Infection Control Today: Environmental Services

May 1, 2005

Partners in Clean

ES and SPD Staff Collaborate to Keep the SPD Spotless

By Kris Ellis

Each facilitys sterile processingdepartment (SPD) is an indispensable component of the effort to provideexcellent patient care. In order to be successful in their mission of providingclean and sterile instrumentation to the operating room (OR), SPD staff musthave an organized and sanitary area in which to work. Imperfect housekeeping inthis area may increase the potential for contamination and hinder the departmentsefficiency.

The American Society for Healthcare Central ServiceProfessionals (ASHCSP) offers several basic guidelines that apply to cleaningthe SPD, including:

  • Cleaning should begin in the sterile holding area and progress to the dirtiest part of the area

  • The sterile storage area must be as clean as possible and free from dust and insects

  • Floors should be damp-mopped or wet-vacuumed each day

  • All work surfaces should be cleaned using a germicidal solution

  • Walls, ceilings, vents and ceiling fixtures should routinely be inspected for dust and other debris, and should be damp-dusted at least monthly, or as needed

  • Carts and containers should be cleaned regularly using detergent and a disinfecting agent

  • Records should be kept of all cleaning activities.1

The SPD presents a unique challenge for environmental services(ES) departments in several respects. I think its a unique area in thefact that theres so much activity happening in that area, so you try to doyour job around whats going on in there, says Brett Higgins, manager ofenvironmental services and grounds at Davenport, Iowabased Genesis MedicalCenter. Its just a very busy place weve got some very busy ORs, andto be able to get in there and co-exist while theyre doing all the equipmentand do what it is that we do is a challenge in itself.

Thomas J. Fitzgerald III, CHESP, chief of environmentalmanagement service at VA Palo Alto Healthcare System, and president of theAmerican Society for Healthcare Environmental Services (ASHES), points out thatcooperation between SPD and ES staff is the basis for successfully coordinatingthe cleaning. We have a commitment from them, and theres a commitment fromus also, and thats the thing you have to work with youve got to have ateam commitment in the SPD, because theyre always busy, he says. Butthe bottom line is its non-negotiable on cleanliness, because a mistake wemake could cost somebody their life. We have to get in there, and thats thebottom line. If theres an emergency, we might have to stop momentarily,but the fact is that the work must go on it cannot wait until tomorrow.

Establishing and maintaining a regular, workable schedule canalso be tricky. The challenge lies in consistency having it cleanedroutinely, says Rose Seavey, RN, MBA, CNOR, ACSP, past president of ASHCSP,and director of the SPD at the Childrens Hospital in Denver. There arevarious reasons for that; one of them is that its hard to get in therebecause were a 24/7 operation, so you need to coordinate with the ESdepartment when they can get in and when they cant get in. Sometimes itsdependent on the staffing in the ES department; do they have enough people? Mainly I think there needs to be a routine time that itsdone. Here what we do is we team up with them and we tell them that if they giveus the time then we will make sure that we have people to help them move things.

Scheduling conflicts inevitably arise in some situations, butSeavey maintains that they must be taken in stride and worked around. Thenyou have to negotiate a better time for them to come back, because were inthat environment we work with the OR emergencies that come in, depending onwhat the OR schedule is like. They have to be sensitive to our needs, and wehave to be sensitive to theirs and negotiate what works best.

Seavey also suggests that team-building activities can bebeneficial. What weve done here is weve tried to make them,especially those who work directly with us, feel like part of our team, so weknow them we might invite them to potlucks or into the lounge to have coffeewith us; we try to make them feel like theyre part of our team. Due to longer OR hours, Higgins says finding a mutuallyconvenient time for cleaning is more difficult than ever. We do it on secondshift, and that has less activity, but second shift is almost equal in activityanymore, until you get right down to the very end of the shift, he says. Twentyyears ago, second shift was a ghost town around here because surgeries werenthappening like they are today; ORs werent scheduled from four in the morninguntil 10 at night.

For Higgins, this aspect of the cleaning process can beparticularly demanding. Thats why I say its the most challenging piece we dont have a third shift, and because of that we moved our second shiftback to 12:30, we started an hour later, and then we have a small gap in betweenservice, and we leave one person here to handle things. The real challenge iscoexisting in that space and doing what we both do at the same time.

Its complete cleaning daily, but its a sharedresponsibility, Higgins continues. As far as floors, walls, any highdusting or the high items, those are done by ES. The walls are done on a monthlybasis, just like the OR.

Fitzgerald notes that dust and dirt are the perfect vehiclesfor hospital-acquired infections, and thus must not be allowed to flourish inthe SPD. Since surgical instruments are prepared for use in the SPD, the area isheld to the same cleaning standards as the OR. In the SPD, we really clean itlike we would a surgical suite, because a lot of the instruments and suppliesend up in the OR, and they also end up in areas where patients have open wounds,and cancer units, so we have to make sure that we have a dust-free environmentand an aseptic environment at all times, he says. We have to do detailedcleaning in there seven days a week.

Variation in size and composition of a facility dictates thetime and resources that must be dedicated to this area. We have a big SPD we have more than 913 beds here, so were one of the largest healthcare systems in the United States, and second largest in VA(Veterans Affairs), Fitzgerald says. Our SPD is probably not the norm, but wedo have someone assigned there about six hours per day. We are also on call ifthey have some kind of emergency, like an air vent blows out or a filter fallsand theres dust coming out, then well send someone in whos trained.

Maintaining a baseline level of cleanliness is in everyonesbest interest, as Seavey explains. As with any area, if you dont keep itup its going to be harder, she says. The other thing is that theresso much equipment that needs to be moved, and thats another issue or concern,because we cant just do surface or just spot cleaning; you need to do theentire thing, because contamination can happen just about anywhere, so the wholefloor has to be done.

In terms of specific areas of the SPD that require particulareffort and attention, the decontamination areas are often mentioned. Theyreso busy in there, so sometimes, logistically, its hard to get in there, butyou need to have some kind of schedule in place where regardless of what theyredoing, unless its an emergency, they have to let you in there so that you cando the things that you need to do to make sure that area stays clean andsterile, Fitzgerald says. The decontamination area is very critical, andthe prep area is also extremely important.

From Seaveys perspective, the decontamination area is notthe only area that presents a significant challenge in maintaining cleanliness. Everybodys going to say decontam because thats wherethe majority of the microorganisms are; we put a lot of emphasis into thatbecause of the nature of what goes on in there, but for me, I think its theprocessing areas and the sterile storage areas, she offers.

The processing areas contain delicate equipment and differentkinds of sterilizers that may need to be treated differently. Some of thesterilizers can be moved, and they need to be moved in order to get back thereand get the dust bunnies and things like that, Seavey continues. If youthink about it, thats probably the cleanest area because youre preparingthings at that time to be sterilized, so it has to be a very clean environment.Also, thats positive air flow, so you need to be cognizant of that.

Talking about the sterile storage area, you have to limittraffic in there. Thats where all your sterile stuff is stored, so you reallyneed to follow the guidelines as far as how things are stored and mounted onfloors, because that area needs to be cleaned daily. You cant have dustfloating around in that area.

Christina Ragan, CRCST, supervisor of sterile processing atGenesis Medical Center, points out that the potential for exposure alwaysexists, and SPD staff must do their part. We have to have things done as soonas possible because of that, and you never know whats on an instrument, soyou treat everything equally, and you have to stay on top of it, she says.Thats continual; the counters, the case carts we take care of thosetypes of things.

Higgins notes that ES staff must have special training fordealing with the SPD. The training is that of critical care areas as far ashow we do the scheduled walls and floors and rolling equipment through adisinfectant, regardless of where that may be whether its in a cath lab,an OR, an SPD, Higgins says. And you can kind of almost relate thosethings just as far as the requirements, even from a physical standpoint; theykind of follow hand-in-hand with each other.

Fitzgerald says that established guidelines and standardsshould serve as the basis for effective cleaning. We use Association forProfessionals in Infection Control and Epidemiology (APIC) guidelines forcleanliness and we also use recommendations from the Centers for Disease Controland Prevention (CDC), says Fitzgerald. We also have our own protocol forsurgical areas, and we follow really the same protocol that we use for thesurgical suite. The difference versus a regular area is that every day we do thesame thing over and over detailed cleaning every day. In regular areas youdont have to detail every day, but in there you must pay special attention toall surfaces.

Reference:

1. ASHCSP Training Manual for Health Care Central ServiceTechnicians, fourth edition.

ASHES to Launch Initiative to Assist Environmental Services inOptimizing Operations

Responding to its members and other environmental services(ES) managers challenged by inadequate industry guidelines for day-to-dayoperations to guide performance to ensure a clean and safe healthcareenvironment, the American Society for Healthcare Environmental Services (ASHES)is taking the leadership role in an industry-wide effort to establish bestpractices.

The National Environmental Services Performance Indicators(NESPI) project ranks among the most comprehensive undertakings ASHES hasembarked upon in its entire 20-year history. NESPI will compile, analyze, andreport performance indicators for ES disciplines for areas such as staffing,waste management and compensation.

In the coming weeks, all environmental services professionalswill be asked to participate in this unprecedented national data collectioneffort. The survey tool will be accessible via the Internet utilizingstate-of-the-art information technology to assure the complete confidentialityof respondents. The goal of this effort is to provide, in aggregate, realisticand viable performance indicators to help the profession reduce costs, improveproductivity, and achieve optimal outcomes in all areas of responsibility.Technology-based reporting capabilities will facilitate the participantsability to establish meaningful benchmarks based on these customized reports.

ASHES leadership, board, committees and staff will be callingon all ES managers nationwide - members and nonmembers alike - to respond tothis national survey. Watch for additional details and information on how toparticipate at www.ashes.org