The first step? To “get a full picture of the current state of cleaning and disinfection in all of the hospitals,” he said; this includes looking at policies, procedures, and products and seeing if they fall in line with current evidence and guidelines. In addition, this means looking at the visual appearance of the hospital (if the floors are shiny, if it looks
clean), doing objective assessments, checking adherence to current policies and protocols, looking at Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores related to environmental cleanliness, as well as looking at patient outcomes that may be related to environmental cleaning. However, Dr. Calfee added, “I would argue that none of these [actions] by themselves really give you that full picture. I think you really need to look at it from multiple avenues in order to really understand what’s going on in your hospital.”
Dr. Calfee continued, “We needed to step back and critically look at our systems and understand what it was about them that was preventing us from receiving or achieving the results that we wanted, and identify what we needed to do differently in order to get our desired results.” To do this, his team used a non-judgmental, objective, impartial observer and had the individual shadow the Environmental Services (EVS) team to learn from them and observe their activities and interactions.
To get an even bigger picture, they also created and implemented a knowledge, attitudes, and practices (KAP) survey “so we can get a more representative understanding of what some of the barriers were and really start to quantify and even prioritize some of the barriers that exist,” said Dr. Calfee.
A total of 45% of the EVS workers completed the survey, and it yielded a wealth of important information, according to Dr. Calfee. “We found some opportunities for education, personal safety concerns (such as toxicity of the disinfectants and concern about getting infected by being near patients),” he said, adding, “There was opportunity to increase their understanding of the important role that they play in preventing infection transmission, and basics about hospital-acquired infections, and infection prevention strategies.” Based on the results of the survey, they also found that the workers desired more constructive feedback regarding their performance.