Healthcare-associated infections cost facilities millions of dollars, but Environmental Services can stop the trend

Even with cleaning regulations in place, too often the wrong cleaning materials are used. The U.S. Environmental Protection Agency (EPA) reported in 2009 that approximately one-third of 325 registered disinfectants and 36 of the 72 tuberculocides tested thus far under its Antimicrobial Testing Program, failed to meet standards for effectiveness against bacteria.

But a study by Mayo Clinic researchers found that consistent daily cleaning of all high-touch surfaces, using a spore-killing bleach disinfectant, in areas with high endemic rates of C.diff almost eliminated the problem. And at Roseland Community Hospital in Chicago, C.diff infection rates in surgical units was reduced to zero within six months of replacing cotton string mops with a system of chlorine stable, microfiber cloths and mops, in conjunction with a sodium hypochlorite solution, as recommended by the CDC.

Even with the best products and most effective cleaning processes, though, the program is only effective if the staff is properly trained. For example, the program at Roseland included a comprehensive in-service training program of all environmental services staff. Staff learned best practices for effective infection and cross-contamination prevention.

Specifically to mitigate the risk of room-to-room contamination, the 450-person cleaning staff at University of Chicago Hospitals — including Roseland — were trained to use a color-coded system. They used a fresh set of color-coded products in each restroom, patient room and operating room. Products never crossed the threshold into a second room, but instead were laundered according to CDC guidelines before being put back into service.

In addition to classroom training, staff can be lead by example — through demonstration that infection prevention is an organizational priority. For instance, studies have shown that facilities with well-established cultures of safety, led by an actively engaged senior leader, are able to achieve and maintain high hand hygiene adherence rates.

One best practice is having the chief executive or chief medical officer round on patients and take each opportunity to wash hands in plain sight of staff. Another is for these executives to vocally promote hand hygiene and its link to lower infections at every opportunity.

It may seem simple, but even though most healthcare workers believe hand hygiene is important, they often fail to appreciate how dramatic an effect it can have on infection rates and the reduction of cross-contamination.

Moving Forward

Government payment reforms and the rising costs of care in the United States are putting pressure on the health system to stem the rising tide of HAIs. Though there is some evidence of progress, clearly much more needs to be done.

Maintaining a sufficient environmental service staff, training them in proper procedures, providing them with “best in class” cleaning and disinfecting products costs little more than is currently spent on the housekeeping operations of any facility. And yet reports find that room cleaning has been sacrificed because of budget cutting in many organizations.

Considering what we know, is it wise, is it sustainable, to continue cuts to the environmental services department? Or is it time to restore financial resources to a department that is vital to a hospital’s infection prevention program?

Few actions in a hospital carry such an obvious return on investment as infection prevention. Without reimbursement, the hospital is absorbing an average of more than $25,000 in added costs per care involving an HAI. Adding in the HAI penalties in the Affordable Care Act under value-based purchasing and excess readmissions, the financial case for taking action is clear.  

J. DARREL HICKS is a consultant and seminar and webinar presenter. For more information, visit

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