Improving the Quality of Environmental Cleaning By Providing Education and Feedback to Environmental Services (ES) Staff at The Ottawa Hospital

Background:

Transmission and acquisition of MRSA, VRE, resistant gram-negative bacilli and Clostridium difficile during hospitalization is increasingly common. The role of the hospital environment as an important reservoir for these and other pathogens is now well recognized. Proper attention to environmental cleaning and disinfection is paramount in order to minimize the role of the environment in ongoing transmission of these pathogens.

Objective:

Assess 1) thoroughness of environmental cleaning and disinfection before and after education of ES staff; 2) perceived barriers to effective environmental cleaning among ES staff.

Methods:

Three consecutive baseline evaluations of environmental cleaning were obtained at 2 acute-care inpatient sites of The Ottawa Hospital (TOH) over a 2 month period (Period 1). Up to 14 high touch surfaces in inpatient rooms were marked with a fluorescent, water soluble marker, and removal of the marker was assessed after rooms had been terminally cleaned at least once. Examples of high touch surfaces include toilet seats and flush handles, call bells, bedrails, bedside tables, door knobs, light switches. Education, and feedback of baseline evaluations, were provided to ES staff at one TOH site (Civic). ES focus groups were also held, to improve understanding of ES staff morale, attitudes, and barriers to performing their jobs effectively. Evaluations were repeated at both sites, 1 to 2 months after education at the Civic (Period 2), and results from the two Periods compared.

Results:

Evaluations were conducted on 24 inpatient units. Period 1 evaluation was conducted in 618 rooms, and Period 2 evaluation in 174 rooms. The proportion of high touch surfaces cleaned per room in Period 2 increased significantly at both sites, but the increase was greater at the Civic, where education and feedback were provided (Table). ES staff identified several issues that hindered effective performance, including: inability to physically move patients in order to access some items needing cleaning; crowding by visitors and personal effects; pressure to complete tasks quickly due to workload and competing requests for ES services.

  

Campus	Period 1		Period 2		% increase	p value
	Mean % of high touch surfaces cleaned per room	Total no.  rooms	Mean % of high touch surfaces cleaned per room	Total no. rooms
Civic	65.3	353	89.2	94	+ 23.9	< 0.0001
General	68.2	265	78.5	80	+ 10.3	< 0.0001
All TOH	66.5	618	84.3	174	+ 17.8	< 0.0001

Conclusions:

Education and feedback to ES staff can result in significant improvements in environmental cleaning. ES staff identified several obstacles to effective performance, which must be addressed in order to ensure that adequate environmental cleaning can be performed. Sustained improvements in environmental cleaning may contribute to reduced transmission of healthcare-acquired pathogens over time.