Dont forget to wash your hands. Dont touch that, its dirty. Every childs mother nagged them with these statementsbefore and after meals, after sneezing or coughing and certainly anytime a public bathroom was involvedfollowed by the threat of impending illness if the instructions were not followed. Turns out, she was right. And in the healthcare facility climate, those words of wisdom are rules to live by, as created and implemented by environmental services (ES) and infection prevention and control practitioners.

Hospital-acquired infections (HAIs) are a leading cause of patient deaths in hospitals worldwide, specifically those infections caused by unsanitary facilities and unwashed hands.

Everyone recognizes the need for cleaning, says Mark Regna, special advisor to the American Society for Healthcare Environmental Services (ASHES) and director of healthcare services at Addison, Texas-based Jani-King International, Inc. But, really, the proper terminology is clean and disinfect.

The relationship between cleaning and disinfecting is symbiotic and both must be actively implemented in order to achieve the goal of preventing the spread of infection. Basically, cleaning removes the dirt, or bioload, allowing a disinfectant to kill the infectious agents that are presentbut the two procedures must be used in tandem for the best result.

Dirt must be removed before disinfecting can be accomplished, says Rose Hamann, director of environmental services at Blessing Hospital in Quincy, Ill., and president of ASHES. Not decreasing the bioload before using a disinfectant decreases the efficacy of the disinfecting solution.

As a result, strict cleaning and disinfecting procedures are a necessary component of any healthcare facilitys goal of preventing the spread of infection; the question is, how can healthcare staff members raise the profile of these contamination issues within their facility and on a broader scale?

There Is No I In Team

Ultimately, the job lies with those responsible for creating and implementing sanitization procedures like surface cleaning and hand hygienethe ES and infection control (IC) departments.

ES is responsible for actually doing the work of keeping the facility clean and safe; IC is responsible for developing the policies and procedures of having an infection control program in a healthcare facility, says Bill Slezak, healthcare industry segment manager at Winchester, Va.-based Rubbermaid Commercial Products and industry liaison for ASHES.

Though separate departments, ES and IC personnel comprise a facilitys frontline effort to reduce the statistics of HAIs, and as time goes on, it is becoming increasingly obvious that such a goal cannot be accomplished unless they work as a team.

The whole healthcare environment has really come to understand how collaborative things need to be so as to achieve the ultimate goal of preventing a patient from getting sick while at the hospital, Slezak says. Before, it was more that IC would make the rules and ES would carry them outbut now, these two groups have created a unique partnership and are beginning to truly understand the value of that partnership.

However, this partnership is still a work in progress and requires both departments to work hand-in-hand in order to be successful, especially because the two groups worked separately for so long. Also, because ES staff members still take much of their lead from the IC director, hierarchy issues can create a problem.

ES and IC must share the lead regarding the prevention of HAIs each is just one part of a bigger program, Regna says. We look at ES personnel as being in a support function, but they are also in an operational function as the frontline to preventing a patient from acquiring an HAI; that means that both IC and ES must be involved in decisions like what soap to useand each must be an expert about cleaning and disinfecting the healthcare facility.

Keeping Your Head in the Game

The key to overcoming departmental differences and achieving the status of partners is communication; unfortunately, communication between the two groups is not always easy. Most healthcare facilities only have one or two IC directors vs. 60 to 100 ES staff members, and turnover in the ES department is often a problem in regard to maintaining proper training and familiarity with the facilitys policies and procedures.

Due to a lack of understanding regarding all that the ES department in responsible for, they consequently can be an easy target for budget cuts and outsourcing, Slezak says. You constantly have new people on board, so you must have different strategies to account for issues like language barriers.

Because of such issues, ES and IC personnel must work even harder to ensure that ES staff members are appropriately trained. Not only will that have a large impact on how successful the two groups are in achieving their goal of lessening HAI statistics, it is a large component of maintaining interdepartmental cooperation between ES and IC.

Everyone must be educated about the mechanics of infections and the role both departments play in the elimination and prevention of infection, says Tina Cermignano, an ASHES board member and manager of quality assurance, systems and development for environmental and linens services at the Childrens Hospital of Philadelphia. ES staff especially must be trained, as they have the potential to be the ambassadors of a facility safe; IC is responsible for developing the policies and procedures of having an infection control in regard to contamination issues. It is what they do every day and how they do it that keeps the patients, staff and visitors safe.

Holding staff meetings and educational in-services are two more ways to bolster communication and foster a true sense of partnership between departments. It also offers an opportunity for ES and IC personnel to see things from one anothers perspective and a forum in which to share their opinions with each other.

Inclusion gives evidence to the fact that each departments duties are important to the big picture, because it takes everyones efforts to be successful in maintaining a safe environment, Hamann says. Therefore, its important for IC to be invited to speak at ES meetings, especially when new chemicals or procedures are proposed; also, ES should feel able to report infractions or potential problems to IC. These things foster a team mentality.

Also, attending meetings and in-services ensures that ES workers are aware of what they are responsible for and are kept up-to-date on any changes in procedure; similarly, it helps the IC director keep abreast of what is and is not working for the ES staff in regard to those responsibilities and procedures.

Healthcare is a heavily regulated industry, but regulations arent specific, Slezak says. They say that you have to provide a clean and safe environment, but they dont say you have to clean and disinfect the floor, specifically. Those specifics are left up to the individual facility, which is why it is so important that ES and IC get together to discuss these things.

Hamann adds that not explaining new developments or simply changing something without notice are two common problems that can negatively affect the ability of ES and IC personnel to work together.

ES and IC must be involved with each other when changes need to be made, if only to educate everyone about why such a change is necessary, she says.

However, if ES and IC staffs are routinely attending meetings and educational in-services together, chances are that these problems will not arise.

The Overarching Goal

In addition to maintaining open lines of communication, IC personnel have a responsibility to walk the floors alongside the ES staff. Becoming complacent in their role as policy-makers without assessing how the policies and procedures they have generated are accomplishing the overall goal of infection prevention is not a foolproof way to address contamination issues.

Walking rounds together is an important facet of working together, Cermignano says. There should be regular rounds that IC and ES participate in together, not separately, because when these rounds are conducted jointly, there is an appreciation for one anothers role and knowledge.

By maintaining a collaborative work environment, the ES and IC staffs can work as a team to spread the message of cleaning and disinfecting and not just within their departments. From staff members to patients to visitors, everyone at a healthcare facility can affect the rate of HAIs; therefore, everyone must be made aware of contamination issues and the importance of surface cleaning and proper hand washing. It is not enough for ES and IC personnel to clean and disinfect all contaminated and high-touch surfaces and practice good hand hygienethey must also encourage all other staff members, patients and visitors to do the same, Hamann says.

Regna agrees, and says that visitors are often under the impression that what they do has no impact, because hospital staff will clean up after them when they leave.

Sometimes even doctors dont realize the contamination issues that can arise from things like ties or jackets, Slezak says.

As a result, the ES and IC departments have a responsibility to be active partners in the process of eliminating HAIs in healthcare facilities through the generation and implementation of policies and procedures that address contamination in order to prevent the spread of infection.

Ultimately, if we can stop infections from spreading, we eliminate HAIs, Cermignano says. Therefore, there must be a partnership between ES and IC to ensure that there are policies, practices and procedures in place that enable all healthcare workers the ability to break the chain of infection.

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