In recent years, there has been considerable focus around cleaning and disinfection by environmental services staff (EVS) as we become more in tuned with the risks associated by direct or indirect transmission mission due to a contaminated environment. EVS have been audited, have received training and feedback and have I am certain been reprimanded for neglecting to clean and disinfect one, two or more high touch surfaces. I know for fact, some of these surfaces get missed as a result of the pressure they get for trying to turn over rooms as fast as possible. In the end, I think we would all agree that having a well trained staff, having an auditing and feedback process and a management team that genuinely appreciates the work EVS does as part of a facility's infection prevention program helps to ensure that EVS are doing the best job possible.
At the other end of the scale are the nursing and other clinical staff who utilize patient care equipment - particularly the portable kinds, on wheels, that can easily move from place to place. While there have been outbreaks associated with contaminated patient care equipment, there has not been as much focus on who cleans said equipment with what frequency or how to audit to ensure that cleaning and disinfection is in fact occurring. The best example I have of this, and one that I have used for years to highlight the importance of developing roles and responsibilities of who cleans what is what I will refer to as the "case of the poop splattered commode".
Imagine a facility, dealing with a C. diff outbreak, who utilized commodes in semi-private rooms as their way of maintaining private bathrooms. This facility had an audit program in place using UV reflective markers and was in the process of conducting a clinical study. In one room, for 5 days the underside of the commode seat was marked and the researcher noted there was fecal matter on the rim of the commode bowl. For 5 days, the commode did not get cleaned. There were 5 distinct UV marks that had not been removed or even smeared to show some form of wiping had occurred... Long story short, when EVS and Nursing were brought together to determine what was going on, EVS stated "a commode is on wheels, therefore is a patient care device that should be cleaned by nursing" and nursing stated "a commode is a toilet, which is a surface that EVS should be cleaning". Clearly, no one had thought to sit down and define who cleaned what.
It for this reason that Havill et al's study titled "Cleanliness of portable medical equipment disinfected by nursing staff" is so interesting. This facility has taken the time to clearly define roles and responsibilities for what items need to be cleaned and disinfected between use by nursing and clinical staff. The researchers sought to find out if they were to audit for cleaning compliance and provide feedback, if like the improvements they had found in their EVS staff could they improve the cleanliness of patient care equipment.
During unannounced visits, mobile medical equipment used for patient's vital signs were sampled using ATP (Adenosine Triphosphate Bioluminescence) as well as environmental cultures. Sites tested included: the control button on the blood pressure unit, thermometer, BP Cuff, machine handle and pulse oximeter. The results found that these pieces of patient care equipment were frequently contaminated with organic material as well as aerobic bacteria. While VRE was not found on any of the sites sampled, MRSA was found on several surfaces. The study showed there was a wide variation in cleaning compliance despite polices that clearly outlined who was responsible for cleaning and disinfection. Similar to results found with EVS staff, implementing an auditing program and periodic education of nursing and clinical staff may be beneficial.
Which leads me back to the title of the blog - Have Wheels? Will Travel. Do you know the cleaning and disinfection compliance rates for patient care equipment at your facility? Or better yet....are you confident that everyone knows who is responsible for cleaning and disinfecting what? You never know where your "dirty commode" may turn up!