Cleanliness is next to………….
In 2011 the Ministry of Health of BC asked PICNet to review and evaluate the policies and processes that were in use by Health Authorities to direct housekeeping processes. ◦ Timeline was just over 2 months
Timeline allowed only for a high level review ◦ Review of provincial, national and international acute healthcare housekeeping policies, guidelines, best practices ◦ Review of British Columbia health authority acute care housekeeping policies, for analysis and comparison to national and international standards
Recognize that just because we didn’t find evidence of something in the written policies did not mean that it did not exist in reality. ◦ e.g. in some HAs the role of IPC was very clear while in others not evident
PICNet found a lack of consistency across Health Authorities in housekeeping practices including: ◦ Processes for routine cleaning including mobile equipment and their storage ◦ Processes for cleaning rooms under precautions ◦ Processes for accommodating surge capacity ◦ Education material for housekeeping personnel ◦ Training and orientation processes for housekeeping staff ◦ Assessment tools and processes
Similar to the Provincial Reprocessing Working Group, the provincial housekeeping technical team should include representation from Infection Control. This team should work collaboratively with Infection Control to: ◦ Create a standardized risk matrix/assessment to be used to determine type and frequency of cleaning regardless of service delivery provider.
Provide advice to the MOH that includes evidence informed provincial best practices for environmental cleaning from an infection prevention and control perspective. ◦ To do this by building upon current initiatives underway within the health authorities. ◦ This document will ensure that, regardless of the service provider, environmental cleaning will meet the minimum quality standards needed to contribute to the prevention and control of infections.
PICNet worked with key stakeholders to identify best practice standards that address: ◦ Roles and responsibilities of housekeeping staff, managers and care providers; ◦ Expectations for performance of routine and enhanced surface cleanings; ◦ Standards for cleaning all mobile equipment; and ◦ Performance measures to ensure appropriate processes are in place and to demonstrate that appropriate outcomes are being achieved
Providing funding for a consultant to work with the stakeholders to create the document Representatives from the Ministry were active participants in the guidelines development group, providing advice and feedback through out the process Provided a general review of the draft document to ensure the needs of the various stakeholders would be addressed
Literature review and information gathering Form Stakeholder Working Group Stakeholder working group meetings & document development General review of draft document by MoH General revisions Community of Practice Review Revisions Review by committee Final revisions Final Approval Final edits Send to Ministry
PIDAC Best Practices for Environmental Cleaning was chosen to adapt. ◦ Permission was requested and granted. Individual contracted to do bulk of literature review and write draft document by adapting PIDAC document into a BC-ized context. Fairly short turnaround times for stakeholders to review various iterations of document.
Literature review began in September 1 st draft ready for review by stakeholders-mid November First meeting of stakeholders-December 10th 2 nd iteration and review by stakeholders-mid January Posted for community of practice review - early February 3 rd iteration and review by stakeholders end of February Final draft review end of March Will be sent to Ministry of Health by mid April.
Housekeeping personal did not routinely perform hand hygiene between patient bed spaces. ◦ Resolved by group consensus to educate and encourage staff to perform hand hygiene between patient bed spaces Review of literature found inconsistencies in recommended contact time for sodium hypochlorite ◦ Resolved by group consensus Travelling toilet brushes ◦ Resolved by group consensus
Balanced mixture of Infection Control and Environmental Services Huge interest and commitment from health authority stakeholders ◦ Genuine desire to “do the right thing” Willingness and commitment to develop a high quality, workable document Commitment to meet short turn around timelines
Take more time at front end to do a systematic search of literature and review ◦ Relied heavily on PIDAC methodology Not rely on documents from other jurisdictions for recommendations but review and critically analyze the evidence, using a formal tool, ourselves. Recognize and that to do this utilizing volunteers takes time and advocate for that.
Jim Curtin Our thanks to the many Sandra Daniels Alan Davies contributors to the Rita Dekleer Darrel Elliot document: Lauren Ferreira Nicki Gill Working group members Louise Holmes Murray Hutchison Infection prevention and Dan Jackson Felicia Laing control community of Dr. Victor Leung Benson Low practice Holly-Lynn Nelson Mike Petrie Cynthia Proskow Jessica Finerty Brian Sagar Joanne Archer Bev Dobbyn
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