Fostering Collaboration Between Infection Prevention and Environmental Services

Roye-Horn says that cultivating the right stakeholders can also serve the infection prevention agenda. “While we have just one FTE for infection control, there are ways to get others to invest in infection prevention. For instance, the clinical nurse leader (CNL), who is our patient safety nurse, is really an extension of infection control; they are not under my department but they play a big role in infection prevention by observing practices out on the floor, by educating people, or by deciding certain competencies are needed because of what they are observing. So, having CNLs is almost as good as having more ICPs at my facility.”

Observational rounds performed by ES directors and ICPs is another important collaboration that pays big dividends in improved infection control by noting any variations in practice that could be hampering compliance. These rounds have helped Hunterdon to develop a cleaning sequence for patient-touch surfaces that is a helpful teaching tool, according to Roye-Horn.

“When addressing environmental services practices, it works well for me to go with our ES director,” Roye-Horn says. “She is as committed to infection prevention as I am, and so we like to observe staff practices together. That way, it becomes a little less formal and intimidating, as we are chatting together and with them. In other kinds of observations, for instance, our CNLs perform clinical practice observations relating to direct patient care. It may be difficult for them because they are in the role of having to correct people, but it’s been such a valuable process. For years we had people who were on the performance improvement council for nursing observe handwashing, and we would always have 100 percent or 98 percent compliance — that’s because they were sitting at the desk and if people clean their hands in a room, they mark ‘yes’ on a form. Now, we have people who actually observe how they did it, did they rub their hands together for the right amount of time, with the right amount of product, and did they do it before a patient interaction and after? That’s when we saw numbers that were much worse. The quality and detail of the observation is what makes a difference. We detected many things via direct monitoring that surprised us. We thought people know a certain protocol, but when you actually watch what the practice is, step by step, it’s eye-opening. I don’t think we’ve found a more valuable tool than direct observation.” 

References:

Crnich CJ, Safdar N, and Maki DG. The role of the intensive care unit environment in the pathogenesis and prevention of ventilator-associated pneumonia. Resp Care. Vol. 50, No. 6. June 2005.

Hota B. Contamination, disinfection, and cross-colonization: Are hospital surfaces reservoirs for nosocomial infection? Clin Infect Dis. 2004;39:1182-1189.

Kramer A, Schwebke I and Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infectious Diseases. 2006;6:130.