How Purposeful Infection Prevention Rounding Supports Patient Safety and EVS Collaboration

Infection preventionists (IPs) occupy a critical leadership role in preventing and reducing health care-associated infections (HAIs); however, the breadth of their responsibilities may be unintentionally constrained by institutional practices, professional training, and longstanding organizational norms. Within some health care settings, IP surveillance and rounding may place substantial emphasis on environmental services (EVS)-related observations, including dust accumulation, deficiencies in high-touch surface cleaning, and visible floor debris.

Although environmental cleanliness and effective health care environmental hygiene are fundamental components of infection prevention, HAIs result from a complex interplay of clinical, behavioral, procedural, device-associated, and environmental factors that extend well beyond the scope of EVS operations. Consequently, a disproportionate focus on readily visible environmental deficiencies during routine rounding may divert attention from other potentially significant infection prevention risks, including inappropriate medical waste segregation, lapses in central line care, improper disposal of hazardous materials, and deficiencies in the cleaning and disinfection of reusable medical devices.

A comprehensive approach to HAI prevention, therefore, requires IPs to employ structured, purposeful rounding practices that systematically evaluate the full spectrum of infection prevention domains while engaging EVS, nursing, clinical services, and other relevant disciplines in shared accountability for patient safety.

The Problem With Overemphasizing EVS

Environmental contamination contributes to pathogen transmission, but it is rarely the primary driver of HAIs. According to the CDC, the most significant contributors to HAIs include central line-associated bloodstream infections, catheter-associated urinary tract infections, surgical site infections, and ventilator-associated events—all of which stem largely from clinical practices rather than environmental dust or debris.¹

When IPs place disproportionate emphasis on environmental services (EVS), several concerns may arise. First, clinically significant infection risks may receive insufficient attention. For example, blood-soaked dressings discarded in general waste or improper handling of a contaminated central-line hub may present substantially greater risks for HAI than relatively minor environmental deficiencies, such as dust accumulation on a windowsill. Second, EVS personnel may perceive this emphasis as inequitable, particularly when environmental deficiencies are repeatedly identified while more consequential clinical practices remain insufficiently addressed. Third, an excessive focus on EVS may inadvertently narrow the perceived scope of infection prevention, reinforcing the view that IPs function primarily as environmental inspectors rather than as interdisciplinary clinical safety partners.

This imbalance is further complicated by professional dynamics. Given the historically strong representation of nursing professionals within the infection prevention field, EVS personnel may perceive that nursing-related workflows receive preferential consideration when infection prevention concerns intersect with clinical operations. This dynamic not only undermines EVS morale but also weakens the interdisciplinary collaboration essential for effective infection prevention.

In an interesting study, EVS personnel reported discomfort with directly identifying lapses in physicians’ hand hygiene practices and with requesting additional time to complete environmental cleaning activities.² This finding is significant because it highlights a potential barrier to effective interdisciplinary communication and infection prevention practice. IPs should actively engage EVS personnel as essential members of the health care infection prevention team and systematically solicit their observations, concerns, and recommendations.

Given their continuous presence in patient care environments, EVS personnel may identify environmental and practice-related risks that might otherwise go unrecognized. Establishing a culture in which EVS personnel can communicate concerns without fear of reprisal or professional marginalization may strengthen collaboration, facilitate timely identification of infection prevention lapses, and support a more robust culture of patient safety.

Improper Waste Disposal: A Significant and Underaddressed Risk

Nursing teams generate most of the bedside waste, yet improper disposal practices remain common across many hospitals. These behaviors create exposure risks for EVS staff, nurses, visitors, and patients.

Historically, nursing pioneers such as Florence Nightingale demonstrated that clinical competence extends beyond the direct treatment of disease to include the systematic management of the health care environment. Nightingale’s renowned nightly rounds through medical wards, symbolized by her lamp, reflected a disciplined commitment to sanitation, environmental hygiene, ventilation, and other practices that helped reduce the transmission of disease. Her advocacy for these measures challenged prevailing medical assumptions of the mid-nineteenth century, at a time when environmental and sanitary interventions were not universally accepted within the medical profession and were perceived as a challenge to established professional authority.

Nightingale’s legacy, therefore, underscores an enduring principle: the prevention of disease requires both clinical knowledge and rigorous attention to the entire environment in which care is delivered. That responsibility must continue to guide contemporary health care practice, particularly through purposeful rounding, in protecting patients and health care workers, including environmental services personnel.

Blood-Soaked Waste in Regular Trash and Segregation Failures

Items saturated with blood or bodily fluids must be disposed of in regulated medical waste (RMW) receptacles.³When blood-soaked dressings, gauze, or personal protective equipment (PPE) are thrown into standard trash bins, they create occupational hazards and violate Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens standards.⁴ EVS staff frequently discover these items, including containers filled with urine, during routine trash removal, placing them at unnecessary risk.

Improper segregation of health care waste streams can complicate downstream handling and disposal processes and increase occupational exposure risks. EVS personnel are often well-positioned to identify waste-segregation discrepancies because of their direct involvement in environmental cleaning and waste management; however, research suggests that their observations and concerns may be undervalued within the broader health care team.²

Linen contaminated with blood should be placed in designated soiled linen bags. Improper disposal, such as placing bloody linen in regular trash, creates cross-contamination risks and exposes staff to preventable bloodborne pathogen hazards.

Misuse of Hazardous Waste Receptacles

Sharps containers, RMW bins, and pharmaceutical waste containers are frequently misused or ignored. Common issues include:

• Overfilled sharps containers
• Leaking biohazard bags
• PPE stuffed into pharmaceutical waste bins
• Regular trash mixed with biohazard waste

These problems represent systemic breakdowns in safety culture and cannot be mitigated by EVS alone.

Other High-Risk Areas Requiring IP Attention

Beyond waste disposal, several domains consistently demonstrate higher clinical impact than environmental cleanliness alone:

• Central line maintenance and access practices
• Point-of-care equipment disinfection
• Hand hygiene adherence
• Isolation precaution adherence
• Device reprocessing and storage

These areas demand structured, intentional rounding—not reactive attention only when an outbreak occurs. Purposeful rounding is a structured, proactive method that allows IPs to evaluate the full infection prevention ecosystem rather than isolated environmental concerns. Effective purposeful rounding includes:

Direct Observation of Health Care Worker Workflows

Watching how staff dispose of waste, handle linen, access central lines, or disinfect equipment reveals risks that cannot be captured through environmental inspection alone. These observations also validate EVS concerns and reinforce interdisciplinary accountability.⁵

Real-Time Coaching and Education

Purposeful rounding positions IPs into partners who support safe practice. Coaching staff on proper waste disposal or central line access is equally impactful as repeatedly identifying environmental deficiencies attributable to EVS.

Building a Culture of Shared Accountability

Infection prevention is a shared responsibility. Nursing, EVS, respiratory therapy, sterile processing, and pharmacy all contribute to infection prevention. Purposeful rounding must reflect this reality.

Rounding should be informed by HAI trends, waste audit findings, sharps injury reports, and unit-specific risks. This ensures that IPs address the most significant threats in their jurisdiction rather than the most visible ones. EVS plays a vital role, but so do nurses, physicians, respiratory therapists, and ancillary staff. A holistic approach:

• Promotes fairness and balance
• Strengthens interdisciplinary relationships
• Improves safety culture
• Reduces HAIs more effectively

Recognizing EVS staff as essential partners and validating their observations helps dismantle hierarchical barriers that impede infection prevention efforts.⁶

Conclusion

Hospital IPs must resist the tendency to overemphasize environmental concerns at the expense of more clinically significant risks. Improper waste disposal, contaminated central lines, and misuse of hazardous waste receptacles represent serious infection prevention failures that require equally focused attention. EVS staff frequently identify these issues, yet their concerns may be overlooked due to professional dynamics within the hospital.

By adopting purposeful, structured rounding that evaluates all infection prevention domains, IPs can more effectively reduce HAIs, strengthen interdisciplinary collaboration, and elevate the hospital's overall safety culture. Comprehensive infection prevention is not only best practice but also essential for protecting patients and ensuring high-quality care.

References

1. About HAIs. CDC. Updated July 15, 2026. Accessed September 28, 2026. https://www.cdc.gov/healthcare-associated-infections/about/index.html
2. Yanke E, Moriarty H, Carayon P, Safdar N. “The invisible staff”: a qualitative analysis of environmental service workers’ perceptions of the VA Clostridium difficile prevention bundle using a human factors engineering approach. J Patient Saf. 2021;17(8):e806-e814. doi:10.1097/PTS.0000000000000500
3. McDonnell GE, Hansen JM, eds. Block’s Disinfection, Sterilization, and Preservation. 6th ed. Wolters Kluwer; 2021.
4. Bloodborne pathogens, 29 CFR §1910.1030. Accessed September 28, 2026. https://www.ecfr.gov/current/title-29/subtitle-B/chapter-XVII/part-1910/section-1910.1030
5. Rutala WA, Weber DJ. Disinfection and sterilization in health care facilities: an overview and current issues. Infect Dis Clin North Am. 2016;30(3):609-637. doi:10.1016/j.idc.2016.04.002
6. Townsend S, Cermignano T, Karley P, Seon N, Coffin SE. Wiping out confusion: a toolkit to define roles and improve cleanliness in complex patient care spaces. Am J Infect Control. 2026;54(7):810-814. doi:10.1016/j.ajic.2026.02.002