Becker's Spine Review

50 OUTPATIENT SURGERY Environmental Cleanliness in an Ambulatory Care Setting: 5 Things to Know By Mackenzie Garrity D espite their best efforts, infection and prevention leaders can struggle to keep facilities, especially in ASCs, due to limited resources available to imple- ment a standardized environmental cleaning program. However, as all settings of care are susceptible to infection, ambulatory leaders must have infection prevention on their radar to ensure they yield excellent patient outcomes. "All healthcare settings, regardless of the level of care provided, must make infection pre- vention a priority," said Barbara Connell, vice president of medical affairs/quality at Med- line Industries Inc., during a Medline-spon- sored webinar. Here are five things for healthcare leaders to know about implementing a standardized en- vironmental cleaning program. 1. How do patients and staff transmit infections and diseases? Aer an inan- imate surface is contaminated, patients and staff can easily and unknowingly transmit its pathogens to susceptible others within the fa- cility. ese pathogens are oen passed aer touching the contaminated surface. Patients oen shed pathogens onto nearby objects, and Ms. Connell said 20 percent to 40 percent of cross contamination occurs via healthcare personnel's hands. "e revelation that cleaning is not done consistently and that drug-resistant organ- isms can be recovered from hospital surfaces has brought about an awareness of the role of these areas in disease transmission," Ms. Connell said. Hand hygiene compliance has gained awareness in surgery centers. In the past, The Joint Commission recommended hand hygiene compliance rate exceeding 80 per- cent, according to Ms. Connell. However, the agency has since altered its position and no longer requires a certain level of com- pliance. The key is to have a robust hand hygiene program that includes surveillance and shows continued improvement in com- pliance. 2. Cleanliness affects patient satisfac- tion. Patient satisfaction has a positive cor- relation with a clean environment. Ms. Con- nell cited a 2016 Health Industry Distributors Association survey that found 48 percent of patients said one core reason their provider surpassed their expectations was his or her dedication to infection prevention. Infection prevention and cleanliness includes: • Hand sanitizer and other cleaning and sterilization products being visible throughout a facility • Staff frequently washing their hands • Issuing masks to patients who need or request them • Presence of infection control signs Staff should ensure every area adheres to the same level of cleanliness. ey should also routinely perform cleaning and sterilization tasks. 3. Understanding the difference be- tween cleaning and disinfecting. e words 'cleaning' and 'disinfecting' are oen used interchangeably; however, the two terms define different tasks. Cleaning always precedes disinfecting and entails removal of visible soil and organ- ic contamination. Cleaning is also typically done with appropriate chemical agents. Disinfecting is the process of eliminating or reducing harmful microorganisms from in- animate objects and surfaces. Ms. Connell recommended using microfiber cloths and mops to apply liquid disinfectants to surfac- es. She noted staff members should disinfect shared equipment between each patient use and according to the manufacturer's instruc- tions. "Disinfectant should be used in the manner recommended by the manufacturer," Ms. Connell said. She reiterated while staff may have found short cuts or quicker meth- ods, it is always important to follow the man- ufacturer's directions to achieve the required level of disinfection." 4. Who is responsible for clean- ing? Some facilities bring in cleaning ser- vices while others rely on their staff to get the job done. If your facility relies on staff, your facility should provide training upon hire, and repeat sessions or when policies and procedures are updated. Job-specific infection prevention education is invalu- able for staff On a regular basis, facility managers and administrators can assess the cleanliness of their center by monitoring their facility with techniques such as, florescent gel markers or ATP bioluminescence systems. But, it is up to the facility to determine the standard for measuring cleanliness. "ere is no standard method for defining the level of microbial contamination that correlates with good or poor environmental hygienic practices," said Ms. Connell. 5. Resources are available for facility leaders to improve cleanliness. e CDC provides a detailed checklist for outpa- tient settings. e checklist includes: • Whether personnel who clean and dis- infect patient care areas are properly trained • If the facility is regularly audited • If the facility has written policies for routine cleaning and disinfecting envi- ronmental surfaces e CMS surveyor's worksheet is also avail- able to show you what they will be looking for during an inspection. e CDC checklist and the CMS surveyor's worksheet are great tools to help you identi- fy areas for improvement in environmental cleaning and disinfection program. By uti- lizing these checklists, facilities can develop robust environmental cleaning programs that show their dedication to preventing disease and infection. n

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