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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
*
Author for correspondence: David P. Calfee, MD, MS, Weill Cornell Medicine, 525 East 68th Street, Box 265, New York, NY 10065. E-mail: dpc9003@med.cornell.edu

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. 

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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.

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