Transcript Environmental Services Leaders in Infection Prevention

Environmental Services
Microsystems Team
Cooley Dickinson Hospital
Daniel English
Linda Riley
March 29, 2011
Objective
• On completion of this session, participants
will be able to:
– State 3 strategies to engage Environmental
Services staff in infection prevention
– List 3 interventions that will improve
environmental cleanliness
Rate
-2 Sigma
UCL
LCL
+1 Sigma
Average
-1 Sigma
Q1 09:
add'l dat a
source
2.5
Rate per 1000 Patient Days
+2 Sigma
Trendline
2.0
1.5
1.33
1.21
1.16
1.0
1.11
0.88
0.93
0.88
0.67
0.56
0.5
0.80
0.75
0.71
Q4 2010
Q3 2010
Q2 2010
Q1 2010
Q4 2009
Q3 2009
Q2 2009
Q1 2009
Q4 2008
Q3 2008
Q2 2008
Q1 2008
0.0
HA-CDI RATE
30.000000
20.000000
10.000000
May
April
Mar
Feb
Jan
Dec
Nov
Oct
Sept
Aug
July
June
May
Apr
Mar
Feb
Jan
0.000000
One Patient’s Story
• 72 yrs of age, diagnosis pneumonia, prescribed
antibiotics
• CDI, decreased urine output, kidney failure with
hemodialysis for remainder of her life
• OR for colectomy - colon removed, wears a bag
• Slow recovery, CCU, on ventilator
• Stroke, speech and mobility issues
• Readmitted three times
• Family members assist with care
Causative Factors
• How healthcare facilities contribute to CDI:
– Insufficient hand hygiene
– Insufficient environmental cleanliness
– Poor antibiotic stewardship
• Patient risk factors:
– Advanced age and underlying illness
– Certain medications
– Immunosuppression
Two studies highlight contamination of
hospital environment with C. diff. spores as
a major risk factor.
Dubberke and colleagues, 2003
Shaughnessy and colleagues, 2006
• “Both studies raise the issue of contamination of
the hospital environment with C. diff. spores as a
- if not THE – major risk factor for nosocomial
CDI. This issue deserves much greater
attention than it has received in the past.
Richard Ellison, MD
Learned About Our Microsystems
by Assessing Our 5 P Data –
Patients, Professional, Purpose, Patterns, Processes
Q1 2008
• Expectations for work performance not
clear to staff
• Difficult to hold staff accountable
• Staff received little training
• Staff feels no power to improve work
• Communication processes cumbersome
Workflow – Fishbone, Q1 2008
MATERIALS
PROCESS
Unclear expectations
Do not have correct equipment
New approaches are needed
Poor training, needs update
In disrepair
Communication
customers unawaare
Tight budget
Outdated job flows
Lack of a sense of accountability
Communication
Different levels of urgency
Short staff at times
Staff set in their ways
Building
No laundry chutes
Small soiled rooms
Large floor area
Focus on area
Lack of trust in supervisors
Different skill levels
Staff overwhelmed
Perception of unfair workload
PEOPLE
Carpet hard to clean
ENVIRONMENT
Changes in location of depts
with no notice
Work areas are not
defined and have
no task lists or
frequencies
What engages employees?
• It is a commonly held belief that
employees will feel more committed to an
organization if they believe that their
efforts are valued.
• This is even more relevant during
challenging economic times, when
employees are expected to do more with
fewer resources.
- SHRM 2009 Employee Job Satisfation Survey
What engages employees?
• The August 2009 Gallup Employee
Engagement Index reported that only 33%
of workers are engaged in their jobs, 49%
are not engaged, and 18% are actively
disengaged.
• Engagement is not the same as
satisfaction.
• Progress is the biggest employee
engager.
- March 2011, HR Magazine, ‘Raising Engagement’.
What Motivates Employees?
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Recognition
Meaningful work
Challenging work goals
Rewards for meeting goals
Environment that is caring and connected.
Our steps to staff engagement
• Daily Huddles
• Patient stories
• Making improvements, raising the level of
professionalism
• Invite Infection Prevention to staff meetings
• Share data: Infection rates and patient
satisfaction results
• Bulletin board turned into ‘Staff Feedback’
• Include EVS staff in hospital and community
news letters
• Getting everyone involved…ask for their opinion
30+ Initiatives accomplished within three years
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Fresh eyes
Communication
Dept aim statement
Job flows
Inspections
Chemical Inventory reduced
Confidential trash
Sharps containers
Instigated daily huddles
ED Turnaround
Seven step cleaning
process
Code of conduct
Patient interaction scripts
Reduce clutter
Equipment storage
Blood borne pathogens
Patient room work flow
• Standards and Regulations, OSHA,
TJC, DPH,
• Precaution room process
• C’diff room communication with
Infection Prevention
• TB and Negative Pressure Rooms
• Soiled Linen bags
• ED Cleaning, working together
• Uniform switch over
• 2 % below budget initiative
• ESCt program
• Micro-fiber cleaning products
• Relocate the department
• Meeting room furniture
• Pass codes, keys and pagers
• Stairwell cleaning schedule
• Steam cleaning
Improvements targeting C-diff
Q2 2008
Q3 2008
Q4 2008
Q1 2009
Q3 2009
Q4 2009
Q2 2010
Q3 2010
Q1 2010
Education on chemical efficacy and dwell time
Trained staff in the 9 step cleaning process
Average pt. room turn around from 65 to 48 mins
Cleaning pt. discharge rooms from 14 to 24 mins
Environmental services management software
Increased ES staff by 2 FTEs
Microfiber cloths/mops
Steam clean selected areas / projects
Restroom cleanliness, Bleach in all
Bathrooms / ED / Cdiff rooms
UV Light treatment for all pt. discharge rooms,
operating rooms and emergency department.
Focus on the Environment
PX-UV Light
Current focus is the introduction of
UV Light room treatment:
‘Taking Disinfection to the Next Level’
• Destroys all major classes of
microorganisms that cause hospitalacquired infections.
• Uses high intensity broad spectrum UV light
to penetrate the cell walls, fusing their DNA,
leading to instant damage and the inability
to reproduce or mutate.
• 99.99% of germs and spores are killed.
Objective
• On completion of this session, participants
will be able to:
– State 3 strategies to engage Environmental
Services staff in infection prevention
– List 3 interventions that will improve
environmental cleanliness
Thank You
Any questions……?