Protecting against infection

Implementing proper cleaning procedures goes a long way in preventing HAIs in Continuing Care Communities, but processes must include more than just mopping the floor and calling it a day.  

“I often hear employees say, ‘We can clean a room any way we want,’” explains Dr. Lloyd-Krejci.  

To counter that argument, she uses the example of a blood draw, suggesting the idea that the technician skip the use of the alcohol wipe before inserting the needle.  

“We come to the agreement that that’s dangerous pretty quickly,” says Dr. Lloyd-Krejci. “That same standard of practice holds true for environmental services, too.” 

The standard of practice, say experts, starts with working with cleaning/disinfecting chemicals that are registered through the U.S. Environmental Protection Agency (EPA).  

“It sounds like a no brainer, but it was rare that everything in the cleaning arsenal was EPA registered before COVID,” says Dr. Lloyd-Krejci.  

Chemicals need to be compatible with building materials to avoid costly damage. They also need to be matched to current, local threats.  

“This is a real challenge,” admits Dr. Patterson Burdsall. “The environmental services team needs to know what kind of pathogens are circulating so they can use the right disinfectant to combat it.”  

To do this, Dr. Patterson Burdsall suggests phoning a friend, specifically the infection preventionist that works with the healthcare group.  

She emphasizes, “Someone needs to communicate with an infection preventionist or the local health department to understand current threats.” 

Once the right cleaning chemicals are secured, the next step is using them correctly. The standard for Continuing Care Communities includes protocols such as starting work in the cleanest spaces and moving to the dirtiest areas.  

“Many people start in the restrooms but that’s a mistake. It creates too great of an opportunity for cross-contamination,” explains Dr. Lloyd-Krejci.  

Using personal protective equipment (PPE) also helps cut the risk of cross-contamination while also protecting the cleaning worker. It’s imperative that frontline staff are trained on how to put on and take off gear. That training should also include the requirement to change gloves after touching contaminated surfaces and before moving into a new room.  

Because pathogens are often transferred from the hands of facility occupants, frequently touched surfaces will require special attention from environmental services staff. That means routinely cleaning and disinfecting surfaces such as doorknobs, counter tops, medical charts, tables, bedrails and phones. This common-sense activity can be harder to do in independent living facilities.  

“Many times, housekeepers don’t want to touch people’s personal items, so surfaces don’t get cleaned or disinfected and pathogens build up,” reveals Dr. Patterson-Burdsall.  

Dining rooms and food service areas also need the highest level of attention. In addition to specified and properly executed cleaning procedures, these spaces should provide access to hand sanitation, insists Lloyd-Krejci. She also suggests that environmental services staff treat everything in the dining area — tables, chairs, dishes, flatware, glasses and mugs — as if it is contaminated.  

“That means washing them at a high temperature, or a low temperature with the appropriate cleaning chemicals, every time. There should also be a record of how things were cleaned after every meal,” she says.  

The same mindset applies when it comes to laundry. Cleaning teams should treat every piece of linen as if it was contaminated with C. diff and clean it appropriately. Evaluations should also verify that microfiber towels are graded for use in professional healthcare settings and being laundered correctly. Doing things like using fabric softener or drying at high heat can damage the fibers and make the towels less effective.  

Assessments and Training 

Infection prevention experts agree that assessing cleaning and disinfecting policies and procedures are vital to preventing HAIs in continuing care communities.  

“A facility assessment is required for skilled nursing facilities but it’s also a great tool for looking at the rest of a long-term care community,” says Dr. Patterson Burdsall. When doing an assessment, she always asks who is writing their policies. “It should be reviewed by someone who understands the challenges,” she explains.  

Continuously training staff is the best way to reinforce the proper cleaning and disinfection protocols defined in the assessment. It may also be met with some resistance. 

“I have heard some say that special training for environmental services personnel is not needed because they know how to clean their own homes,” says Dr. Carrico. “We must stress that healthcare environmental services are very different from activities used to clean houses. Workers need to know how to safely use, store and dispose of chemicals. They need to know what types of PPE are needed and how to put them on, take them off, and properly dispose of those items when finished. They need to know how organisms are transmitted so they can be proactive in their cleaning and disinfection practices.” 

For the best results, Dr. Lloyd-Krejci insists that training should be live and hands on.  

“Don’t just have the environmental services team watch a 20-minute video module,” she says. “Insist on demonstrations and give workers a chance to practice and develop skills.”  

Monitoring work is also important. Surfaces may look clean at first glance, but monitoring can provide verification. Hospitals may use an adenosine triphosphate (ATP) machine to detect living organisms left on a surface, but that technology can sometimes be too costly for long-term care facilities.  

Dr. Patterson Burdsall suggests using an inexpensive florescent marker instead. Mark touchpoints before cleaning is conducted, then managers can use a blacklight on that same surface following cleaning to verify whether the mark was removed. This will judge cleaning efficacy.  

But the best way to get environmental services staff to embrace cleaning protocols is for management to embrace them, according to Dr. Lloyd-Krejci.  

“That’s my biggest call to action to anyone in continuous care community leadership: Embrace your environmental services workers,” she says. “They are often overlooked. But these workers probably have more interactions with residents than any other staff members.” 

Those other staff members, family members, and even the residents themselves are the final link in the HAIs prevention chain. Staff members should feel comfortable reporting safety concerns without fear of discipline. Communicate with family and residents and encourage them to report problems.  

“Infection prevention and control is everybody’s job,” says Dr. Patterson Burdsall.  

Amy Milshtein is a freelancer based in Portland, Oregon. She is a frequent contributor to Facility Cleaning Decisions

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How EVS Can Battle Back Against Infections