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Friday, August 28, 2015

How full is your bucket?

I admit there are times I get a “bit” riled up but to be fair, sometimes I get riled up because some people find it amusing to “push my buttons”.  I will also openly admit there some topics that I am passionate about, probably to the point of being a zealot. Tonight I was flipping through my latest copy of Infection Control Today when I came across an article written by the editor Kelly Pyrek “Room Turnover Times: Trash-and-Dash Approach Jeopardizes Patient Outcomes”. One a scale of 1 to 10 in terms of having strong feelings and opinions over cleaning of patient rooms, I am about an 11, and just reading the title started to make me quiver.

I have long said that focusing on what a disinfectant product kills is not the answer to our environmental hygiene issues.  Certainly, choosing a product with contact times faster than 10 minutes will help ensure contact time compliance which will help ensure we are killing the bugs we are concerned with, but don’t be fooled. A faster contact time is not the silver bullet we are looking for either. The truth is there is no silver bullet. We have had the answer for years. The answer is understanding that cleaning and disinfection is a process that requires meticulous attention and sufficient time allowed to ensure corners do not get cut. As one of the people interviewed by Pyrek had stated “When I talk about processing, this includes cleaning and disinfection practices, because healthcare environmental services (EVS) is process-driven, just as surgery and nursing is process-driven. EVS is finally standing up and stating we cannot cut out parts of our process and expect to get proper results. We must follow our processes, and we require sufficient time to perform the job properly, and if we don’t, we risk poor patient outcomes.”

EVS staff genuinely want to do a good job and like doctors, nurses and other clinical staff they want to be acknowledged for the work they do and their role in improving patient outcomes.  How often have you heard someone (or you being that person saying) “Get this room done in 10 minutes!”  I know how I feel when rushed and end up cutting corners or producing work that is not to the standard that I set for myself.  I become frustrated.  I become angry.  I feel bad about myself.  My invisible bucket tips over and big invisible drips spill out.

As the article states if you were to tell a surgeon to remove a gall bladder in 10 minutes or a nurse to insert a central line in 5 minutes they would revolt.  They would push back stating they cannot do it properly or safely in that length of time.  They would cite the fact that they have standards and a code of conduct they must adhere to.  It’s interesting that we do not allow EVS staff to do the same.  It’s interesting that there is a plethora of published data supporting the importance of cleaning and disinfection and the importance that achieving compliance (e.g. contact times, wiping all high touch surfaces, etc) has on improving the status of environmental hygiene, reducing bioburden, reducing HAIs and improving patient outcomes. 

It’s interesting that we acknowledge the work of our doctors, nurses and other clinical staff.  We’re quick to fill their buckets.  Similarly, it’s also interesting that we do not applaud and celebrate the important work that our EVS staff does.  We’re quick to empty their buckets by pushing them to do more with less and by pointing fingers and blaming them for environmental transmission of HAIs.  We’re less apt to applaud them for their work and ensure their buckets are full.
What is this bucket I talk of?  We all have an invisible bucket.  It’s that part of you that when it’s empty you feel bad and when it’s full you feel great.  It’s that happy feeling you get when you’ve helped someone or have been nice to someone and that sad feeling you get when you’ve been hurt by someone or know that you’ve done something wrong.  If you still don’t get it read “How full is your bucket – for kids” by Tom Rath and Mary Reckmeyer.  It’s a favorite bedtime story of my son’s and tonight he rightly told me I make him feel bad when I rush him in the morning.  He doddles...I get impatient....our buckets start emptying.....

I’ll leave you to read the full ICT article.  It’s well worth the read and I hope will change your attitude on the time it takes to clean the room, and if you have the authority I hope you’ll help your EVS team to strengthen the importance of their roles.  I hope you’ll solidify the importance of following processes and not cutting corners.  I hope you’ll help EVS justify their budgets and FTE levels the next time they are told to cut their budgets and fire some staff. I hope you’ll start filling the buckets of your EVS staff!

Bugging Off!                                                                                                       

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