Infection Prevention: It's About People

Infection prevention depends on many interrelated activities connecting everyone in the healthcare facility—patients, visitors, clinicians, and support staff.

There are thousands of activities performed by hundreds of people each day that have the potential to transmit infection. To address the problem, we tend to focus on technical solutions—re-engineering protocols, adopting new products, and researching new technology. But what cannot be overlooked is the Human factor. Most of the challenges surrounding infection prevention revolve around educating, training, and gaining the cooperation of everyone on the team. This often requires altering behaviors, perhaps changing “the way things are done” by highly skilled and experienced people.

The Challenge

One of the key aspects of maintaining an infection-free environment is, of course, performing the daily cleaning and disinfecting activities properly, with an eye toward protecting patients. This activity depends on the tireless work of front-line housekeeping staff, who are often “low on the totem pole” and may not feel they are in a position to be change agents. According to a 2008 Health Care Advisory Board study:¹

The consistent theme that repeatedly surfaced during research was the cultural divide between the clinical staff of the hospital and those that are tasked with maintaining its cleanliness. Environmental services staff face any number of obstacles to achieving optimal performance, but glaringly among them are gaps in training, education, and understanding that leave them without a quality context for their role.

Infection Preventionists Who Shared Their Thoughts

Crothall reached out to Infection Preventionists at some of our Environmental Services accounts to get their perspective on these cultural challenges. This article summarizes the key findings. The full text of the interviews is available by clicking here.

Ann Davy, RN, CIC Infection Control Officer Freeman Health System Joplin, MO	Barbara Fry-Arrighy, BSMT (ASCP) (SM), MBA, CIC Director, Infection Prevention and Control Hahnemann University Hospital Philadelphia, PA
Jill Bickings, RN, BSN, CIC Infection Preventionist Nazareth Hospital Philadelphia, PA	Jennifer Roberts, RN, BSN Infection Control Manager St. Vincent’s East Birmingham, AL
Linda Burton, BSN, CIC Infection Preventionist University of Colorado Hospital Aurora, CO	Terry Burger, MBA, BSN, RN, NE-BC, CIC Director of Infection Control and Prevention Lehigh Valley Health Network Allentown, PA

#1: EVS is a key player in infection prevention.

Although there are many factors, successful infection prevention depends on the consistent removal of pathogens from infected surfaces. Successful Environmental Services departments are fully involved in the infection prevention efforts of the hospital. EVS leadership needs to be part of I.P. committees and task forces, as well as being part of regular rounds performed with the clinical staff. EVS experts can provide guidance to the I.P. department by recommending proper cleaning procedures, products, and new technologies.

“Environmental Services is the platform for infection prevention; if it is not solid, nothing else can be effective. It is the most important department to help us get to the goal of preventing infections.” – Barbara Fry-Arrighy

“I find that Kelly Brennan, our EVS Director, helps educate us. She is very knowledgeable about cleaning protocols and explains the cleaning process and challenges to help us craft better solutions.” – Jill Bickings

“Crothall has been a great partner, very responsive to our needs. They are able to deploy resources for fast action, when we ‘need it now.” – Terry Burger

#2: Clinical involvement with the EVS staff is important.

Regular interaction between the I.P. department and front line housekeepers builds a trusting relationship and allows for the clinician to provide guidance and answer questions. Infection Preventionists should also participate in in-service training of the EVS staff to reinforce I.P. topics and prepare them to deal with special outbreaks. Research by Dr. Philip Carling² showed that clinician-led training opportunities help elevate the importance of the cleaner’s role and empower him or her to promote proper methods.

“It helps to be visible and approachable to the front line staff. I talk with them on a daily basis and want them to feel comfortable to ask me questions when they arise.” – Ann Davy

“A unit-dedicated housekeeper is able to build relationships with clinicians on the unit and become part of the team whose purpose is to deliver quality health care on that unit.” – Linda Burton

“There are many opportunities to connect with the staff while they are out on the floors. In addition, I am often invited to present to the EVS department on special topics such as flu season.” – Jill Bickings

#3: EVS needs to be viewed as full-fledged members of the care team.

When it comes to preventing infection, everyone has an equal responsibility to take precautions. It must be viewed as a collaborative effort, with the needs of the patient put first. It should be a blame-free environment in which everyone is treated with respect. A positive, supportive relationship between nursing and EVS is the key to making the cultural piece of infection prevention fit.

“We need to make everyone feel like part of the team. It is everyone’s job—no one is more or less important.” – Barbara Fry-Arrighy

“I have tried to build up the EVS workers. I call them my heroes because I believe they are just as important as any clinician to our efforts.” – Jennifer Roberts

“The whole issue of dealing with patients must be collaborative. All of their needs, whether provided by a food service worker, cleaner, or nurse, are part of the patient-centered approach.” – Terry Burger

#4: Cooperation breeds empowerment.

A fully included, cooperative, and valued team creates a sense of empowerment in its members. An EVS worker who feels connected to the infection prevention goals of the team is more likely to speak up in the name of patient safety.

“To encourage everyone to feel empowered, we have a hand hygiene campaign called ‘Hands Up.’ If anyone in the hospital sees anyone else not following proper handwashing practices, they need to raise their hands and let them know.” – Ann Davy

“We are on our journey to becoming a Highly Reliable organization. This means we are all expected to have 200% accountability, meaning you are responsible for what you do to care for the patient as well as what everyone else does.” – Jennifer Roberts

“We have one particular housekeeper named Angelica who is the model for how all of our EVS staff members should feel empowered…we even featured her in a training video to demonstrate the importance of speaking up and challenging others to follow proper hand hygiene and isolation practice.” – Linda Burton

Sources

1. The Advisory Board Committee. “The Journey to Zero. Innovative Strategies for Minimizing Hospital-Acquired Infections,” 2008, pg 62.
2. Carling, Philip, et al. “Improving Cleaning of the Environment Surrounding Patients in 36 Acute Care Hospitals,” Infection Control and Hospital Epidemiology, 2008, 29:1035-1041.