Environmental Service Workers Not Feeling the Love

January 13, 2021
Frank Diamond

Many members of environmental service teams feel underappreciated and these health care professionals are not trained in any systematic and continuous way, a study states.

Environmental service (EVS) teams play a crucial (but often unsung) role in preventing infection at hospitals and long-term care facilities (LTCFs), but they’re not trained as well as they should be and see themselves as having a low social status. These are two of the findings in a preprint study in the American Journal of Infection Control. Investigators with Clemson University conducted a systematic literature review of English language studies about EVS conducted between 2000 and 2009.

While environmental service workers (ESWs) felt that they provided little value to the organizations that they worked for, most of them nonetheless felt that the work itself was important in keeping patients safe from infections. The problem is that ESWs are not trained in any systematic and ongoing manner, the study states.

“To sustain improvements in disinfection practices, education/training sessions need to be continuous,” the study states. “The long-term commitment of an organization is also essential for continuous improvement in disinfection outcomes. While knowledge transfer is critical for behavior change, education/training also needs to focus on the skills and perceptions of ESWs.”

In 31 studies that the investigators looked at they note that ESWs know how to do their jobs but that knowledge “does not address many of the barriers identified by ESWs, such as high work demands, ‘me/us versus them,’ interruptions, low status or value for ESWs, and lack of communication,” the study states.

Training of ESWs should not only focus on organizational and work environment elements, but also intrapersonal and interpersonal skills. “Even in a skills-focused field like environmental service, leadership, self-management, conflict resolution, communication, emotional intelligence, and other ‘soft-skills’ are necessary to perform the job effectively,” the study states.

But how to measure how well ESWs perform? In the best of all worlds, that would be done by microbial assessments before and after cleaning. However, there are substantial barriers to doing so, including time constraints, financial costs, and the need to have the microbial samples examined in a laboratory.

At any rate, training about pathogens and microbials should be handled with care. “Many ESWs may not be able to understand advanced microbiology,so information in some areas (e.g., pathogens) should be simple. For example, rather than giving detailed descriptions of what pathogens are, the focus should be on how these pathogens can spread in hospital environments and what procedures ESWs can implement to prevent the spread of pathogens.”

Investigators also noted a dearth of data about EVS at LTCFs, which have been one of the main nexuses of the coronavirus disease 2019 (COVID-19) pandemic. Only one study looked at LTCFs.

“Long-term care facilities have been reported to pay considerably less attention in disinfection than hospitals, perhaps because of limited staff, insufficient infection prevention education, and staff perception of isolation and contact precautions,” the study states.

The training of ESWs noted in the studies involved presentations, instruction booklets, photographs, checklists, and online education modules. Training interventions covered importance of environmental disinfection, importance of disinfecting frequently touched objects, and transmission of health care associated pathogens and infections. “Opportunities for providing feedback during the intervention was reported as a motivational strategy in many studies to improve performance,” the study states.

The main point of the AJIC study is that hospitals and LTCFs must make more of an effort to train ESWs and make them feel welcome.

“Even with the ongoing COVID-19 pandemic highlighting disease transmission in health care facilities, environmental services is still an occupation that receives little attention in society, and carries low occupational prestige in the United States,” the study states. “In the United States, many ESWs are immigrants, people of color, and receive low wages. The reviewed studies identified many ESWs who feel limited respect, appreciation, or positive feedback at work, yet ESWs consistently identified the need to do the job well. They are concerned about patient safety, which forces them to do a good job even if it takes too much time and they are possibly underappreciated.”