe environment of care

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