1. Environmental Services Microsystems Team Cooley Dickinson Hospital Daniel English Linda Riley March 29, 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

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 Q1 2008 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, Q1 2008

11. What engages employees? It is a commonly held belief that employees will feel more committed to an organization if they believe that their efforts are valued. This is even more relevant during challenging economic times, when employees are expected to do more with fewer resources. - SHRM 2009 Employee Job Satisfation Survey

12. What engages employees? The August 2009 Gallup Employee Engagement Index reported that only 33% of workers are engaged in their jobs, 49% are not engaged, and 18% are actively disengaged. Engagement is not the same as satisfaction. Progress is the biggest employee engager. - March 2011, HR Magazine, ‘Raising Engagement’.

13. What Motivates Employees? Recognition Meaningful work Challenging work goals Rewards for meeting goals Environment that is caring and connected.

14. Our steps to staff engagement Daily Huddles Patient stories Making improvements, raising the level of professionalism Invite Infection Prevention to staff meetings Share data: Infection rates and patient satisfaction results Bulletin board turned into ‘Staff Feedback’ Include EVS staff in hospital and community news letters Getting everyone involved…ask for their opinion

15. 30+ Initiatives accomplished within three years 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

16. Improvements targeting C-diff Q2 2008Education on chemical efficacy and dwell time Q3 2008Trained staff in the 9 step cleaning process Q4 2008Average pt. room turn around from 65 to 48 mins Cleaning pt. discharge rooms from 14 to 24 mins Q1 2009Environmental services management software Q3 2009Increased ES staff by 2 FTEs Q4 2009 Microfiber cloths/mops Q2 2010 Steam clean selected areas / projects Q3 2010 Restroom cleanliness, Bleach in all Bathrooms / ED / Cdiff rooms Q1 2010 UV Light treatment for all pt. discharge rooms, operating rooms and emergency department.

17. Focus on the Environment

19. PX-UV Light

20. Current focus is the introduction of UV Light room treatment: ‘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.

21. 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

22. Thank You Any questions……?