Becker's ASC Review

20 Executive Briefing: Sponsored by: W hile infection control practices have contributed to declines in healthcare associated infections, the morbidity and mortality associated with these conditions remains significant. The bacteria Clostridium difficile (C. diff) is one of the most common healthcare associated infections (HAIs). Each year in the U.S. the pathogen causes more than 223,000 infections, contributing to approximately 12,800 deaths, according to the U.S. Centers for Disease Control (CDC). Treating infections like C. diff also places a considerable financial burden on the healthcare system. One 2018 study published in the journal Clinical Infectious Diseases estimated the cost of treating C. diff to be $24,205 per patient. Leaders of healthcare organizations are tasked with protecting their patients and their bottom lines from HAIs. To achieve this, interdisciplinary teams must be assembled to enact a terminal cleaning policy. These policies require cleaning processes to occur every 24 hours. These processes should include cleaning the entirety of a healthcare facility, including walls, floors and all equipment. Gabrielle Cox, RN, MSN, Director of Education and Training for STERIS Instrument Processing Solutions said that in the past, healthcare facilities have focused mainly on cleaning operating rooms. "Less time and attention is spent on places like sterile processing and the rooms where patients come in and wait before they go back to surgery," she said. "We haven't treated those spaces in the manner that they deserve." Lack of adequate and thorough cleaning in healthcare facilities can contribute to the proliferation of HAIs like C. diff. Research published by the Lancet pointed out that only 50 percent of surfaces in hospital rooms are sufficiently cleaned between uses. As a result, patients who then occupy rooms used by patients infected with multidrug resistant organisms are at an increased risk of infection. Additionally, when staff come across surfaces that haven't been properly cleaned, they can spread the infection to others. Creating and using a terminal cleaning policy can help decrease the spread of multidrug resistant organisms. "Terminal cleaning is the responsibility of everybody in the facility," Ms. Cox said. A terminal cleaning policy is more than just scrubbing floors, taking out trash or straightening a patient's bed table. A successful policy includes having all staff on the same page, with each staff member assigned their own task to complete. There should also be dedicated teams tasked with cleaning both the operating rooms and perioperative areas. The Association of periOperative Registered Nurses describes 1 this approach as having a "pit crew mentality," where each member of staff is laser-focused on their specific task to ensure nothing is overlooked. This approach leads to a more efficient and thorough terminal cleaning process. Ms. Cox recommends taking the "5S" approach when developing a terminal cleaning policy. "The five steps include sorting, set to order, standardizing, shine, and sustaining," she said. "The policy should include cleaning the entire area instead of focusing on certain areas or pieces of equipment." The 5S's of terminal cleaning The first step to creating an effective terminal cleaning policy includes keeping areas tidy and sorted before cleaning takes place to ensure staff don't feel overwhelmed by the mess. Setting to order requires every cleaning item to be in the same place so everyone can easily access and use them. Facilities should then standardize products and supplies that can be used by each member of the team when cleaning their respective areas. That way, when staff moves from room to room, they don't have to waste time stopping and reading labels on chemicals they're trained to use. Standardizing involves evaluating staff performance to ensure everyone is following through with their assigned tasks and taking a consistent approach. Maintaining consistency can be difficult in the operating room when cleaning can be rushed along by surgical staff. "It's really important to have a champion surgeon who understands the terminal cleaning workload so they're not setting the expectation of hurrying through the process," Ms. Cox said. "Consider searching for a champion surgeon within the organization to get everyone on board with the policy." The next step — shine — involves developing a maintenance schedule for the facility where each member assigned to a room knows their role in maintaining it and shares status updates about it with other staff to ensure there's no overlap in cleaning schedules between rooms. How a 'pit crew mentality' can improve a healthcare facility's terminal cleaning policy 1 Association of periOperative Registered Nurses. (2018). Guidelines for perioperative practice. Denver, CO: Author

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