1. Emphasize hand hygiene.

Train EVS staff in principles of hand hygiene. According to a recent Health Affairs study, infection control interventions such as hand washing resulted in patients leaving two days earlier and reduced mortality rates by 2 percentage points. Hospital costs also were $12,000 less.

2. Create a customized critical touch point (CTP) testing program.

Implement your own critical touch point testing program. CTP testing has emerged as a definitive method for monitoring the effectiveness of training, and therefore reducing the spread of HAIs. Work with your Infection Control/EVS department to develop a well-defined set of critical touch points that could transfer pathogens, viruses and bacteria.

3. Develop CTP-focused training.

Define a training model that incorporates critical touch points and subtasks in the room cleaning process. Utilize hands-on training sessions or role-playing for better retention of knowledge.

Get Started

Interested in starting a critical touch point testing and training program at your hospital? Start with our CTP Challenge. Simply complete our online form and we’ll send you a free testing kit complete with glow gel and UVA LED light.

Hospital patients in Tennessee were known to have higher-than-average bloodstream infections in the intensive care unit (ICU). To combat the trend, hospitals began utilizing safety checklists and transparent benchmark reporting. The result? Hospitals in the state began scoring 22 percent above the national average.

In fact, one Nashville area hospital improved their score by 32 percent within one year. Making prevention efforts a priority and committing to transparency helped the hospital reduce its benchmark infection ratio in 2009 from 2.5 down to a 1.7 ratio. Posting infection ratio results to their website allowed their patients to make an informed decision whether or not to seek care at the hospital.

Are you currently following a safety checklist and providing transparent results to your patients?

The full article can be found at http://www.fiercehealthcare.com/story/checklist-transparency-cut-infection-rates/2011-11-15.

That leaves some hospitals concerned that their reimbursements will crumble under the new patient satisfaction considerations, reports Kaiser Health News and The New York Times. Hospitals that either can’t afford luxury amenities or simply hospitals who already receive low scores might not appreciate the somewhat subjective ratings.

Effective October 2012, the Centers for Medicare and Medicaid Services will withhold 1 percent of regular reimbursements based on performance, an estimated $850 million, according to The Wall Street Journal. Patient experience makes up for 30 percent of the total bonus payments.

Available on the governmental Hospital Compare website, ratings include patient survey questions, such as the following: Did the doctors and nurses communicate well? Was pain well controlled? Was the room clean and the hospital quiet at night? Only hospitals that receive a grade of 9 or 10 (out of a 10-point scale) will count for Medicare credit, according to the Kaiser-NYT article.

So far, the Hospital Compare data show that only 67 percent of patients gave their hospitals the top two ratings, according to the WSJ. Only 58 percent reported quiet environments, and 60 percent said their physicians and nurses always communicated well about medications.

With the Centers for Medicare & Medicaid Services’ (CMS) first national pay-for-performance program, hospitals now link quality with reimbursements. Through the Hospital Inpatient Value-based Purchasing Program (VBP), starting on July 1 hospitals began reporting clinical and patient experience measures from which CMS calculated VBP scores. HCAHPS makes up 30 percent of the total hospital inpatient VBP score. Effective Oct. 1, 2012, those scores will translate into reimbursement changes, according to the report. And by 2013, hospitals will face penalties for negative clinical outcomes, such as high readmission rates and hospital acquired infections.

“We need to think more about the environment around the patient. We know that the environment can get contaminated and pathogens can be passed on to the next patient,” Dr. Philip C. Carling of Boston University said at the annual European Congress of Clinical Microbiology and Infectious Diseases.

Current cleaning procedures may not be enough to prevent the transmission of hospital acquired infections. In fact, eight published studies show a 74% increase in patients’ likelihood of acquiring an infection if their room was previously occupied by a patient with a nosocomial infection — even when the room was first cleaned according to hospital policy.

Similar poor results were found in a study of 103 medical institutions conducted by Dr. Carling. After evaluating over 62,500 critical touch points (CTPs) — surfaces with a high touch probability — it was determined that only 34% were effectively cleaned postdischarge. Additional studies by Dr. Carling revealed only 49% and 39% cleaning rates.

One of the most objective ways to measure the effectiveness of your EVS program — and its contribution to preventing HAIs — is to implement a critical touch point testing program. A critical touch point testing program involves an inspector marking high-touch surfaces with fluorescent “glow gel” prior to the room being cleaned. Then, after EVS has cleaned the room, the inspector checks for the presence of glow gel with a UVA LED light. If glow gel is present, the surface was not cleaned effectively and represents an opportunity for infection to spread.

Interested in starting a critical touch point testing program at your hospital? Start with our CTP Challenge. Simply complete our online form, and we’ll send you a free testing kit complete with glow gel and UVA LED light.

Does your hospital use a critical touch point testing program?

Reference: http://www.acep.org/Content.aspx?id=66144

Some hospitals are taking steps to reduce excess sounds, including:

• Replacing squeaky wheels.
• Installing noise-absorbing ceiling tiles.
• Flattening patient room thresholds.
• Transmitting white background noise through speakers.

Besides improved care and a stress-free environment for patients and workers, hospitals should be working to reduce noise because “Quietness of the Hospital Environment” is part of the HCAHPS patient satisfaction surveys.

What steps has your facility taken to reduce noise?

The survey by Harris Interactive shows that hospital-acquired infections (HAIs) are influencing people’s perceptions of a hospital’s safety. And the ability to protect patients from hospital germs, such as methicillin-resistant Staphylococcus aureus (MRSA), is becoming a major factor in choosing where to receive care.

When choosing a hospital in a non-emergency situation, 75% of respondents believe lower infection rates are more important to consider than convenience.

What’s more, 94% would prefer to go to a hospital that uses the latest technology available for preventing the spread of infection.

How do you position your EVS department? As specialists in HAI reduction, or as just housekeepers?

Shining a light on the EVS department from a different perspective may be just the ticket to increasing patient’s confidence in your hospital’s ability to combat HAIs, which in turn may increase their satisfaction.

The literature also suggests that at least 20 percent and as much as 70 percent of HAIs are preventable, depending on the setting and type of infection.

In addition to the fundamental costs, patients are becoming more educated to the risks of HAIs and are starting to compare hospitals based on several data points such as their performance on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys.

One of the questions on the survey is geared to how often the rooms and bathrooms are cleaned. Patients often equate cleanliness with safety. Hospitals using new technologies to help ensure cleanliness and patient safety have an opportunity to position themselves in the marketplace and help reassure patients of their commitment to safety. Another benefit is a strengthened infection-control effort. HCAHPS data also will be used to evaluate reimbursement.

This presents a significant juggling act for hospitals as they work to balance the desire to be above the 75th percentile in terms of satisfaction, but in the 25th percentile on cost. To achieve the best outcomes, the entire care team must work together to help reduce and manage the risk of infection. Environmental services (EVS) teams play an important role in this effort and there are a number of technologies that can help.

The key is to determine which technology works with the needs of the health care facility. In addition to a focus on daily cleaning and high-touch surfaces, technology provides an added level of safety.

What technologies has your hospital implemented or adopted to reduce HAIs and what role does your EVS department play in that effort?

*Exerpt from Gordon Buntrock, CHESP, appearing in Health Facilities Management

View the full report submitted to the Institute for Healthcare Improvement.

Strategies

A variety of strategies were developed, focusing on EVS staff training and education, handwashing and a rigorous checklist system. Some of the strategies included:

• Training hospital environmental services staff in critical touch points — areas with a high touch probability — using pictures to overcome communication obstacles.
• Reviewing proper handwashing techniques with environmental services staff and implementing a “See Something, Say Something” campaign that encouraged staff to report improper hand washing.
• Establishing a multidisciplinary team that included EVS staff to review infection control issues.
• Developing and deploying a cleaning checklist that used an “all-or-nothing” system in which all elements must be completed in order to be counted.
• Developing a checklist for supervisors’ cleanliness assessments.
• Making PPE and waterless hand cleaning stations available outside every patient room.

Lessons Learned

By including hospital environmental services staff in the improvement project, they became engaged participants in reaching the goal of eliminating hospital-acquired MRSA bloodstream infections. Reaching the goal was a motivator for staff, and became a source of pride.

The campaign educated EVS staff on their role in preventing HAIs, though high turnover that is common in the industry can pose a challenge for maintaining the level of education. Supervisor intervention during room cleanliness evaluations can help combat this, as staff are educated real-time.

What strategies has your EVS team implemented to combat HAIs? What results have you seen? What lessons have you learned?