By Peter Teska
Healthcare-associated infections (HAIs) take a toll on patients, their families, hospital staff and the bottom line, and impact the reputation of and funding for healthcare facilities. In fact, on any given day, 1 in 25 hospitalized patients, or roughly 600,000 each year, must deal with an HAI, according to the Centers for Disease Control and Prevention (CDC).
Since pathogens in the environment are believed to contribute to some portion of HAIs, it’s crucial that every healthcare facility practices proper environmental hygiene through cleaning and disinfection of surfaces and proper hand hygiene. Environmental hygiene is an approach that requires proper planning and fulfillment of multiple tasks. A Facility Hygiene Plan (FHP) helps organizations address critical elements that can contribute to environmental hygiene issues which can cause infections.
What drives facility managers?
Multiple factors impact how a facility is run, including concerns with:
• Productivity – of the staff doing facility maintenance and cleaning
• Ergonomics – of tasks to minimize the risk of injury
• Results – to align with expectations of facility appearance and hygiene
• Consumption – to manage the chemicals, water, energy and other supplies needed to run the facility
• Safety – to ensure the staff and public are appropriately protected while in the facility
Many of these factors are reflected in the choices made in an FHP. An FHP is a comprehensive plan that should be created before a time of crisis, such as an infection outbreak. It outlines how the healthcare facility will conduct certain processes in order to maintain cleanliness at all times. Every employee should be aware of and understand the information within the FHP so that they comply with the proper processes and are prepared during times of heightened risk.
The Elements of an FHP
Development of an FHP includes consideration of numerous elements, including:
1. Risk Assessment and Planning: Facilities should conduct an assessment to determine and outline various pathogen risks. After the assessment, the facility can determine changes that need to be made, such as additional storage for infection prevention supplies or the addition of more handwashing stations.
2. Cleaning and Disinfection Products, Processes, Tools and Machines: The FHP should outline the recommended products, processes, tools and machines so that cleaning standards are maintained. For products, organizations should consider what disinfectants and cleaners will be used and on which surfaces, as well as limitations for their use. Facilities must also determine if current cleaning processes address the risk of environmental transmission. For tools and machines, organizations should consider ease of use, efficiency, ergonomics, safety, noise level, water consumption and the advantages of disposables versus reusables.
3. Stock Level of Supplies: Facilities should set a base level of important supplies for daily operation, such as disinfectants, hand hygiene products, trash bags and paper towels. Facilities should know in advance what supplies will be needed, the quantity to order and the lead time. Typically, there should be two to four weeks of supplies on hand, but during outbreaks, two to three months of supplies is recommended. The lead times in obtaining additional supplies during an outbreak should be a consideration during the planning process.
4. Training for Staff: The FHP should highlight important training topics for cleaning staff and/or building service contractor employees, including how, what, when and where to clean, hand hygiene practices and personal protective equipment (PPE) requirements.
5. Visitor Communication Materials: Facilities should consider developing materials like posters, table tents and pamphlets for staff and the public that communicate the risks of certain pathogens and desired behaviors. For routine concerns, such as cold and flu season, materials can be developed in advance. For emerging pathogens, materials may have to be created during the outbreak. Identifying key behaviors for staff and visitors is an important consideration in developing the FHP.
6. Hand Hygiene: FHPs need to specify points where hand hygiene is available, either via soap dispensers and sinks or hand sanitizing stations. Facilities must also ensure that hand hygiene products are effective against pathogens of concern and that they are conveniently located within the facility.
7. Blood and Body Fluid Cleanup: Blood and body fluids can transmit pathogens so staff should use a disinfectant meeting CDC guidance. In addition to the proper disinfectant, the FHP will detail the proper PPE for workers dealing with blood and body fluids and outline how to decontaminate tools after they are used to clean such spills.
8. Respiratory Hygiene: Some illnesses are transmitted by respiratory secretions, so staff, patients and visitors should be encouraged to cover coughing and sneezing by using their elbow rather than their hands, and dispose of tissues after a single use and wash hands after using a tissue.
9. Staff Personal Hygiene and Vaccinations: Facilities should encourage clinical and cleaning staff to bathe daily, wear clean uniforms for each shift, perform frequent hand hygiene and keep vaccinations up to date. Many healthcare facilities now require staff to receive annual influenza vaccinations, which can help reduce the risk of staff being sick during times of peak influenza activity.
10. PPE: Cleaning staff need access to gloves, fluid-resistant gowns, masks, face shields and leg and foot coverings. The FHP should detail when these items are required and how to put on and take off PPE to ensure proper protection.
11. Compliance Monitoring and Auditing: Healthcare facilities should have programs that monitor hand hygiene, environmental surface cleaning and PPE usage so that they can track compliance and make necessary improvements. The FHP will outline the programs in place so that employees are aware of their existence and purpose.
Protecting What’s Important
Each consideration within a facility hygiene plan supports the same goal: protecting patients, visitors and staff. When organizations develop and follow a detailed FHP, and update it as additional pathogens emerge, it’s easy to understand what to do and when to do it. As a result, organizations are better able to prevent outbreaks and limit the impact of those that do occur, which in turn improves their bottom line, reduces costs and pain and suffering for patients and their families, and helps protect the facility’s reputation.
Peter Teska is a global healthcare sector expert with Diversey Care, a division of Sealed Air Corp., a leader in food safety and security, facility hygiene and product protection.