In the battle against healthcare-associated infections (HAIs), one common denominator continues to stand out amongst all requirements for clinical area surface disinfection, and that is time – time for the chemical to have the proper dwell time for disinfecting high-touch areas, staff time for proper environmental services programs, and time for training. As an environmental services director or infection preventionist, time can be your friend — or enemy — depending on how you manage this one area.
This issue has caused great debate for many years. The issue is whether or not the product is killing the germs on the surface, and how long it really takes for that to occur. As we all know, it depends on the bio-load or bioburden on the surface being treated. Dwell times are important and are also dependent on the cleaning tools and process used, i.e.; cloths, wipes or microfiber. The dwell time must be calculated in the overall cleaning time of a patient-care area. As a director of environmental services or an infection preventionist, it is imperative to understand the process of the chemical being used and the different types of applicators that are used to apply the chemical to the surface. The biggest question that one should ask is this: Does the applicator play a role in proper surface disinfection and dwell time reduction when cleaning and disinfecting surfaces?
Over the last few years, it has been shown that in order to assist in the reduction of HAIs, cleaning and disinfecting high-touch areas play a major role in providing a clean, safe environment for patients, visitors and staff. When the environmental services director calculates the time required to clean and disinfect these areas, he or she should have the infection preventionist involved in the process. The areas of focus and time required to provide high-touch surface disinfection should be documented and submitted to the facility’s Infection Control Committee for approval and implementation. The purpose for this process is to ensure a facility best practice and decision based on data and information. There are a multitude of entities in healthcare providing facilities with best practice times (how fast can you get it done) but do not provide the best practice processes to meet these times. You and your facility should establish the individual best practice for times and processes depending on the population served, the environment and the cleaning standard set by your organization. Getting there should include the Practice Guidance for Healthcare Environmental Cleaning, a step-by-step best practice for cleaning every area in a healthcare facility and the recommended tools for doing the job. The Practice Guidance has been reviewed and recommended by leading infection preventionsists and is becoming the best seller in healthcare cleaning and surface disinfection.
Maintaining the environment, while providing a barrier for infections and providing a safe environment for patients, visitors and staff requires time – time to complete floor maintenance to ensure floor surfaces are safe to walk on, and time for removing the different waste streams from the facility properly in order to ensure proper facility sanitation. Removing waste from the facility has its own challenges due to the nature of the waste and federal requirements to do so. Environmental services directors should know how many different waste streams they handle as well as the volume and weight of each waste stream. This is important because it takes time for staff to handle, remove and document this process. Knowing how long it takes to maintain the trash piece of the equation is also key to ensuring proper best practice processes and times.
The only way to achieve time efficiencies is to educate the environmental services front line staff on recommended practices to facilitate achieving best practices. Staff must be trained on how to properly and safely use equipment and chemicals to assure surfaces are properly cleaned and disinfected. A best practice is not how fast it can be done, but rather how effectively and efficiently can it be done with the right time. The only way one becomes effective and efficient is to be educated on the process and to assure the steps in the process are being followed.
Lastly, time is a concern for everyone, and if work processes are done properly, there are many ways to reduce time and costs in an organization. Arbitrarily cutting staff or reducing the time needed to clean and disinfect can have a serious impact on patient safety and the bottom line. In order to fully comprehend the time factor, more than just the environmental services director must understand the need for adequate time and the outcome of the process. Now, more than ever, entire teams that include the infection preventionist, environmental services director, safety, quality and administration must understand how and why time is used and the impact of following best practice with best process and if that is a good use of time. So, as you look at your organization, remember – time is money, so how are you spending yours?
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Mark Regna, MHA, CHSP, CHESP, is at-large board member of the American Society for Healthcare Environmental Services (ASHES), and director of healthcare services at Jani-King International.