Environmental Services
Microsystems Team
Cooley Dickinson Hospital
Daniel English
Linda Riley
October, 2011
Objective
• On completion of this session, participants
will be able to:
– State 3 strategies to engage Environmental
Services staff in infection prevention
– List 3 interventions that will improve
environmental cleanliness
– Demonstrate the effectiveness of UV light in
reducing CDI
Hospital Associated C-Diff Rates
Trendline
1.5
1.0
1.33
1.21
1.16
0.88
0.56
0.5
1.11
0.88
0.75
0.67
0.80
0.93
0.71
Q4
2010
Q3
2010
Q2
2010
Q1
2010
Q4
2009
Q3
2009
Q2
2009
Q1
2009
Q4
2008
Q3
2008
Q2
2008
0.0
Q1
2008
Rate per 1000 Patient Days
C-Diff Rate
One Patient’s Story
• 72 yrs of age, diagnosis pneumonia, prescribed
antibiotics
• CDI, decreased urine output, kidney failure with
hemodialysis for remainder of her life
• OR for colectomy - colon removed, wears a bag
• Slow recovery, CCU, on ventilator
• Stroke, speech and mobility issues
• Readmitted three times
• Family members assist with care
Causative Factors
• How healthcare facilities contribute to CDI:
– Insufficient hand hygiene
– Insufficient environmental cleanliness
– Poor antibiotic stewardship
• Patient risk factors:
– Advanced age and underlying illness
– Certain medications
– Immunosuppression
Two studies highlight contamination of
hospital environment with C. diff. spores as
a major risk factor.
Dubberke and colleagues, 2003
Shaughnessy and colleagues, 2006
• “Both studies raise the issue of contamination of
the hospital environment with C. diff. spores as a
- if not THE – major risk factor for nosocomial
CDI. This issue deserves much greater
attention than it has received in the past.
Richard Ellison, MD
Learned About Our Microsystems
by Assessing Our 5 P Data –
Patients, Professional, Purpose, Patterns, Processes
• Expectations for work performance not
clear to staff
• Difficult to hold staff accountable
• Staff received little training
• Staff feels no power to improve work
• Communication processes cumbersome
Workflow - Fishbone
MATERIALS
PROCESS
Unclear expectations
Do not have correct equipment
New approaches are needed
Poor training, needs update
In disrepair
Communication
customers unawaare
Tight budget
Outdated job flows
Lack of a sense of accountability
Communication
Different levels of urgency
Short staff at times
Staff set in their ways
Building
No laundry chutes
Small soiled rooms
Large floor area
Focus on area
Lack of trust in supervisors
Different skill levels
Staff overwhelmed
Perception of unfair workload
PEOPLE
Carpet hard to clean
ENVIRONMENT
Changes in location of depts
with no notice
Work areas are not
defined and have
no task lists or
frequencies
Staff Engagement
• Daily Huddles
• Patient stories
• Making improvements, raising the level of
professionalism
• Invite Infection Prevention to your meetings
• Data: Infections by unit, Patient survey results
• Bulletin board turned into ‘Staff Feedback’
• Include EVS staff in hospital and community
news letters
• By getting them involved…ask for their opinion
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30+ Initiatives• Accomplished
Standards and Regulations, OSHA,
Fresh eyes
Communication
Dept aim statement
Job flows
Inspections
Chemical Inventory reduced
Confidential trash
Sharps containers
Instigated daily huddles
ED Turnaround
Seven step cleaning
process
Code of conduct
Patient interaction scripts
Reduce clutter
Equipment storage
Blood borne pathogens
Patient room work flow
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TJC, DPH,
Precaution room process
C’diff room communication with
Infection Prevention
TB and Negative Pressure Rooms
Soiled Linen bags
ED Cleaning, working together
Uniform switch over
2 % below budget initiative
ESCt program
Micro-fiber cleaning products
Relocate the department
Meeting room furniture
Pass codes, keys and pagers
Stairwell cleaning schedule
Steam cleaning
Improvements targeting C-diff
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Trained in the 9 step cleaning process
ESCt room management system
Increased ES staff by 2 FTEs
Average turn around time from 65 to 48 Mins
Education on chemical efficacy and dwell time
Cleaning time from 14 mins to 24 mins
Microfiber cloths/mops
Restroom cleanliness, Bleach in all
Bathrooms / ED / Cdiff rooms
• PX-UV Light treatment
Focus on the Environment
PX-UV Light
Xenex PX-UV Light : Taking
Disinfection to the Next Level
• Destroys all major classes of
microorganisms that cause hospitalacquired infections.
• Uses high intensity broad spectrum UV light
to penetrate the cell walls, fusing their DNA,
leading to instant damage and the inability
to reproduce or mutate.
• 99.99% of germs and spores are killed.
• Goal: Flash all discharged patient rooms;
Flash OR’s & ED daily.
Implementation
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Attention
Intention
What does it mean for my work?
Accountability
System support
Challenges
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1st Step
Contract
Early adopter of new technology
Flow
Procedure and Equipment
Sustaining Change
Outcomes
Rate of CDH Acquired C. diff., MRSA and VRE
Q1-Q3, 2006 through 2011 YTD
2.5
Rate per 1000 patient days
2
64% decrease in
CDH acquired
Infections
1.5
1
0.5
0
2006
2007
2008
2009
Year
2010
2011
Number of Patients with Poor Outcomes after Acquiring C. diff. at CDH
2009- June 2011
9
8
8
100% Decrease in
Poor Outcomes
2011 YTD
7
6
# Patients
6
5
Deaths
Colectomies
4
3
3
2
1
1
0
0
0
2009
2010
Year
2011
Thank you.
Questions?