Fostering Communication Between the Guardians of the Hospital Environment
By Weston Thiss, CHESP, and Carolyn Bratcher, RN
Im the director of environmental services (ES), and I want to talk about her. You know the one ... she quotes JCAHO standards and CDC guidelines, knows the health commissioner by first name, and even thinks that handwashing will stop nuclear proliferation. She seems to believe that cubical curtains spread the plague. In fact, YOU are probably that one, and have I got something to say to you: Thanks!
Im the infection control professional (ICP) and once again Im paging the director of environmental services. What product is being used to clean in pediatrics? I saw linen being transported today and it was uncovered. Are you certain the mop water is being changed at least every three rooms? I witnessed your staff member using perfect technique when entering an isolation room; let me come speak to the group at your next staff meeting.
Keeping a hospital clean, safe and sanitary is the job of all healthcare professionals. However it is the ICP and the ES director who ultimately have ownership. Yet, why in so many situations do those two professionals clash? How can effective infection control policies be enforced with reduced FTEs, demands for quicker bed turns, squeezing in one last case in the OR, and of course reduced supply expenses? Its easier than it sounds, through efficient communication, teamwork and most importantly a little common sense.
ES professionals report to thousands of experts daily, including every visitor, physician and those mothers whose bathrooms are shrines. Dont forget the CEO who equates a shiny floor to a clean hospital, or the nurse who cant figure out how all those paper punches got onto the floor. Everybody knows what clean is, but do they know what is needed in a high-risk environment to reduce the opportunity of nosocomial infection? This team has to accomplish both, keeping the facility visibly clean and microscopically healthy.
Are you regularly attending ES staff meetings? Do ES personnel know your name, and more importantly, do you know theirs? The basis of a strong alliance lies here, facilitating understanding to the front-line employees; helping them understand just what it is they are really doing not just getting a bed ready or wiping a doorknob, but breaking the chain of infection and stopping those bugs before they make somebody else sick. The front-line ES staff members are the guardians of the environment.
Have you ever been asked to do something and couldnt figure out why? To these guardians, some of our directions seem dumb; they may ask, what is the reason for doing it that way? Such as changing the mop water when it doesnt appear dirty? Or changing out cubical curtains in certain rooms when the patient couldnt even get out of bed? Or removing my gloves when leaving the patients room? ES personnel can be the eyes and ears of the ICP, and they cherish the responsibility once they know, understand and value the importance of their guardianship. The role of the ICP is to embrace this staff, understand their value by creating an ES/ICP partnership. Know them as they know you, attend their staff meetings and explain simply, there are good bugs and bad bugs; I need your help keeping the bad bugs from our patients. The way to help is use the tools and guidelines we provide to stop them where they are, not carry them down the hall. There never are dumb questions, if you dont understand why, please ask; we are here to help you to help our patients.
At Bon Secours St. Marys Hospital in Richmond, Va., environmental services and infection control are definitely friends, not foes. The ES staff eagerly rush to report breaks in the practice of infection control. They realize how important they are in breaking the chain of infection.
The rapport was established years ago and is maintained through continuing education, personal contact and infection control/environmental rounds. Front-line staff are invited to participate in rounds and encouraged to point out what they see as potential infectious hazards. This role as messenger is rewarded through commendation letters, recognition at staff meetings and an occasional prize. Never forget to give these important guardians praise and credit for the hard work they do.
Weston Thiss, CHESP, is director of environmental services and Carolyn Bratcher, RN, is infection control coordinator at Bon Secours St. Marys Hospital. Thiss is 2003 president of the American Society for Healthcare Environmental Services (ASHES) and Bratcher is the legislative representative for the Virginia chapter of the Association for Professionals in Infection Control and Epidemiology (APIC).