1. Environmental Services Microsystems Team Cooley Dickinson Hospital Daniel English Linda Riley October, 2011

2. Objective On completion of this session, participants will be able to: –State 3 strategies to engage Environmental Services staff in infection prevention –List 3 interventions that will improve environmental cleanliness –Demonstrate the effectiveness of UV light in reducing CDI

6. One Patient’s Story 72 yrs of age, diagnosis pneumonia, prescribed antibiotics CDI, decreased urine output, kidney failure with hemodialysis for remainder of her life OR for colectomy - colon removed, wears a bag Slow recovery, CCU, on ventilator Stroke, speech and mobility issues Readmitted three times Family members assist with care Anne

7. Causative Factors How healthcare facilities contribute to CDI: –Insufficient hand hygiene –Insufficient environmental cleanliness –Poor antibiotic stewardship Patient risk factors: –Advanced age and underlying illness –Certain medications –Immunosuppression

8. Two studies highlight contamination of hospital environment with C. diff. spores as a major risk factor. Dubberke and colleagues, 2003 Shaughnessy and colleagues, 2006 “Both studies raise the issue of contamination of the hospital environment with C. diff. spores as a - if not THE – major risk factor for nosocomial CDI. This issue deserves much greater attention than it has received in the past. Richard Ellison, MD

9. Learned About Our Microsystems by Assessing Our 5 P Data – Patients, Professional, Purpose, Patterns, Processes Expectations for work performance not clear to staff Difficult to hold staff accountable Staff received little training Staff feels no power to improve work Communication processes cumbersome

10. Workflow - Fishbone

11. Staff Engagement Daily Huddles Patient stories Making improvements, raising the level of professionalism Invite Infection Prevention to your meetings Data: Infections by unit, Patient survey results Bulletin board turned into ‘Staff Feedback’ Include EVS staff in hospital and community news letters By getting them involved…ask for their opinion

12. 30+ Initiatives Accomplished Fresh eyes Communication Dept aim statement Job flows Inspections Chemical Inventory reduced Confidential trash Sharps containers Instigated daily huddles ED Turnaround Seven step cleaning process Code of conduct Patient interaction scripts Reduce clutter Equipment storage Blood borne pathogens Patient room work flow Standards and Regulations, OSHA, TJC, DPH, Precaution room process C’diff room communication with Infection Prevention TB and Negative Pressure Rooms Soiled Linen bags ED Cleaning, working together Uniform switch over 2 % below budget initiative ESCt program Micro-fiber cleaning products Relocate the department Meeting room furniture Pass codes, keys and pagers Stairwell cleaning schedule Steam cleaning

13. Improvements targeting C-diff Trained in the 9 step cleaning process ESCt room management system Increased ES staff by 2 FTEs Average turn around time from 65 to 48 Mins Education on chemical efficacy and dwell time Cleaning time from 14 mins to 24 mins Microfiber cloths/mops Restroom cleanliness, Bleach in all Bathrooms / ED / Cdiff rooms PX-UV Light treatment

14. Focus on the Environment

16. PX-UV Light

17. Xenex PX-UV Light : Taking Disinfection to the Next Level Destroys all major classes of microorganisms that cause hospital- acquired infections. Uses high intensity broad spectrum UV light to penetrate the cell walls, fusing their DNA, leading to instant damage and the inability to reproduce or mutate. 99.99% of germs and spores are killed. Goal: Flash all discharged patient rooms; Flash OR’s & ED daily.

18. Implementation Attention Intention What does it mean for my work? Accountability System support

19. Challenges 1 st Step Contract Early adopter of new technology Flow Procedure and Equipment Sustaining Change

20. Outcomes

23. Thank you. Questions?