Environmental Services Microsystems Team

1. Environmental ServicesMicrosystems Team Cooley Dickinson Hospital Daniel English Linda Riley October, 2011

2. 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 • Demonstrate the effectiveness of UV light in reducing CDI

6. 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 Anne

7. 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

8. 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

9. Learned About Our Microsystems by Assessing Our 5 P Data – Patients, Professional, Purpose, Patterns, Processes • 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

10. Workflow - Fishbone

11. Staff Engagement • Daily Huddles • Patient stories • Making improvements, raising the level of professionalism • Invite Infection Prevention to your meetings • Data: Infections by unit, Patient survey results • Bulletin board turned into ‘Staff Feedback’ • Include EVS staff in hospital and community news letters • By getting them involved…ask for their opinion

12. 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 30+ Initiatives Accomplished

13. Improvements targeting C-diff • Trained in the 9 step cleaning process • ESCt room management system • Increased ES staff by 2 FTEs • Average turn around time from 65 to 48 Mins • Education on chemical efficacy and dwell time • Cleaning time from 14 mins to 24 mins • Microfiber cloths/mops • Restroom cleanliness, Bleach in all Bathrooms / ED / Cdiff rooms • PX-UV Light treatment

14. Focus on the Environment

16. PX-UV Light

17. Xenex PX-UV Light : Taking Disinfection to the Next Level • Destroys all major classes of microorganisms that cause hospital-acquired 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. • Goal: Flash all discharged patient rooms; Flash OR’s & ED daily.

18. Implementation • Attention • Intention • What does it mean for my work? • Accountability • System support

19. Challenges • 1st Step • Contract • Early adopter of new technology • Flow • Procedure and Equipment • Sustaining Change

20. Outcomes

23. Thank you. Questions?