As the science behind the transmission of microbes on hospital surfaces becomes clearer, an appreciation of environmental services (EVS) departments grows stronger. At least 25% of surfaces in a patient room are contaminated with pathogens, which can then be transmitted to the patient.1A study by Cohen et al found that patients have 5 to 6 times increased odds of acquiring an infection when they were placed in a contaminated room.2
EVS staff in healthcare settings are either employees of the facilities or those working with outside vendors. In either situation, infection preventionists need to understand the competencies and training of the staff who are performing cleaning and disinfection in their facility. IPs should meet with the EVS leadership to review what their competencies and training include, in particular for daily cleaning, terminal cleaning, special isolation rooms (ie, Clostridiodes difficile or norovirus), and cleaning in procedural areas such as operating rooms (OR), cardiac catheterization labs, or interventional radiology suites.
The IP can bring the standards and guidance from various national groups as references, such as the US Centers for Disease Control and Prevention (CDC) and the Association of Operating Room Nurses (AORN). The EVS leadership can bring standards from their national organization, such as the Association for the Healthcare Environment (AHE).
IPs can work with EVS to evaluate and approve the best cleaners and disinfectants that are used in the facility.
Criteria to make the decision include: kill claims, contact time, how the product must be applied (ie, ease of use), personal protective equipment (PPE) that is required of the EVS staff when using, the dilution requirements of the product, whether a rinsing step is needed after application, compatibility of the disinfectants with the surfaces to be cleaned, and cost. Any time there are product changes proposed, the products need to be reviewed and approved through infection prevention.
EVS should be part of the infection prevention committee of the organization and be included on agenda items as appropriate. The IPs can work with EVS leadership to develop quality assurance metrics that can be measured and reported out on a regular basis at the IP committee meetings. That venue allows for multidisciplinary review and discussion of any concerns or issues with EVS quality metrics or processes that need to be reviewed and implemented. Some ideas for quality measures for EVS include monitoring throughput to ensure that enough time is given for terminal or discharge cleaning; audits of high-touch surfaces being cleaned on a daily basis, terminal cleans utilizing fluorescent gel, or ATP programs; and audits of cleaning in procedural areas. Evaluation of cleaning practices can start at a basic level, depending on the amount of resources available to the EVS program. As hospitals develop and launch these programs and gain resources, the auditing program can expand, in particular when or if there’s a spike in transmission of multidrug-resistant organisms or other hospital-associated infections (HAIs). IP and EVS can develop expectations based on CDC guidance and other industry standards. The CDC has developed an example of these types of auditing programs that are available for IP and EVS programs to use as templates for their own facilties.3
IPs can promote collaboration with EVS by attending staff meetings and huddles. IPs can introduce themselves and discuss how EVS contributes to the infection prevention activities of the facility. IPs can also learn from EVS staff about the challenges they face and provide a voice for EVS staff in hospital operations. IPs can provide education on topics of interest to the EVS staff and promote the role the EVS staff play in IP programs.
New technology has emerged in EVS practices that the IP can assist in reviewing in order to develop a proposal for the organization to adopt the technology. UV disinfection and hydrogen peroxide mist technology are both recent advances to supplement the cleaning and disinfection process for EVS. The IPs at the facility can assist with researching the latest technology, determine what would be the best fit for their organization, and work with EVS leadership to develop proposals for capital purchases and return on investment proposals for these innovative devices and products.
AHE provides certification in infection prevention. The certification for mastery of infection prevention for environmental services professionals (CMIP) is a national program that promotes the integration of infection prevention into environmental services programs. This program is aimed at EVS leadership. IPs can promote this certification in their organization. For EVS staff, there are education modules available from national organizations, such as APIC and AORN that can be utilized in developing training information that the IP can distribute at the facility based on the needs of the staff.
The APIC modules include such areas as: basic principles of infection prevention; safe PPE use; chemical safety; and surface disinfection processes.
These trainings are available in Spanish as well. AORN has modules specific to cleaning in the OR for between case cleaning and terminal cleaning. The CDC offers training for EVS staff on the importance of infection prevention, and also provides posters and print materials. All of these resources are excellent ways to provide information to EVS staff and help them understand their role is integral for infection prevention.
IPs perform routine rounding in their facilities. EVS leadership can be included in those environmental rounds. A joint checklist can be developed for all areas of the facility that includes items for IPs and EVS to review on the rounds and issues can be discussed at the time of the observations. Construction meetings and rounds should also include EVS for the importance of cleaning during and after the completion of the project. EVS staff are involved in every area of the facility and are a resource that can be trained as covert hand hygiene observers. By including EVS staff in this process, they become eyes for the IP program and will also develop a stronger sense of the importance of hand hygiene and the appropriate times when hand hygiene is needed.
EVS should be included in the plans for a facility’s response for high-consequence diseases, such as Ebola, as well as other emergency preparedness scenarios. EVS needs to be included in the development of organizational plans, serve as subject matter experts in the disposal of biohazardous waste from such events, and participate in tabletops and drills. IPs can assist with the collaboration of EVS into emergency preparedness scenarios by ensuring those questions are asked during the creation of the plans and by interjecting those challenges into exercises that would bring EVS concerns to the forefront.
Infection preventionists have to be masters at collaboration across departments in order to achieve the goals for their programs. The work of EVS is one of the fundamental cornerstones of infection prevention and IP has the opportunity to connect with their partners in EVS and promote their importance in the organization as a key player in patient safety and the quality agenda.
Rebbeca Leach has been an infection preventionist since 2010, with a background in nursing and epidemiology. Her interests include social determinants of health and reproductive health.