According to the National and State Healthcare-Associated Infections Progress Report released in May 2016, on any given day, about 1 in 25 hospital patients have at least one healthcare-associated infection. While the number of HAIs has decreased overall, we certainly have a long way to go. The stats currently spewed in so many studies or reports estimate that there are 722,000 HAIs in US hospitals each year, with 75,000 patients dying during their hospitalization as a result of an HAI. The attributed cost for these HAIs according to a 2013 study is an estimated $96-147 billion annually.
I think we can all agree there has been a significant focus on trying to reduce HAIs. I’m sure we can all agree that there is not one single magic bullet. Reducing HAIs is a bundled approach where we need to ensure environmental surfaces and medical devices are cleaned and disinfected, everyone cleans their hands, and antibiotic stewardship programs are put into place. Unfortunately, we also know that hospitals need to balance their budgets. HAIs and outbreaks are expensive. There are times when a hospital is forced to rob Peter to pay Paul. The ugly truth is that Environmental Services staff are often on the chopping block when it comes to having to make cut backs.
I realized it may seem logical when you are just looking at numbers on a piece of paper, but let’s think about the unintended consequences of such an action. Does the size of the facility change? No. Can you cut back on cleaning and disinfection? No, there is a plethora of data linking the fact that effective cleaning and disinfection can reduce HAIs. What then is the reality of cutting back on the number of staff when the workload has not been reduced? Corners get cut. Short cuts are taken. The result is a potential increase in HAIs.
According to a survey conducted in 2016, understaffing in environmental services is getting worse, with reports of layoffs and cuts occurring regularly. Concerns are growing among environmental service workers that hospitals do not have the capacity and enough cleaning staff to keep key surfaces like bedrails, mattresses, taps, door handles and chairs clean. The survey revealed a disturbing pattern of having to speed through the cleaning, being short staffed due to vacations or sick days, employees admitting to having high levels of stress and injuries occurring at work. In fact, a large majority reported that more duties have been added to their already heavy workloads. Over half of the respondents believe the situation is unsafe.
A study from 2014 noted that cleanliness in hospitals can be characterized as less than optimal. Nearly 40% of respondents did not judge their hospital to be sufficiently clean for infection prevention and control purposes. If we admit the truth, we know there is reams of data to support the fact that infection rates would decline and fewer people would die if we just cleaned. The problem is determining how to apply the science and the data generated into mathematical models that can calculate the return on investment (ROI) and define what the value proposition is for supporting a fully staffed Environmental Services department.
We know that cleaning works. We know that cleaning is time and labour intensive. We know that having adequate staff will impact the budget. Are we willing to risk the lives of patients when we know the harm that can be prevented by improving our cleaning and disinfection programs? I’m hoping the answer is no.