The Vital Role of the EVS Worker on the Patient Safety Team David - - PowerPoint PPT Presentation

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The Vital Role of the EVS Worker on the Patient Safety Team David - - PowerPoint PPT Presentation

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The Vital Role of the EVS Worker on the Patient Safety Team David P. Calfee, MD, MS October 19, 2017 1 What is your main job activity? A. Frontline EVS worker (i.e., housekeeper) B. EVS manager, supervisor, or director C. Infection

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SLIDE 1

1

The Vital Role of the EVS Worker

  • n the Patient Safety Team

David P. Calfee, MD, MS October 19, 2017

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SLIDE 2

What is your main job activity?

  • A. Frontline EVS worker (i.e., housekeeper)
  • B. EVS manager, supervisor, or director
  • C. Infection preventionist or hospital epidemiologist
  • D. Other
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SLIDE 3

Where do you work?

  • A. Hospital
  • B. Long-term care facility (nursing home)
  • C. Outpatient facility (clinic)
  • D. Other
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SLIDE 4

Do you consider yourself to be a member

  • f the infection prevention and patient

safety team at your facility?

A.Yes B.No

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SLIDE 5
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SLIDE 6

By the end of this presentation, I want you to believe 3 things.

  • 1. The environment is an important source of germ

transmission in health care facilities.

  • 2. Effective cleaning and disinfection of the

environment can prevent germ transmission and infection among patients.

  • 3. YOU play an important role in preventing

infections in patients admitted to your facility.

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SLIDE 7

The environment is an important source of germ transmission in health care facilities.

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SLIDE 8

The hospital environment is frequently contaminated with germs.

Occupied hospital room Non-contaminated hospital room Contaminated hospital room Germ: Acinetobacter

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SLIDE 9

The hospital environment is frequently contaminated with germs.

42%

Germ: MRSA Non-contaminated hospital room Contaminated hospital room Germ: Acinetobacter

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The hospital environment is frequently contaminated with germs.

42% 73%

Germ: Acinetobacter Germ: MRSA Germ: C. difficile (C dif) Non-contaminated hospital room Contaminated hospital room

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The hospital environment is frequently contaminated with germs.

Germ: Acinetobacter Germ: MRSA Germ: C. difficile (C dif)

42% 73% 100%

Non-contaminated hospital room Contaminated hospital room

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SLIDE 12

Germs are frequently found in the hospital environment after cleaning.

After daily cleaning

Occupied hospital room Non-contaminated hospital room Contaminated hospital room

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Germs are frequently found in the hospital environment after cleaning.

After daily cleaning After discharge cleaning

34%

Non-contaminated hospital room Contaminated hospital room

Shams AM. Infect Control Hosp Epidemiol 2016; 37: 1426

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SLIDE 14

Germs are frequently found in the hospital environment after cleaning.

After daily cleaning After discharge cleaning

34% 18%

Non-contaminated hospital room Contaminated hospital room

Shams AM. Infect Control Hosp Epidemiol 2016; 37: 1426

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SLIDE 15

Environmental contamination leads to contamination of healthcare workers’ hands.

Hands on bedrail and

  • ver-bed table

for 5 seconds

Bhalla A. Infect Control Hosp Epidemiol 2004;25:164-7.

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SLIDE 16

Hand contamination after contact with the environment: OCCUPIED ROOMS

53%

Bhalla A. Infect Control Hosp Epidemiol 2004;25:164-7.

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Hand contamination after contact with the environment: VACANT ROOMS

24%

Bhalla A. Infect Control Hosp Epidemiol 2004;25:164-7.

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1 out of 2 high-touch surfaces in hospital rooms is not cleaned at discharge.

52%

14 High-Touch Surfaces, 36 hospitals

Not Cleaned Cleaned (48%)

Carling PC. Infect Control Hosp Epidemiol 2008;29:1035-41

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SLIDE 19

Many pathogens can survive in the environment for long periods of time.

Organism Duration of Survival

Acinetobacter sp. 3 days-5 months Clostridium difficile spores 5 months

  • E. coli

1.5 hours-16 months Enterococcus (e.g., VRE) 5 days-4 months Klebsiella sp. 2 hours->30 months Proteus vulgaris 1-2 days Pseudomonas aeruginosa 6 hours-16 months Serratia marcescens 3 days-2 months

  • S. aureus (including MRSA)

7 days-7 months

Kramer A. BMC Infect Dis 2006;6:130

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SLIDE 20
  • C. difficile is one of the top 3 antibiotic

resistance threats in the U.S.

https://www.cdc.gov/drugresistance/threat-report-2013/

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Environmental contamination can lead to patient infections.

1 in 25 patients gets

  • C. difficile

3 in 25 patients get

  • C. difficile

No Yes

Shaughnessy MK. Infect Control Hosp Epidemiol 2011;32:201-6

A similar risk occurs with MRSA and other germs.

Did the last occupant of the hospital room have

  • C. difficile infection?
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Environmental contamination can lead to patient infections.

1 out of every 5 hospital patients with C. difficile infection was infected by another hospital patient’s germs.

Eyre DW. Clin Infect Dis 2017;65:433-441

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Effective cleaning and disinfection of the environment can prevent germ transmission and infection among patients.

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Proper cleaning and disinfection prevents infections and deaths.

Fewer germs

  • n surfaces

Fewer germs

  • n patients

and health care workers

Fewer infections

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Improvements in cleaning and disinfection can prevent infections.

MRSA infections in ICU patients Before discharge cleaning was improved: After discharge cleaning was improved:

Datta R. Arch Intern Med. 2011; 171 (6): 491-494.

305 infections

  • 182 infections

_________________

123 infections prevented!

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SLIDE 26

Is this room as clean and safe as it can be?

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SLIDE 27

How do we know an elephant is an elephant?

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SLIDE 28

How do we know if our health care facilities are optimally clean?

Visual appearance Objective assessment

Adherence to policies and protocols Patient surveys (HCAHPS scores)

Patient

  • utcomes

Policies, products

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SLIDE 29

“Every system is perfectly designed to get the results it gets.”

  • Paul Batalden, MD
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Are we doing all that we can to make our hospitals and nursing homes clean and safe?

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Do you think that there is room for improvement in cleaning and disinfection at your facility?

A.Yes B.No

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Elbow grease

Detergent Communication Contact time Disinfectant Avoiding recontamination

Teamwork

Maintaining a clean and safe environment is a very complex process.

Other complicating factors

  • Must be done frequently
  • Occupied spaces
  • Differing expectations
  • Competing priorities
  • Human behavior
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SLIDE 33

Why do we do what we do? Why don’t we do what we don’t do?

Behavior

Attitude What is “ok” Do we think we can do it?

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SLIDE 34

Why do we do what we do? Why don’t we do what we don’t do?

Behavior

Attitude

Acceptance/awareness of responsibility Impact on patient outcomes Impact on the worker What is “ok?”

Do we think we can do it?

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SLIDE 35

Why do we do what we do? Why don’t we do what we don’t do?

Behavior

Attitude

What is “ok?”

Expectations of supervisor, colleagues Institutional culture Feedback

Do we think we can do it?

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SLIDE 36

Why do we do what we do? Why don’t we do what we don’t do?

Behavior

Attitude What is “ok?” Do we think we can do it?

Training/skills Time, workflow barriers Tools, equipment, supplies

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SLIDE 37

We need to identify, understand and eliminate barriers that prevent us from doing the right thing, EVERY TIME.

Opportunities for education

  • Expectations and technique
  • Personal safety concerns (cleaning products, patients)
  • Role of the environment in infection transmission and infection prevention strategies

Desire/need for constructive feedback Workflow barriers

  • Pushback from patients and residents
  • Clutter
  • Interruptions
  • Lack of clarity regarding cleaning responsibilities

Culture

  • Lack of appreciation and respect
  • Concern about disturbing patients
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SLIDE 38

Do you feel that you’ve been properly trained to perform your job effectively?

  • A. Yes
  • B. No
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SLIDE 39

Do you get enough useful feedback about your quality of you work?

A.Yes B.No

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What is your biggest challenge during DAILY cleaning of patient rooms?

  • A. Getting the necessary supplies
  • B. Concern about your own safety (exposure to chemicals,

patients) C.Clutter in the patient’s room D.Patients refuse to have their room cleaned

  • E. Something else
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SLIDE 41

What is your biggest challenge during DISCHARGE cleaning of patient rooms?

  • A. Not enough time
  • B. Interruptions

C.Concern about your own safety (exposure to chemicals, patients) D.Uncertainty about what EVS cleans and what others clean

  • E. Something else
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Make interventions that address facility- specific needs.

Optimize job-specific training

  • Topics: technique, protocols, expectations
  • Methods: hands-on training, return demonstration, assessment of

competency

Provide constructive feedback Educate

  • Rationale for and importance of the work

Eliminate/reduce barriers

  • Make supplies available and easy to use
  • Provide communication tools and skills: patient refusals, clutter

Enhance relationships

  • Intradepartmental
  • Interdepartmental
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SLIDE 43

We can make a difference.

Ray AJ. Infect Control Hosp Epidemiol 2017;38:777-783

Higher is better

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SLIDE 44

We can make a difference.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Before After

Items Clean (%)

Daily Cleaning Improvement Initiative

Toilet Seat Toilet Flush Overbed Table Bed Rail Call Bell/Remote Visitor Chair Martin E. IDWeek 2017. San Diego CA. Abstract 501

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SLIDE 45

Improvements in cleaning and disinfection can prevent infections.

5 10 15 20 25 30 35 40 45 50

C difficile Infection Rate

Before After

Lower is better

Orenstein R. Infect Control Hosp Epidemiol 2011;32:1137-9

85% lower

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SLIDE 46

It is the end of my presentation, do you believe these 3 things?

  • 1. The hospital environment is an important

source of germ transmission in hospitals.

  • 2. Effective cleaning and disinfection of the

environment can prevent germ transmission and infection among hospital patients.

  • 3. YOU play an important role in preventing

infections in patients admitted to your hospital.

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SLIDE 47

Do you consider yourself to be a member

  • f the infection prevention and patient

safety team at your facility?

A.Yes B.No

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SLIDE 48

Thank you!