Environmental Hygiene Case Studies


ICT invited members of industry to submit case studies illustrating practices and products that facilities are using to combat healthcare-acquired infections (HAIs).

PDI Case Study: Improving Environmental Hygiene in a Pediatric System Through a Multi-Disciplinary Approach

Recently, a large pediatric teaching hospital system presented study findings at the 2010 Association for Professionals In Infection Control and Epidemiology annual meeting in New Orleans. The study examined the impact of contaminated environmental surfaces on the development of healthcare-acquired infections (HAIs). Environmental surfaces have a documented 30 percent to 40 percent associated with healthcare acquired infections. Many microorganisms are very resistant to cleaning and disinfection practices. The Agency for Healthcare Research and Quality states that, "ungloved hands became contaminated with low levels of pathogenic microorganisms more than 50 percent of the time, even from surface in rooms that had been terminally cleaned after patient discharge."

Collaboration between the clinical staff and the environmental services personnel is critical to maintaining a clean environment of care, and also aids in reducing of the presence of multidrug-resistant organisms (MDROs). In this study, the facilitys infection prevention team collaborated with the environmental services department to implement a best practice, evidence-based bundle to include deep cleaning of all patient rooms, education of both clinical and EVS staff members, recognizing the healthcare worker and the environmental services workers role in the prevention of HAIs, and the house-wide use of a disposable germicidal wipe (PDI Super Sani-Cloth®) for disinfection of high-touch surfaces and noncritical items throughout the facilities.

In phase one of the study, a multi-disciplinary team evaluated the systems, processes, and regulatory requirements to attain a best practice model. Systems monitoring was also enhanced. Out of these conversations amongst the stakeholders, a full cleaning and disinfection bundle was developed and key environmental services staff were educated regarding the components.

The results of the study demonstrated a clear delineation of understanding of roles and responsibilities for cleaning and disinfection, the bundle being completely adopted by the stakeholders, and a reduction in environmental contamination. Collaboration between departments was critical to overcoming obstacles and building relationships between healthcare workers and environmental services Staff. C-Suite support helped build the bridge for a cultural transformation. Beside installation of disinfectant wipes (PDI Super Sani-Cloth®) allowed for point-of-service use, thus hardwiring the process for environmental cleaning and disinfection. Through this initiative, the facility was also able to align stakeholder to the same goal of zero tolerance of healthcare acquired infections.

Reference: Peace D. A Multi-Disciplinary Approach to Improving Environmental Hygiene in a Pediatric System. Am J Infect Control. July 2010.

Ecolab Inc. Case Study: Improving Patient Room Cleaning Outcomes

There is a growing body of evidence that shows the environment plays a key role in the transmission of pathogens to patients. As such, hospitals are increasingly looking for ways to improve their environmental hygiene programs to address this area of concern for infection prevention.

In an effort to continuously improve cleaning outcomes, Advocate Christ Medical Center, a 650-bed hospital in Oak Lawn, Ill., and Hamot Medical Center, a 350-bed hospital in Erie, Pa., both implemented pilots of Ecolabs PROTECT Environmental Hygiene Program in 2009.

The pilot projects looked at three main challenges to environmental cleaning:

-- Research shows that, on average, patient rooms are effectively cleaned only 47.9 percent of the time.

-- Cleaning of high touch objects is critical to prevent transmission of pathogens from the environment to patients.

-- Methods used to monitor and evaluate the effectiveness of environmental hygiene are often subjective.

The two pilot studies evaluated the impact of a programmatic approach to environmental hygiene on cleaning practices, efficiency, sustainability and staff competency. The program consisted of staff training and coaching on best practices for environmental hygiene, a new, more accurate dispensing system, EPA-registered disinfectants, microfiber cloths and mops, ergonomic cleaning tools, a cleaning station that improves efficiency and prevents cross contamination and DAZO® Fluorescent Marking Gel.

To measure baseline and post-implementation outcomes of the PROTECTTM Environmental Hygiene Program, each site evaluated the thoroughness of high-touch surface cleaning using DAZO® Fluorescent Marking Gel. Dispensing system accuracy, room cleaning time, water and chemical use and staff competency were also measured. Advocate Christ Medical Center also used environmental culturing to correlate removed DAZO® marks with a decrease in total colony forming units of bacteria.

After implementation of the PROTECT Environmental Hygiene Program, both hospitals improved their cleaning effectiveness, dispensing accuracy, room turnover time, water and chemical usage and staff competency (see Table 1).

"Its critically important that the environmental services staff understand their role in infection prevention," says Emily Shears, at Hamot Medical Center. "The DAZO® marking gel was helpful in providing immediate feedback and training opportunities on cleaning effectiveness."

Through the use of both the DAZO® Fluorescent Marking Gel and environmental culturing, Advocate Christ Medical Center was able to show that there was a higher correlation between removal of DAZO® marks and decreased colony forming units of bacteria on high touch surfaces after implementation of the program. "We strive to continually improve environmental cleaning outcomes," says Karen Martin, RN, BS, HPN, MPH, CIC, director of infection control/epidemiology and environmental services at Advocate Christ Medical Center. "The PROTECT programs training and best practices are helping us do that."

Successful environmental hygiene programs take a comprehensive approach that includes the right tools and EPA-registered products, education, training and best practices to help hospitals clean patient rooms more consistently and effectively. A comprehensive program can significantly help reduce the environmental transmission of harmful bacteria. To view the table associated with this case study, see the December 2010 issue of ICT.


1. Carling PC, Po JL, Bartley J, Herwaldt L. Identifying Opportunities to Improve Environmental Hygiene in Multiple Healthcare Settings. Fifth Decennial meeting, Atlanta. March 18-22, 2010.

Rubbermaid Commercial Products Case Study: Cleaning Patient Rooms and Boosting Productivity

St. Agnes Hospital, a full-service teaching hospital serving southeast Baltimore and the northeast Maryland corridor, has joined with industry leaders to strengthen the facility's commitment to provide a safe and clean healthcare environment. Rubbermaid Commercial Products, in partnership with Crothall Services Group, provided integrated microfiber cleaning and waste management product solution sets in support of the St. Agnes commitment to both patient care and employee well-being, as well as to controlling infection and complying with Joint Commission and OSHA guidelines.

A member of Ascension Health, St. Agnes Hospital is a 323-bed, full-service community teaching hospital operating under the umbrella of St. Agnes Healthcare. St. Agnes has the second busiest emergency department (ED) in Maryland, with more than 60,000 cases annually, as well as providing a broad range of key services including the St. Agnes Cancer Center, the Chest Pain Emergency Care Center, bariatric and cardiovascular services, and orthopedic and spine care programs.

The St. Agnes Hospital commitment focused on:

-- Continuing to lower facility infection rates through the implementation of a best-in-class microfiber cleaning solution.

-- Support green cleaning practices and sustainability through lower chemical/water usage, increased product lifespan, improved productivity through decreased re-supply times, and increased public safety by safeguarding hazardous supplies.

-- Enhance worker well-being with lighter, more maneuverable and ergonomically designed cleaning tools, carts, and waste receptacles.

Crothall Services Group, acting as the product review team for St. Agnes Hospital, chose Rubbermaid Commercial Products HYGEN Microfiber Cleaning System and products from the utility and decorative refuse container categories. Chris Smith, environmental services director at St. Agnes Hospital and a member of Crothall's national products selection committee, says that Rubbermaid® products are designed with "process changing technology." He adds that the cohesive product technical support and training provided by Rubbermaids Healthcare Product Specialist Team played a strategic part in the decision process. The best-in-class product solutions from Rubbermaid were chosen because they offered compelling features and benefits in support of the commitment targets. Sales support from the Rubbermaid team provided facility needs-analysis and training, coupled with Rubbermaid branded product quality assurances.

"We have significantly increased the productivity of cleaning patient rooms, especially in the ED and ICU," says Smith. "With the Charging Bucket, we are able to clean every room in each unit without having to go back to the housekeeping closet. Per unit we have saved each housekeeper 30 minutes, which at the end of the year is equal to one full-time employee."

Among the products being used at St. Agnes is the Rubbermaid HYGEN High Security Cleaning Cart, which has a compact, easy-to-maneuver footprint with efficient space organization, and features a locking hood for extra security. The facility also uses the Rubbermaid HYGEN Microfiber Wet and Dry Pads. The split-end microfiber, as documented by William A, Rutala,1 has been scientifically proven to remove almost 100 percent of dangerous bacteria like MRSA without the use of any chemicals. The durable construction is bleach tolerant, withstanding hundreds of commercial launderings. The pads are color-coded for high absorbency, reduces chemicals, supports one pad per room cleaning, and highly effective for reducing cross-transmission incidents. Also being used is the Rubbermaid Mega BRUTE Mobile Collector, a versatile waste and linen collection and sorting system. "The Mega BRUTE® is friendly to all users both clinical and non-clinical," Smith says. "Its large capacity and maneuverability has greatly increased the productivity of our waste stream collection."


1. Rutala WA. Disinfection, Sterilization and Antisepsis. 2007.

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