One consistency within the healthcare sector is that there are too few rooms, and when one does becomes available the urgency to have it cleaned and ready to put back into circulation is enormous. Why? Well, there are also targets to meet with respect to admitting patients, and as always...there are patients who need it.
The question that is posed time and time again is how long does it take to clean a room? In this day and age, the faster we can clean a room the faster we can fill it. This issue with focusing on how fast a room can be turned around is similar to our question regarding how to find the fastest disinfectant with the most claims. Something has to be given up. For disinfectants, that generally means we sacrifice safety for efficacy and contact time. For cleaning, it generally means corners inevitably get cut and that can be deadly. Cutting corners with cleaning means that surfaces get missed, and we all know if we do not clean a surface, bugs are left behind leaving the room a danger zone for the next patient.
Don’t get me wrong, I understand that time is money. But I also know that like a good wine, things get better with time and cleaning is one of the things in life that with the more time you have, the better the end result will be. It was interesting then to see a research poster at last week’s IPAC-Canada conference by a group of researchers from Queen’s University, the Journal of Environmental Management and Facility Hygiene and the Canadian Association of Environmental Management focusing on Patient Room Cleaning Times in Canadian Acute Care Hospitals. As the researchers rightly stated, current bench marks are not specific when it comes to the types of rooms and their conditions (e.g. discharge clean? isolation? private? semi-private?). The aim of their study was to determine if and what the benchmarks for terminal and daily routine cleaning would be or should be.
What was interesting to me was how the times were determined. Nearly 100% of the respondents relied on past experience while only 53% of these same sites used time and motion studies. When looking at the time to perform daily cleaning, as expected, the larger the room (e.g. the number of beds) the more time it took and as the level of infection prevention precautions increased (e.g. a MRSA vs a C. diff room) the more time it took to clean. The average time for a daily clean single patient room was 17 minutes while a C.diff patient room with 4 beds was 67 minutes (37 minutes for a single bed). A similar story unfolded for terminal or discharge room cleaning.
Certainly, this is the most comprehensive study to date in terms of looking at the average time we take to clean a room, but as the researchers so rightly concluded, do we know if these times ensure that the rooms are adequately cleaned? Do we know if using these times the surfaces are free and clear of pathogens and safe for the next patient? We do not. It does however, give us the perfect step off for additional work where we use these times to clean our room and then examine if the room is in fact clean and free of pathogens.
As I said, I understand that time is money and if we can improve upon cleaning times we can turn over rooms faster, and perhaps reduce the manpower needed to clean our facilities and get the next patient in so we can charge for that room. But I caution that thought and stress the fact that we need to ensure that we are doing what’s right for the patient and our staff. What if the workload changes? More discharge rooms or more isolation rooms means more time. Is there a buffer we should also be looking at? For example, is there a tipping point where staff cut corners to speed up their cleaning if the number of isolation rooms or discharge rooms they have increases? I hope we’ll look into that too!