1. Knowing Your ES staff How often does the facility IP meet with the Environmental Services (ES) management? ◦ Yearly ◦ Quarterly ◦ Monthly ◦ Weekly ◦ Daily ◦ More than daily?

2. What formalized rounding processes does the facility IP participate? ES Rounds Environment of Care Rounds Emergency Preparedness Rounding Construction (Including the design phase) ◦ Internal construction (Daily) ◦ External

3. Weekly Rounding All patient Care Units All OR areas Decontamination areas Sterile stores areas Hospital waste areas Kitchen Outside the facility, roof, tunnels, parking lot, green space areas, local vicinity

4. Non-Patient Area Rounding Engineering areas Boilers, water heaters, chillers, cooling towers, air handlers Water softeners, water quality, water reserves, compressed air, O2 Planned maintenance schedules: Who, What, When, Where, How, Why?

5. Patient Rooms / Equipment / Patient areas What exact products are used to clean and disinfect? How are the products used? Are they used alone or in combination? Cleaning vs. disinfection? Are they mixed or ready to use products?

6. Patient Rooms / Equipment / Patient areas If mixed, ◦ How and where are they mixed? ◦ What ratios to optimum concentrations? When are the products being used after mixing? When are they tossed?

7. Contributing Variables What are the wet times? How long does it take the product to dry on the surface in winter, in summer? How does the internal humidity and air exchanges affect wet times? How and when are processes adjusted to accommodate?

8. Nursing Staff Education What is the training frequency for available products? What is the training / retraining for use of new products? What is the training for how and when to use each product? Who on the nursing staff is responsible for cleaning what? Is there a mechanism for reporting deficiencies in the cleaning process? Where is it documented what roles is responsible for cleaning of what items?

9. ES Staff Education What is the training program for ES employees? How often is retraining conducted? What are the differences for each process and product? Is there a mechanism for reporting deficiencies in the process? Where is it documented whose role is responsible for cleaning of what items?

10. Evaluation of processes What is the mechanism for reporting deficiencies in the cleaning process? How is quality control checked? How often? By whom? Daily Feedback? What are the expectations, standards, benchmarks, matrix…? How are they evaluated and reported upward, downward and laterally? What is ES’s management role and expectations for reporting to the IP?

11. Evaluation of processes What changes are needed? What implementation processes and strategies will be used? How will implementation be evaluated for success? How will implementation be sustained?

12. Take home message Make rounds daily…Go everywhere! Know the processes…Know when they are not working. Know the people…They want what you want and need your help. Ask questions…People like to share their expertise. Ask the hard questions…The best solutions come from answering the hard questions. Ask many, many, many questions!