1. Cleaning Times in Canadian Healthcare Facilities Project Preliminary results of Phase 1 and introduction to Phase 2 Cleaning Times Project Phase 1 and 2

2. Cleaning Times Research Team Dick E. Zoutman, MD, FRCPC, Queen’s University B. Douglas Ford, MA, Queen’s University Keith Sopha, C.E.M., President-Canadian Association of Environmental Management and CEO-CleanLearning Brock Wylie, MA, C.E.M., Consultant- Clean Measures

3. Purpose There is a general lack of knowledge regarding the length of time needed to clean rooms and perform cleaning tasks in Canadian Healthcare facilities There are few benchmarks available for times taken to clean hospital rooms

4. Purpose What data exists is not specific regarding Hospital room type, cleaning procedure, and isolation precautions This study will determine benchmarks for terminal and daily routine cleaning of private, semi-private, and ward rooms with and without isolation precautions AND

5. PIDAC Raised the BAR

6. From CHESS Study More than half the EVS managers indicated that they do not think they have sufficient staff to clean Hospitals to standards Less than 40% of Hospitals are sufficiently clean for infection prevention purposes

7. Room type and size Age of the facility Facility design Geographic's – weather and other elements Activity in the room Clutter Variables that may Impact Standard Benchmark Times

8. We only have limited published information within our industry on cleaning times Generally aggregate and non-specific Occupied: 25 - 30 minutes Terminal: 40 - 45 minutes Industry Benchmarks AHE and CDC

9. International Sanitary Supply Association (ISSA) Provides information for detail or aggregate time study Occupied:14.4 – 16.2 (est. 1993 or earlier) Item specific cleaning times Industry Benchmarks

10. Canada produced viable data in the National Productivity Improvement Program (1985) Occupied:12.9 (without WR) Occupied: 21.7 (with WR) Industry Benchmarks

11. Industry Benchmark Routine Cleaning

12. Methods Phase 1 Online survey Survey items derived from teams’ experience in environmental cleaning Survey completed by Senior Managers responsible for Environmental Services Canadian Healthcare facilities with 50 or more beds

13. Preliminary Results Preliminary results for 33 acute care hospitals At this time there are insufficient responses to report on other types of healthcare facilities Second round of survey invitations to be sent as part of Phase 2

14. Patient Areas Cleaned According to Published Recommendations

15. How Hospitals Determine Room Cleaning Time Requirements* *Respondents could indicate more than one method

16. Time to Perform Daily Routine Cleaning of Patient Rooms* *All hospitals used a single cleaner for daily routine cleaning of patient rooms

17. Time to Perform Daily Routine Cleaning of Patient Rooms Private RoomSemi-Private Room All Beds of a 3-4 Bed Ward Range10-2012-4020-80 Standard Deviation 3.97.113.7

18. SD is a measure of dispersion of data about the mean / average. = or – 1 SD contains 2 / 3s (68%) of data points and 2 SD ~ 95 %.

19. Industry Benchmark Routine Cleaning

20. Time to Perform Discharge/Transfer Cleaning of Rooms Per Cleaner* *8 % of hospitals used 2 cleaners for the discharge/transfer cleaning of private and semi-private rooms and 15 % of hospitals used 2 cleaners for wards

21. Time to Perform Discharge/Transfer Cleaning of Rooms Per Cleaner Private RoomSemi-Private Room All Beds of a 3-4 Bed Ward Range20-60 30-126 Standard Deviation 9.012.326.3

22. Time to Perform Routine Daily Cleaning Under Isolation Precautions and Excluding CDI* *All hospitals used a single cleaner for daily routine cleaning under additional isolation precautions and excluding C. difficile.

23. Time to Perform Routine Daily Cleaning Under Isolation Precautions and Excluding CDI Private RoomSemi-Private Room All Beds of a 3-4 Bed Ward Range15-9020-9025-140 Standard Deviation 17.021.530.4

24. Time to Perform Routine Daily Cleaning Under Isolation Precautions Due to CDI Per Cleaner* *Two hospitals used two cleaner teams for daily routine cleaning under additional isolation precautions due to C. difficile

25. Time to Perform Routine Daily Cleaning Under Isolation Precautions Due to CDI Per Cleaner Private RoomSemi-Private Room All Beds of a 3-4 Bed Ward Range15-8020-12025-160 Standard Deviation 18.126.231.0

26. Frequency of Cleaning of CDI Rooms

27. Method Used to Clean CDI Rooms

28. Daily Routine Used to Clean Floors

29. Use of Ladders to Remove and Replace Privacy Curtains

30. Time to Remove and Replace Privacy Curtains

31. Remove Privacy Curtains Replace Privacy Curtains Range2-203-30 Standard Deviation4.36.3

32. What we have shared to date CAEM – Collingwood Ontario 2014 and Niagara Falls Ontario 2015 Poster presentation at IPAC - Victoria BC 2015 Study accepted for publication in Canadian Journal of Infection Control 2015 Results presented to PIDAC - 2015 for review

33. More to share Approached by the UK Journal of Infection Control 2015 ISSA presentation and quick clip 2015 OPHC – Abstract - Toronto 2016

34. The BIG Question Is the survey results: – time allotted or – time required ???

35. Connecting with CleanMeasures Brock Wylie as Principal Developed plan to survey cleaning practices in a variety of health care settings Included 4 sites Acute Care Complex Continuing Care Mental Health Long Term Care Introduction of Phase 2 The Case Study

36. Time Study Tools …, from this

37. Time Study Tools …, to this

38. What We Found To Date Data collected from Audits indicate inconsistent cleaning practices Times recorded are less than survey results Interrupted cleaning

39. Conclusion Need more audits – more site participation Need financial support Grant - sponsorship

40. Outcomes of a Study Observation Audit Revealed Opportunities Linen Cart Set-up

41. Added Benefits of the Process Some client observations

42. Added Benefits of the Process Some client observations

43. Added Benefits of the Process Some client observations

44. Room type and size Age of the facility Facility design Geographic's – weather and other elements Activity in the room Clutter Variables that May Impact Standard Benchmark Times

45. Systematic cleaning Tools and equipment Interruptions How they clean Variables that May Impact Standard Benchmark Times and Quality

46. 046 Questions