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Charles Gerba, PhD: “I really think that in the future, what you really need is a specialist in infection control who understands both the environmental health services and also the professional staff that deals with the patients.”
Q&A: Bridge Gap Between Infection Preventionists and EVS Teams
As a healthcare consultant, Charles Gerba, PhD, has seen how infection preventionists (IPs) and environmental services (EVS) teams interact at hospitals and other healthcare facilities around the world. Some interact well, but Gerba feels that, in general, the two sides have problems communicating. As he tells Infection Control Today®, they “really have different languages and priorities that need to be brought together.” Gerba, a professor of environmental microbiology at the University of Arizona, thinks it may be time for the creation of a position occupied by someone with skills that would allow that person to bring IPs and EVS together in a more functional way. There’s a lot at stake. “We’re always going to have another organism coming in around the corner that we have to deal with that we didn’t deal with before. And so, it’s going to be a continual evolution of strategies. And I think we saw that with COVID-19.”
Infection Control Today®: What are the best approaches that you’ve seen in terms of infection preventionists and environmental services teams (EVS) working together?
Charles Gerba, PhD: Well, I think it’s really trying to understand the strategies and benefits for each of them. You know, I think environmental services, particularly today, is looking for better technology that they can use to reduce the risk of the transmission of microorganisms that cause disease in the healthcare environment. I think, really working together on different strategies in terms of what are the best products to use. What are the surfaces to treat. And communicating what risk reduction might result from different strategies.
ICT®: What healthcare institution have you seen that really stands out in terms of how EVS and infection prevention departments can work better together?
Gerba: There’s a lot of technology being developed. And what I’ve seen, particularly with the environmental services departments, is that they’re approached by a lot of new technologies. And they really need to develop good programs with developing and understanding the potential benefits of these products and actually getting together and doing pilot-scale work. A lot of our work has been with the two groups getting them together to understand how we can evaluate new technology and development. Try to assess whether it’s an actual and real benefit to them. And that’s what we’re really searching for. I think both are focused, but they need to communicate because that’s where there’s opportunity to evaluating new products that are being developed. Particularly for that healthcare environment they may be looking at all the time.
ICT®: Do you think infection preventionist should actually run environmental services teams?
Gerba: I think there’s a reason for better communication. What I see, particularly, both of them have different perspectives, but understanding. Being able to communicate when and how they can see development of a product and its impact. Being able to develop some kind of language between them to understand that. I think what I’ve seen a lot is environmental services tend to do things…. I mean everything today is return on investment. So, it has to be couched in that way between both of the groups knowing that there is going to be additional costs. But there has to be an understanding of what’s going to be the benefits of that in terms of risk to the patient and the cost of maintaining those surfaces or certain services in the future. I think that’s really what we need to see. From what we’ve seen in our own work, there’s a lot of technology out there that can reduce the risk of transmission in healthcare environments. But it’s getting both parties to understand that and communicate the benefits…. Both from a standpoint of cost and benefit to the patient because I think those are really key issues today.
ICT®: Your answers seem to focus primarily on new technologies. What about new management systems?
Gerba: I think what it is, is that a lot of technologies which may require additional training for staff. Let’s say ultraviolet systems are used for disinfecting. That takes training to use them properly in rooms and the strategy for doing it. That’s going to require additional training for the staff. Or there are other technologies that will leave a continuously acting disinfectant on a surface. But those need to be understand by both parties. They need to communicate and understand the benefits of those. That’s going to require additional training for the environmental services staff. I think that’s one of the things that’s going to be highlighted. That we’re going to see additional sophistication needed by the personnel and environmental health services area to deal with these technologies to be used appropriately and most effectively in healthcare environments.
ICT®: In general, do infection prevention and control departments, and environmental services departments work together well?
Gerba: I think it depends on the individual healthcare facility. Sometimes I’ve seen it work really well together. Some of the healthcare facilities we work with have environmental health specialists or infection control specialists particularly dedicated to that full time. And I think that works out quite well from what I’ve seen, because they have the time and the effort to look at new technology, evaluate technology and make assessments to communicate that the infectious control communities in healthcare facilities. I really think that in the future, what you really need is a specialist in infection control who understands both the environmental health services and also the professional staff that deals with the patients. I think that’s really critical to communicate that. Because in some ways, there’s a little bit of differences in languages and focus. I think really in the future, and particularly in large facilities, there needs to be a specialist in that area to serve in some way in between both groups because there’s different languages and different focuses from what we’ve seen. In healthcare facilities that I’ve worked with, it’s best if I have one person there who really understands the benefits of certain actions in infection control. And then it communicates. They understand, I think the ones I work with, both the professional healthcare staff and environmental services, so they’re able to serve as a go-between. And I think that’s really a need in the future. Somebody that can communicate with both groups, because they have different focuses. And really have different languages and priorities that need to be brought together. I really see that as a need, particularly at large healthcare facilities. They have to have somebody with that kind of focus, that can communicate between both groups. Because in my career, I’ve worked with both groups and I found it easiest to work with somebody that’s just working only on infection control and they have the suitable background and communicate with both groups. And then a lot can be done. A lot of progress can be made, and I think much more effective evaluation of different strategies. That’s one of the things I found a lot of times is lack of focus oftentimes between the healthcare professional staffs and environmental services. And they’re all confused sometimes. Who’s the decision maker in that? Who’s the best person to communicate? And that’s why I think in a large facility that’s so important: one specialist in that area, who can communicate both internally and externally, with people bringing maybe new strategies to the healthcare environment. Do that to reduce the risk of infection transmission in healthcare environments.
ICT®: It sounds like you're talking about the creation almost of a new position in the hospital system?
Gerba: Yes, I really think it’s needed. I think you really need an infection control specialist with training and appreciation both from the environmental service department and the healthcare providers that work with the patients. At least the healthcare facilities I’ve worked, that seems to be the best situation because they have a focus. They can sit there and they can evaluate the different strategies and innovations in products and systems that can be used. I think you really need somebody who’s focused on that to take advantage of progress that’s being made in that area. There’s a lot of rapid progress and technology being developed, particularly driven by the COVID-19 issue now. A lot of strategies have been out there, but now we’re having the resources to assess these strategies. And I think that’s why it’s so important to have a specialist in that area. I think we really need somebody who can communicate well between both groups in the healthcare situation.
ICT®: Could that specialist be an infection preventionist with just a little bit more training?
Gerba: I think they can be somebody that maybe has been in infection control. Some of the people I’ve worked with have largely been in public health departments before and then moved into the healthcare environment and have a background both in studying outbreaks, infection control strategies, inspection strategies. I think some additional training in how microorganisms are transmitted in the environment. How you evaluate strategies for controlling transmission environments. I think training in that area is important. Most of the people that I’ve worked with seem to have a very broad training, both from public health departments standpoint, outbreak investigation, epidemiology, and also an understanding of interventions. You know, like a proper disinfection, what types of disinfectant and what types of products are utilized. It’s really a challenge for the environmental services people too to have the background and be able to evaluate in a rigid manner from their own perspective. And that’s why I think additional training. I think really an infection control specialist if you have it, is really needed to serve as a bridge between both these groups and dealing with infection control communities in large hospitals.
ICT®: What’s at stake here? You must have witnessed in your career hospitals where they did not work well together. What happens?
Gerba: Well, usually it’s been from my standpoint in trying to assess different strategies for infection control, trying to figure out who’s in charge. Like a new antimicrobial product. Well, who do I go to? Environmental services? Or do I go to the infection disease control committee? What professional committee or individual do I talk to to communicate potential benefits or strategies? I find it challenging in dealing with healthcare to find out who’s really the decision maker and the best person to communicate to if we want to come in and do an intervention. A lot of my work is looking at interventions. It’s difficult for me to figure out who is really the person to communicate with. And that’s why I think that the infection control specialist is an easier person to deal with. That way I know which person to go to. And they’re focused on infection control, environmental services, a lot of areas they have to deal with in the hospital. And a lot of times I found they’re overworked a lot of the times and trying to deal with them and talk about a specific strategy that might be a benefit to them [is difficult]. So that’s what I think a specialist is more needed today more than ever, particularly given all the technologies that are getting developed today. I think it’s really important to have somebody who can sit down and spend that time in evaluating these. What’s the benefit? Because I think in the long term that would give you the best return on investment. If you have really somebody that’s really focused on this, rather than randomly selecting strategies that might be done or evaluating them, you have somebody there that can deal with it. And deal with all different groups that might be involved in infection control, and environmental services within a healthcare facility.
ICT®: When you say your role is mostly intervention, does that mean a hospital will call you in and say, “Something’s wrong here? We’re not doing infection prevention correctly here. Tell us what’s going on?”
Gerba: I think a lot of times what happens is: What’s a new strategy that we can we use? The number of cases are increasing. C. difficile is a classic example. What strategies can you use. They haven’t necessarily dealt with a spore forming organism. The strategies may be different than what had been used in the past. It’s usually an increase in a new pathogen or an increase in awareness. You know, sometimes what it is, is additional testing is done in a facility. They realize they have more of a problem with one organism than they previously thought. Or they’re concerned about one exposure route. I think it’s a real challenge in healthcare that won’t go away. We’re always going to have another organism coming in around the corner that we have to deal with that we didn’t deal with before. And so, it’s going to be a continual evolution of strategies. And I think we saw that with COVID-19.
ICT®: Anything else you’d like to add about how EVS and infection preventionists can work better together?
Gerba: What I would say to them is it’s an increasing challenge for them, and it will be an increasing challenge. That’s what I found in working with environmental services. There’s always a new need like COVID-19. Suddenly, personal protective equipment—it becomes a real challenge to provide that. And not only that, but clean it. How do we recirculate it when there’s shortage? I think you have to look to the future. What I would say is plan. In the future, what happens if there’s a shortage of personal protective equipment? Or we have to turn around the equipment really fast and ensure that we adequately provided the needed infection control. I think it’s going to take a lot more future thinking by environmental services on how to deal with these things in the future. And they really should develop a strategy for the next crisis we deal with; the next emerging infection. I think environmental services are going to be really challenged in providing the resources they need to the professional staff in healthcare.
This interview has been edited for clarity and length.