Vert Mont Chapter Vert Mont Chapter “KEEPING THE BUGS OUT” Presented by: Penny Thompson, FAHC Presented by: Penny Thompson, FAHC & Brandon Hier, L&R Pest Control Brandon Hier, L&R Pest Control

FLETCHER ALLEN HEALTH CARE’S ENVIRONMENTAL SERVICES DEPARTMENT F.I.G.H.T.S. HOSPITAL ACQUIRED INFECTIONS FLETCHER ALLEN HEALTH CARE’S ENVIRONMENTAL SERVICES DEPARTMENT F.I.G.H.T.S. HOSPITAL ACQUIRED INFECTIONS

F.I.G.H.T.S. F.I.G.H.T.S. F ollow isolation practices F ollow isolation practices I n-service training for staff I n-service training for staff G auging disinfectant efficacy G auging disinfectant efficacy H and hygiene H and hygiene T esting environmental surfaces T esting environmental surfaces S tandardized cleaning procedures S tandardized cleaning procedures

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The Beginning October 2008 The Environmental Services’ Department Trainer determined the need to increase the department’s orientation program to dedicate ½ day on infection control in a health care environment. The Environmental Services’ Department Trainer determined the need to increase the department’s orientation program to dedicate ½ day on infection control in a health care environment. This was to educate new hires on:  Hand Hygiene Practices  What are HAI’s  How are they spread  What role do we play in the reduction of HAI’s.

F OLLOWING ISOLATION PRACTICES F OLLOWING ISOLATION PRACTICES We started with purchasing new tools for the hand hygiene part of the program, to include glitter bug potion (which simulates germs on your hands), a timer, educational posters, and black lights. These tools brought a great visual awareness to staff that re-enforced “time does make a difference” when performing hand hygiene. We also purchased informational DVD’s on MRSA, VRE, C-Diff and hand hygiene to help educate new & existing staff on the most common infections that they are likely to encounter.

HAND HYGIENNE

BRINGING “LIGHT” TO INFECTION CONTROL November 2008 As the department moved forward working with our glowing hand washing tools, we discovered, by reading the label, that the glitter bug potion could be used on environmental surfaces too!!! As the department moved forward working with our glowing hand washing tools, we discovered, by reading the label, that the glitter bug potion could be used on environmental surfaces too!!! We realized that this would be a great tool to help us re-assure our customers and ourselves that we were indeed disinfecting surfaces. We then started looking at what would a quality improvement program look like if it was centered around environmental surface markings??

TESTING OF SURFACES TESTING OF SURFACES

WHO,WHAT,HOW, WHEN, & WHY December 2008 WHO,WHAT,HOW, WHEN, & WHY December 2008 We needed to determine:  Who was going to apply the potion to the surfaces?  What surfaces were going to be marked  How to apply the glitter bug potion on the surfaces?  When were the surfaces going to be marked?  How would we present Why we were using this new program to our staff..

HOW TO APPLY IT?? HOW TO APPLY IT?? The supervisors started applying the glitter bug potion to surfaces in a patient room with Q-tips before the ESW started cleaning the room. After the room was cleaned, the supervisor would then review the marked surfaces with a hand held black light to see if all of potion was removed. If it still glowed, it needed to be cleaned again. The potion was messy to use, so we trialed invisible markers in place of the potion. The markers were not washing off after a period of time being left on the surfaces. So we went back to the potion and our Q-tips.

WHO & WHEN?? WHO & WHEN?? We developed a policy for Environmental Surface Marking (ESM) which established that our 5 supervisors were responsible to mark and record the results of 140 surfaces weekly. 700 surface markings a week!!! 700 surface markings a week!!! WOW!! WOW!!

WHAT TO MARK?? WHAT TO MARK?? Our Infection Control Manager, Sally Hess, introduced us to Our Infection Control Manager, Sally Hess, introduced us to the 14 high touch environmental surfaces in a room recommended by the CDC where infection is most likely to be transmitted from.

I N-SERVICING STAFF January 2009 I N-SERVICING STAFF January 2009 We introduced our intentions of Environmental Surface Markings and why we were implementing the program to our employees in our January staff meetings. We used a theme around “GERM BUSTERS” for our in- servicing in February that would be focused on the reduction of HAI’s, which included; The method of application for our disinfectant The method of application for our disinfectant The importance of dwell time The importance of dwell time Environmental Surface Markings Environmental Surface Markings Proper flipping/folding techniques of our cleaning cloths Proper flipping/folding techniques of our cleaning cloths

“JESSE THE GERM” “JESSE THE GERM”

G AUGING DISINFECTANT EFFICACY As we were testing surfaces, we noticed smearing of the potion. This prompted us to look at our application method for the disinfectant. we focused on the saturation of our cloths and started testing the efficacy of our disinfectant in the buckets that we using to immerse our cleaning cloths in. We were getting negative results!! We tested many different methods of application and discovered that we were putting too many cloths into the chemical at one time. We now needed to start using only one cloth at a time. Now we require our Lead staff to test 25 disinfectant buckets per week. 250 BUCKET TEST PER WEEK!! 250 BUCKET TEST PER WEEK!!

“BUCKET TESTING” “BUCKET TESTING”

TIME TO TAKE ACTION FEBRUARY 2009 We now needed to come up with a baseline to give us a starting point. We determined that the results that were gathering during the first quarter of the year would be a sufficient time to establish we were at and get the “bugs worked out” of our process. We used our trial data to establish our 75%. Our goal for July 1, 2009 would be to reach 82.5%. Then again another 10% increase for January 1, 2010 which would bring us to 90%.

NEW TECHNOLOGY MARCH 2009 NEW TECHNOLOGY MARCH 2009 While experimenting with our disinfectant application process, we realized that the cotton cloths that we were using, in addition to putting many cloths into our solution, also compromised the effectiveness of our disinfectant. We developed a plan to purchase the micro fiber cleaning system to include cloths, wet mops, dry mops and high dusters. We implemented the use of the micro fiber cleaning tools in our daily cleaning.

MICRO FIBER The “cleaner” cleaning system MICRO FIBER The “cleaner” cleaning system

RESULTS RESULTS Our Press Ganey patient satisfaction results for the “cleanliness of the room” reached 84.2 which is the highest that we have every achieved. Our WERC physical capacity screening for our light housekeeper position is being evaluated due to the ease and the light weight of the micro fiber cleaning system. Moral of the housekeepers has improved due to their voice on the selection of the micro fiber and the ease of using the system. We know we are not spreading infections with the micro fiber process. NO DOUBLE DIPPING!! NO DOUBLE DIPPING!!

STANDARDIZATION OF PROCEDURES STANDARDIZATION OF PROCEDURES Now it was time to hit the books and put all of our new programs in a procedural based format to have available for our staff to resource when needed. Also to provide consistency in the delivery of our training material. We dedicate weekly mini in-services to infection prevention strategies, such as our high touch surfaces and other programs.

MOVING FORWARD MOVING FORWARD We developed a recognition program just for our surface marking. We have met our first goal at 82.7% and are now working on our next goal of 90%. Our department has purchased a quality tracking program, that we can gather input on E.S.M., chemical testing, QA inspections, and training. Grant money was given to the department from our CEO to fund this program in appreciation for the work that our department has done. Our WERC screening for a light housekeeper has been changed to reflect our use of the micro fiber system.

Reward Program Reward Program Monthly Recognition Monthly Recognition The employee with the 1 st, 2 nd and 3 rd highest disinfection percentage receives a monetary reward. In the event of a tie, names will be drawn until all awards are gone. For example, if two employees received 100% scores and a third employee received 90%. The two employees with 100% will go into a hat for a drawing of 1st and 2nd place. The employee with the 90% score will receive the third place award.

SURFACE SCORES 1/11/09 SURFACE SCORES 1/11/09

SURFACE SCORES 12/06/09 SURFACE SCORES 12/06/09

PRESS GANEY

Vancomycin-Resistant Enterococci (VRE) Methicillin-resistant Staphylococcus aureus (MRSA) Clostridium difficile (C-DIFF) (C-DIFF) Respiratory syncytial virus (RSV) (RSV) Influenza A virus subtype H1N1 NOW ANOTHER “TWIST” ON BUGS…………

Brandon Hier from L & R Pest Control