Clean Bill of Health

A Solid Cleaning Program Is Fundamental to Any Infection Control Strategy

Some of the most prevalent strategies for combating infection involve embracing commonsense solutions, such as thorough and persistent hand washing for all personnel and better screening of patients entering the hospital. Others are based on eliminating unnecessary elements in the environment that may allow bacteria to spread; for example, doctors are now discouraged from wearing neckties, and many hospitals are replacing hospital curtains with a disposable variety treated with antibacterial coating. Still other strategies involve more advanced methods for tracking and eliminating causes of infection: ATP monitors to detect living organisms on surfaces, silver-lined hospital gowns that take advantage of the infection-preventing properties of silver, and even a return to the use of bacteriophages (special viruses that destroy bacteria).

THE ENVIRONMENT IS KEY

In developing a comprehensive strategy to identify, treat, and eliminate sources of infection, what must not be lost is a basic focus on the physical environment.
No matter how well hospital employees adhere to hand washing policies or how successful a hospital implements a screening program, the truth is that a hospital cannot totally keep pathogens out. Without a top-quality program focused on not only cleaning, but also disinfecting the environment, infections will continue to be a problem exacerbating the difficulties faced by patients. It is not enough to try to keep germs out or try to treat infected patients; germs must be killed wherever they exist within the hospital environment.

Since 1970, the CDC has not required hospitals to test surfaces for bacteria. The policy ignores the huge rise in HAIs in the last four decades, and the numerous studies linking dirty hospital surfaces to infections.
In April 2008, the House Committee on Government Oversight and Reform met in Washington, DC, for a hearing entitled “Healthcare Associated Infections: A Preventable Epidemic.” The committee determined that the Department of Health and Human Services was ineffective by failing to mandate and enforce certain practices. The committee recommended that some standards be made mandatory and that Medicare reimbursement be tied to compliance.

CROTHALL IS FOCUSED ON CLEAN

Crothall is always researching ways to complement a solid cleaning program with advanced infection-fighting tools. Several client hospitals are currently piloting technologies that will improve the total infection control solution. However, at the core of any Crothall Environmental Services program is a relentless pursuit of cleanliness. To be healing environments, hospitals must not only look clean, they must be free of contamination.

Crothall’s policies meet or exceed those set by a number of regulatory bodies, including: AORN, OSHA, Joint Commission,
and state and local authorities. All Crothall infection control policies are cleared and subject to modification by the Infection Control Practitioner at each client hospital. A successful program depends on the best training, both at the time of hire and continuously throughout employment. Crothall has over twenty training modules that involve infection control procedures, including:

• Standard Precautions
• Hand Washing
• Isolation Room
• Surgical Areas
• MRSA, VRE, & TB
• Clostrum Difficile (C.Diff)
• Bloodborne Pathogens

While a solid Environmental Services program is key to infection control, there are always opportunities to enhance and customize the cleaning process to meet the specific concerns of customers. Crothall strives to have a close working relationship with the Infection Control department and has been involved in countless studies to examine many aspects of cleaning processes, training, chemicals, and tools. By partnering with infection control experts, Crothall not only helps solve hospitals’ specific problems, but also develops new best practices to be shared with other client hospitals.

Recent Infection Control Studies
	Suburban Hospital Bethesda, MD*	Southwest General Hospital Middleburg Heights, OH	Oakwood Hospital & Medical Center Dearborn, MI
	August 2005 - July 2006	March-April 2008	November 2007
	Measure effectiveness of formal training (including hand hygiene), new microfiber mops, and new disinfectant, Johnson-Diversey’s Oxivir.	Closely observed all isolation room discharges. Employees retrained, now graded on high-touch cleaning and adherence to infection control processes.	Swab tests were done following discharges of Acinetobacter-infected patients to identify if contaminated room surfaces were contributing to the spread of infection.
	Combination of training, chemicals, and tools has resulted in 10% decrease in antibiotic use, indicating a reduction in the infection rate at the hospital.	Final results showed an average score of 94% for infection control cleaning audits.	Tests were negative, ruling out contaminated surfaces. Further study identified hand washing and glove policies to be a primary area of opportunity.
	Rita Smith, Nurse Epidemiologist: “Cleaning staff is fundamental to infection control. Crothall has been very cooperative with our infection control program. We would not have been able to carry out our research without the support of the cleaning staff.”	Debra Hohenfeld, Infection Control Practitioner: “Environmental Services is an integral partner in our infection control program at Southwest General – continually looking for better ways to ensure a clean and safe patient care environment.”	Seetha Jayaraman, Infection Control Specialist: “Environmental culturing was helpful to eliminate possible causes for transmission, like equipment used for treatment. It also helped us to enforce hand hygiene and gloving policies throughout the facility.”
*To learn more about this study, read the case study.