Environmental cleanliness in an ambulatory care setting: 5 things to know

Despite their best efforts, infection and prevention leaders can struggle to keep facilities, especially in ASCs, due to limited resources available to implement a standardized environmental cleaning program. However, as all settings of care are susceptible to infection, ambulatory leaders must have infection prevention on their radar to ensure they yield excellent patient outcomes.

"All healthcare settings, regardless of the level of care provided, must make infection prevention a priority," said Barbara Connell, vice president of medical affairs/quality at Medline Industries Inc., during a Medline-sponsored webinar.

Here are five things for healthcare leaders to know about implementing a standardized environmental cleaning program.

1. How do patients and staff transmit infections and diseases? After an inanimate surface is contaminated, patients and staff can easily and unknowingly transmit its pathogens to susceptible others within the facility. These pathogens are often passed after touching the contaminated surface. Patients often shed pathogens onto nearby objects, and Ms. Connell said 20 percent to 40 percent of cross contamination occurs via healthcare personnel's hands.

"The revelation that cleaning is not done consistently and that drug-resistant organisms can be recovered from hospital surfaces has brought about an awareness of the role of these areas in disease transmission," Ms. Connell said.

Hand hygiene compliance has gained awareness in surgery centers. In the past, The Joint Commission recommended hand hygiene compliance rate exceeding 80 percent, according to Ms. Connell. However, the agency has since altered its position and no longer requires a certain level of compliance. The key is to have a robust hand hygiene program that includes surveillance and shows continued improvement incompliance.

2. Cleanliness affects patient satisfaction. Patient satisfaction has a positive correlation with a clean environment. Ms. Connell cited a 2016 Health Industry Distributors Association survey that found 48 percent of patients said one core reason their provider surpassed their expectations was his or her dedication to infection prevention.

Infection prevention and cleanliness includes:
• Hand sanitizer and other cleaning and sterilization products being visible throughout a facility
• Staff frequently washing their hands
• Issuing masks to patients who need or request them
• Presence of infection control signs

Staff should ensure every area adheres to the same level of cleanliness. They should also routinely perform cleaning and sterilization tasks.

3. Understanding the difference between cleaning and disinfecting. The words 'cleaning' and 'disinfecting' are often used interchangeably; however, the two terms define different tasks.

Cleaning always precedes disinfecting and entails removal of visible soil and organic contamination. Cleaning is also typically done with appropriate chemical agents.

Disinfecting is the process of eliminating or reducing harmful microorganisms from inanimate objects and surfaces. Ms. Connell recommended using microfiber cloths and mops to apply liquid disinfectants to surfaces. She noted staff members should disinfect shared equipment between each patient use and according to the manufacturer's instructions for use. "Disinfectant should be used in the manner recommended by the manufacturer," Ms. Connell said. She reiterated while staff may have found short cuts or quicker methods, it is always important to follow the manufacturer's directions to achieve the required level of disinfection."

4. Who is responsible for cleaning? Some facilities bring in cleaning services while others rely on their staff to get the job done. If your facility relies on staff, your facility should provide training upon hire, and repeat sessions or when policies and procedures are updated. Job-specific infection prevention education is invaluable for staff

On a regular basis, facility managers and administrators can assess the cleanliness of their center by monitoring their facility with techniques such as, florescent gel markers or ATP bioluminescence systems. But, it is up to the facility to determine the standard for measuring cleanliness. "There is no standard method for defining the level of microbial contamination that correlates with good or poor environmental hygienic practices," said Ms. Connell.

5. Resources are available for facility leaders to improve cleanliness. The CDC provides a detailed checklist for outpatient settings. The checklist includes:

• Whether personnel who clean and disinfect patient care areas are properly trained
• If the facility is regularly audited
• If the facility has written policies for routine cleaning and disinfecting environmental surfaces

The CMS surveyor's worksheet is also available to show you what they will be looking for during an inspection.

The CDC checklist and the CMS surveyor's worksheet are great tools to help you identify areas for improvement in environmental cleaning and disinfection program. By utilizing these checklists, facilities can develop robust environmental cleaning programs that show their dedication to preventing disease and infection.

To view a recording of the webinar, click here.

To download a PDF of the presentation, click here.

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