Eight expert recommendations for lowering the risk of hospital-associated infection

Each year, an estimated two million patients obtain an infection that is associated with a hospital visit, according to the Centers for Disease Control and Prevention (CDC). About 90,000 of those end in death.

1. Focus on high-touch areas — ES departments should clean rooms as frequently as possible. They should focus particularly on high-touch areas such as doorknobs, bed rails, light switches, call buttons, bed trays and bathrooms, according to Mark Regna, a technical advisor of ASHES and director of health care service with Dallas-based Jani-King International Inc. “As soil loads build up on surfaces, disinfectants have to work harder,” he says. “The more often you clean, the less there is to clean, but you have to determine what is economically feasible.”
2. Prioritize technique over chemicals — ES directors should focus on the cleaning technique used by their staff, rather than the type of disinfectant being employed. “If you simply have a cloth that’s sufficiently wet and has good contact with the surface, it can make a huge difference,” Bartley says.
3. Adhere to product instructions — The Environmental Protection Agency (EPA) requires disinfectant manufacturers to spell out the appropriate methods for using their products, as well as the strengths at which the chemicals are most effective. There’s a misconception that a stronger concentration of a chemical makes it more effective, Sehulster says. “If the label requires the product to be diluted, there’s a reason,” she adds. “Deviations can throw off the ionic balance.”
4. Weigh the risks of using sporicides — Surface disinfectants used in hospitals generally don’t work against C. difficile spores. Chemicals such as gluteraldehyde are effective sporicides, but they can only be used on open surfaces because the vapors can be harmful. A mixture that contains sodium hypochlorite (bleach) might have some sporicidal properties, but it may not be strong enough to completely destroy the spores, she adds.
5. Identify how chemicals can impact patients, staff and the environment — ES directors should choose only the most effective cleaning and disinfection products, Sehulster says. At the same time, they must consider the amount of wear and tear those products will have on the surfaces being cleaned. Bleach-based solutions, for example, can be corrosive to certain metals.
6. Create multidisciplinary teams — Hospitals should create multidisciplinary teams to zero in on infection risks, recommends Sehulster. Clinical staff, for example, need to know how dust from a construction project travels through a health care facility’s ventilation system or be aware of the safety issues related to cleaners and disinfectants. Likewise, ES directors should receive training in chemistry, infection control, industrial hygiene and materials science.
7. Check each other’s work — Checklists should be created by environmental services departments to detail the steps involved in cleaning a room. Then staff can use these lists to ensure all of the steps were followed, Bartley says. However, such a strategy can be difficult to follow because of the pressures on ES staff to turn rooms around quickly, Bartley admits.
8. Underscore the benefits of hand washing — ES managers should emphasize the critical nature of personal hygiene among staff and patients. Hand washing among staff can help to minimize microbial contamination on frequently touched surfaces. “Microorganisms don’t travel from point A to point B by themselves. They tend to be moved by the air, by people touching surfaces or by people exposed to coughs and sneezes, Sehulster says. Hospitals should also make visitors aware of infection and urge them to wash their hands, Regna says. Staff can also post signs in patient rooms to communicate the link between hand washing and infection. “We tell doctors and nurses to wash their hands and to clean their stethoscopes before touching a patient,” Regna says, “but we need help from the patient to tell their visitors to wash their hands.”

The fight against hospital-associated infections is a top priority at facilities. And, increasingly, ES managers are becoming recognized for their crucial role in this struggle. The recommendations discussed in this article will help them expand this role, as well as improve patient health.

This article was reproduced for educational purposes from the December 2006 Health Facilities Management Magazine article entitled “Breaking the Chain” by Steve Davis.
A Washington, D.C.-based freelance writer, Davis is a regular Health Facilities Management magazine contributor with extensive health care industry experience.