Smarter Cleaning, Better Training, and New Tech Help Fight HAIs

Hospital-acquired infections (HAIs) remain one of the greatest challenges in healthcare facilities, affecting one out of every 31 patients and costing the healthcare system tens of billions of dollars annually.

Also known as nosocomial infections, HAIs are contracted while the patient is in the healthcare setting (hospitals, clinics, or long-term care). They are often the result of exposure to bacteria, viruses, or fungi from invasive procedures—such as catheters and surgery—or contact with staff, contaminated patients, surfaces, or equipment.

Today, Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile (C. diff) are two of the most common superbugs that cause HAIs. Another bacterium, Pseudomonas aeruginosa, is one of the leading causes of hospital-acquired pneumonia.

Infection control specialists explain that bacteria like these remain prevalent because of their ability to adapt to changing environments and develop resistance to treatments. Charles Gerba, professor of microbiology and infection control at the University of Arizona, says that C. diff is especially problematic because it spreads through spores and is resistant to quaternary-based disinfectants.

“Microbes are so clever: They don’t have brains, but they have a survival mode and the ability to evolve,” he notes. “That makes it really challenging because they take advantage of us, and they’re always waiting for another opportunity.”

Give EVS a Hand

Environmental services (EVS) staff play a critical role in preventing and controlling the spread of harmful pathogens. But infection prevention requires a holistic, hospital-wide approach that coordinates efforts across all departments.

“To test whether EVS is truly integrated into infection control, I ask two simple questions,” says Hudson Garrett, Adjunct Assistant Professor of Medicine in the Division of Infectious Diseases at the University of Louisville School of Medicine. “First, who is responsible for infection control? The answer should be everyone. Second, who is responsible for patient care? When you walk into a patient’s room, you should see the EVS technician’s name alongside the provider’s and the nurse’s.”

This shared responsibility is evident in everyday practices that protect patients, starting with proper hand hygiene. Experts agree that this is the simplest, most effective measure against the spread of infection. However, maintaining consistent hand hygiene requires commitment and follow-through from every staff member.

“We don’t have a problem with hand hygiene products and protocols,” says Garrett. “We have a problem with hand hygiene culture and accountability.”

To prevent complacency, he suggests enforcing clear consequences when healthcare staff members—nurses, doctors, administrative staff, etc.—fail to follow protocols.

“You can monitor hand hygiene all you want, but if you don’t take action against people who are noncompliant then what are you collecting data for?” Garrett asks. “Until we hold people accountable for these basic interventions, we’re not going to move the needle.”

Like hand hygiene, cleaning and disinfecting high-touch surfaces are shared responsibilities and not solely the domain of EVS staff. As a rule of thumb, nurses should clean equipment connected to the patient, says Garrett, while EVS should clean equipment that is not connected to the patient.

The most common high-touch surfaces EVS teams should pay special attention to are usually found within 3 feet of the patient and include items such as bed rails, over-bed tables, and call buttons. The EVS staff should also focus on surfaces that clinicians touch frequently, including phones and keyboards.

While attention is often focused on obvious sources of contamination in hospitals, some of the most concerning risks are hiding in plain sight. David Trinks, CEO of Trinks Consulting Group, notes that patient divider curtains can harbor a range of microorganisms but are seldom, if ever, laundered—making disposable options a potentially safer alternative, albeit more expensive.

Elevator buttons are another often ignored source of contagion and should be cleaned at least once a shift. Gerba and his team conducted a study using bacteria tracers on elevator buttons in a healthcare facility and were shocked by the results.

“We found the bacteria tracers ended up on 80 percent of surfaces in every patient room we tested,” he says. “When you think about it, it makes sense: everyone has to touch the first-floor elevator button to exit the building.”

Further studies revealed nurses’ break rooms and cafeteria tables teaming with antibiotic-resistant bacteria. Gerba surmised that although these areas are cleaned and disinfected regularly, they are not cleaned as thoroughly as patient rooms.

Research conducted by Trinks using coliform counts identified another unexpected location that frequently goes unnoticed.

“The dirtiest thing you can touch in a hospital is the vending machine button,” says Trinks. “Everyone uses them, and no one ever cleans them.”

Trinks has also turned his attention to a place few would ever think of testing: the undersides of cafeteria chairs. What he found was unsettling—consistently high coliform counts on a surface that is frequently touched, but seldom gets cleaned.

“It’s human nature. When people sit down, the first thing they do is reach underneath the chair to pull themselves in,” he says.

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