Skip to main content Accessibility help
×
Home

Sustained improvement in hospital cleaning associated with a novel education and culture change program for environmental services workers

Published online by Cambridge University Press:  01 July 2019


Elena K. Martin
Affiliation:
Weill Cornell Medicine, New York, New York
Elizabeth L. Salsgiver
Affiliation:
Weill Cornell Medicine, New York, New York
Daniel A. Bernstein
Affiliation:
Weill Cornell Medicine, New York, New York
Matthew S. Simon
Affiliation:
Weill Cornell Medicine, New York, New York NewYork-Presbyterian Hospital, New York, New York
William G. Greendyke
Affiliation:
NewYork-Presbyterian Hospital, New York, New York Columbia University Irving Medical Center, New York, New York
James M. Gramstad
Affiliation:
NewYork-Presbyterian Hospital, New York, New York
Roydell Weeks
Affiliation:
NewYork-Presbyterian Hospital, New York, New York
Timothy Woodward
Affiliation:
NewYork-Presbyterian Hospital, New York, New York
Haomiao Jia
Affiliation:
Columbia University Irving Medical Center, New York, New York
Lisa Saiman
Affiliation:
NewYork-Presbyterian Hospital, New York, New York Columbia University Irving Medical Center, New York, New York
E. Yoko Furuya
Affiliation:
NewYork-Presbyterian Hospital, New York, New York Columbia University Irving Medical Center, New York, New York
David P. Calfee
Affiliation:
Weill Cornell Medicine, New York, New York NewYork-Presbyterian Hospital, New York, New York
Corresponding
E-mail address:

Abstract

Objective:

To sustainably improve cleaning of high-touch surfaces (HTSs) in acute-care hospitals using a multimodal approach to education, reduction of barriers to cleaning, and culture change for environmental services workers.

Design:

Prospective, quasi-experimental, before-and-after intervention study.

Setting:

The study was conducted in 2 academic acute-care hospitals, 2 community hospitals, and an academic pediatric and women’s hospital.

Participants:

Frontline environmental services workers.

Intervention:

A 5-module educational program, using principles of adult learning theory, was developed and presented to environmental services workers. Audience response system (ARS), videos, demonstrations, role playing, and graphics were used to illustrate concepts of and the rationale for infection prevention strategies. Topics included hand hygiene, isolation precautions, personal protective equipment (PPE), cleaning protocols, and strategies to overcome barriers. Program evaluation included ARS questions, written evaluations, and objective assessments of occupied patient room cleaning. Changes in hospital-onset C. difficile infection (CDI) and methicillin-resistant S. aureus (MRSA) bacteremia were evaluated.

Results:

On average, 357 environmental service workers participated in each module. Most (93%) rated the presentations as ‘excellent’ or ‘very good’ and agreed that they were useful (95%), reported that they were more comfortable donning/doffing PPE (91%) and performing hand hygiene (96%) and better understood the importance of disinfecting HTSs (96%) after the program. The frequency of cleaning individual HTSs in occupied rooms increased from 26% to 62% (P < .001) following the intervention. Improvement was sustained 1-year post intervention (P < .001). A significant decrease in CDI was associated with the program.

Conclusion:

A novel program that addressed environmental services workers’ knowledge gaps, challenges, and barriers was well received and appeared to result in learning, behavior change, and sustained improvements in cleaning.


Type
Original Article
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below.

Footnotes

PREVIOUS PRESENTATION. An abstract (abstract 501) summarizing the results of this study was presented as a poster at IDWeek 2017 on October 5, 2017, in San Diego, California.


References

Weber, DJ, Anderson, D, Rutala, WA. The role of the surface environment in healthcare-associated infections. Curr Opin Infect Dis 2013;26:338344.CrossRefGoogle ScholarPubMed
Shaughnessy, MK, Micielli, RL, DePestel, DD, et al. Evaluation of hospital room assignment and acquisition of Clostridium difficile infection. Infect Control Hosp Epidemiol 2011;32:201206.CrossRefGoogle ScholarPubMed
Huang, S, Datta, R, Platt, R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006;166:19451951.CrossRefGoogle ScholarPubMed
Nseir, S, Blazejewski, C, Lubret, R, Wallet, F, Courcol, R, Durocher, A. Risk of acquiring multidrug-resistant gram-negative bacilli from prior room occupants in the intensive care unit. Clin Microbiol Infect 2011;17:12011208.CrossRefGoogle ScholarPubMed
Datta, R, Platt, R, Yokoe, D, Huang, S. Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants. Arch Intern Med 2011;171:491494.CrossRefGoogle ScholarPubMed
Anderson, DJ, Chen, LF, Weber, DJ, et al. Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study. Lancet 2017;389:805814.CrossRefGoogle ScholarPubMed
Guh, A, Carling, P, Environmental Evaluation Workgroup. Options for evaluating environmental cleaning. Centers for Disease Control and Prevention website. https://www.cdc.gov/HAI/toolkits/Evaluating-Environmental-Cleaning.html. Published 2010. Accessed January 17, 2018.Google Scholar
Carling, PC, Parry, MM, Rupp, ME, et al. Improving cleaning of the environment surrounding patients in 36 acute care hospitals. Infect Control Hosp Epidemiol 2008;29:10351041.CrossRefGoogle ScholarPubMed
Rupp, ME, Fitzgerald, T, Sholtz, L, Lyden, E, Carling, P. Maintain the gain: program to sustain performance improvement in environmental cleaning. Infect Control Hosp Epidemiol 2014;35:866868.CrossRefGoogle ScholarPubMed
Bernstein, DA, Salsgiver, E, Simon, MS, et al. Understanding barriers to optimal cleaning and disinfection in hospitals: a knowledge, attitudes, and practices survey of environmental services workers. Infect Control Hosp Epidemiol 2016;37:14921495.Google ScholarPubMed
Bernstein, D, Salsgiver, E, Simon, M, et al. Qualitative and quantitative assessment of daily cleaning of high-touch environmental surfaces in hospital patient rooms. Abstract 1708 IDWeek 2015. San Diego, CA; October 10, 2015.CrossRefGoogle Scholar
Knowles, M, Malcolm, S. Androgogy in action: applying modern principles of adult learning. San Francisco: Jossey-Bass; 1985:xvi and 444.Google Scholar
Kirkpatrick, J, Kirkpatrick, W. Kirkpatrick’s four levels of training evaluation. Alexandria, VA: ATD Press; 2016.Google Scholar
Multidrug-resistant organism and Clostridium difficile infection (MDRO/CDI) module. Centers for Disease Control and Prevention website. www.cdc.gov/nhsn/pdfs/pscmanual/12pscmdro_cdadcurrent.pdf. Published 2018. Accessed on January 2, 2018.Google Scholar
Ray, AJ, Deshpande, A, Fertelli, D, et al. A multicenter randomized trial to determine the effect of an environmental disinfection intervention on the incidence of healthcare-associated Clostridium difficile infection. Infect Control Hosp Epidemiol 2017;38:777783.CrossRefGoogle ScholarPubMed
Sitzlar, B, Deshpande, A, Fertelli, D, Kundrapu, S, Sethi, AK, Donskey, CJ. An environmental disinfection odyssey: evaluation of sequential interventions to improve disinfection of Clostridium difficile isolation rooms. Infect Control Hosp Epidemiol 2013;34:459465.CrossRefGoogle ScholarPubMed
Guerrero, DM, Carling, PC, Jury, LA, Ponnada, S, Nerandzic, MM, Donskey, CJ. Beyond the Hawthorne effect: reduction of Clostridium difficile environmental contamination through active intervention to improve cleaning practices. Infect Control Hosp Epidemiol 2013;34:524526.CrossRefGoogle ScholarPubMed
Carling, P, Herwaldt, LA. The Iowa disinfection cleaning project: opportunities, successes, and challenges of a structured intervention program in 56 hospitals. Infect Control Hosp Epidemiol 2017;38:960965.CrossRefGoogle ScholarPubMed
Chen, LF, Knelson, LP, Gergen, MF, et al. A prospective study of transmission of multidrug-resistant organisms (MDROs) between environmental sites and hospitalized patients—the TransFER study. Infect Control Hosp Epidemiol 2019;40:4752.CrossRefGoogle ScholarPubMed

Altmetric attention score


Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 432
Total number of PDF views: 412 *
View data table for this chart

* Views captured on Cambridge Core between 01st July 2019 - 2nd December 2020. This data will be updated every 24 hours.

Hostname: page-component-79f79cbf67-td25k Total loading time: 0.243 Render date: 2020-12-02T00:53:25.815Z Query parameters: { "hasAccess": "0", "openAccess": "0", "isLogged": "0", "lang": "en" } Feature Flags last update: Wed Dec 02 2020 00:04:09 GMT+0000 (Coordinated Universal Time) Feature Flags: { "metrics": true, "metricsAbstractViews": false, "peerReview": true, "crossMark": true, "comments": true, "relatedCommentaries": true, "subject": true, "clr": false, "languageSwitch": true }

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Sustained improvement in hospital cleaning associated with a novel education and culture change program for environmental services workers
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Sustained improvement in hospital cleaning associated with a novel education and culture change program for environmental services workers
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Sustained improvement in hospital cleaning associated with a novel education and culture change program for environmental services workers
Available formats
×
×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *