Editor’s Note: The following is a free Briefings on Accreditation and Quality article from yesteryear! If you like it, check out more of our work covering quality and accreditation!
After reading this article, you will be able to:
- Identify everyday items that may require additional thought when it comes to infection control procedures
- Describe who should be involved when developing policies for cleaning everyday items in the patient room
- Discuss the development process of disinfection policies for certain challenging items
- Describe leadership’s role in building an effective policy for patient room equipment cleaning routines
Think back to your last visit to a hospital as a patient or family member. Every patient care area has recognizable, ubiquitous items, such as automated blood pressure pumps, compression pumps, and IV pumps. But how do you know if those items were cleaned and/or disinfected? Were they used with the last patient, or have they sat dormant for weeks? Such items are easy to overlook, but in terms of patient safety and infection control, they need to be addressed in every facility.
One organization, St. Joseph’s Healthcare System-which includes St. Joseph’s Regional Medical Center in Paterson and St. Joseph’s Wayne Hospital in Wayne, N.J.-has implemented a method for cleaning these everyday items and identifying them as clean without adding an additional burden to its staff.
“As you know, in healthcare it can be challenging to change processes,” says Anne Marie Pizzi, M.Ed., RN, HACP, TeamSTEPPS trainer, Six Sigma Green Belt, and performance improvement coordinator with St. Joseph’s. “This began as a work in progress three or four years ago as we were struggling with preventing infection control issues and trying to find a way to make life easier for staff to clearly identify items that were already clean, or that needed to be cleaned.”
So the organization-a regional tertiary medical center and an acute care community hospital-brought together all the key departments, including infection prevention and control, nursing, central sterilization processing, and environmental services, to work collaboratively to improve the process.
“In the beginning, the problem boiled down to a real estate issue,” says Pizzi. “The hardest thing for us to decide when we talked about the equipment was, whose job is it to clean it?”
In addition, the team looked at what type of equipment was involved, how frequently it needed to be cleaned, and what kind of cleaning was necessary.
“Anything requiring more than low-level disinfection is not left to the staff on the unit,” says Pizzi. “So there were specific pieces of equipment that had to go to central supply or to individual departments where staff are trained to clean and care for that equipment.”
The equipment that environmental services or the staff on the units will typically clean include automated blood pressure pumps, Accu-Chek® meters, pulse oximeters, and IV pumps.
“You may believe that you have designed a solid process when discussing it in a meeting, but when it is rolled out to the staff, change can be a challenge,” says Pizzi. “So it was really important we talked to the staff to determine the processes they were using and the possible solutions they would suggest.”
And with that feedback, the committee created a policy on which the hospital now operates.
“Any piece of equipment not in continuous use like pulse oximeters, ventilators, etc., has to be cleaned and disinfected using the guidelines set by infection control,” says Pizzi. “They are then bagged and tagged [with the date cleaned] and put in the clean utility room.”
For other items, like those in continuous use (automated blood pressure pumps), it was determined that they did not need the bagging and tagging process, but the items still require low-level disinfection.
Developing the current process involved some trial and error, says Pizzi. This allowed the team members to craft a process with efficiency in mind.
“When we looked at our practice, initially we used nylon blood pressure cuffs on the general population and disposable cuffs for patients on isolation,” she says. “This meant that the entire unit had to be disinfected between patients.” This didn’t work well. Even for a low-level risk of infection, the blood pressure cuff required three minutes of dry time after disinfection.
As an alternative, the team changed the processes to use a disposable sleeve on the patient’s arm. The sleeve provides a barrier to ensure there is no direct contact with the patient’s skin. However, that process ran into design flaws as well, particularly in sizing the sleeves. The sleeves were designed as one size fits all, so patients often were too thin or too large for them to work properly.
“The team continued to meet and evaluate their interventions. Eventually, after limited success with the other process, the group came to a decision,” says Pizzi. “We refitted the automated blood pressure pumps and implemented using disposable cuffs on each patient. This solved the cuff problem, but the machine itself also needs to be cleaned between patients.”
As blood pressures are taken, the machine goes from patient to patient. Staff members have to wash their hands between patients with sanitizing gel before touching the machine. If a staff member touches the machine with contaminated hands, the entire machine has to be sanitized.
“Our internal audit data demonstrates that staff has good hand hygiene practices between patients,” says Pizzi, noting it has been a focus in the organization. “The staff recognizes that any machine left out in the hallway-or not in a designated ‘parking area’-has to be cleaned and disinfected before patient use.”
This aligns with the organization’s philosophy that stresses infection prevention and control.
“When you think about the question ‘how do infections spread,’ it’s not just related to contact between staff and patients; you must also consider the environment,” says Pizzi.
In addition, the organization has reinforced with all its staff that patients should be able to see the organization’s efforts toward cleanliness and infection prevention.
“We coach staff often about how to ensure that we can demonstrate the cleanliness of all rooms-all areas,” she says.
This involves keeping hand sanitizer visible and accessible, and encouraging staff to talk with patients and their visitors about hand hygiene practices.
Perceptions and improvements
As an ISO leader, it is among Pizzi’s duties to identify opportunities for improvement or gaps in organizational processes.
“We’re working to enhance the customer experience and embrace the patient experience,” says Pizzi. “We have implemented the use of hotel-style cards in English and Spanish that are left in the patient rooms and include the name of the person who had cleaned the room. This helps to personalize the cleaning process for the patients and their family.”
During rounds, management staff talks to patients to get real-time feedback on their experience with the organization.
“The patient might not tell you at the moment, but we do our best to try to let them know we’re interested in what they have to say,” says Pizzi.
Overall, the new infection prevention and control procedure for cleaning and managing patient equipment has been a success.
“No process change is immediate, and staff has to relearn the new process-this also takes some time,” says Pizzi.
She draws on her Six Sigma training to facilitate process improvement.
“For your first meetings, make sure you have the right people in the room,” Pizzi says. “If the person(s) who will own this process don’t contribute to the change, it can derail all your efforts.”
The first question for this initiative: Who is cleaning the equipment? It might seem silly and obvious, but often the obvious can be overlooked. The same question is also useful when on environmental rounds.
Many healthcare organizations are working with limited resources, so the decision of ownership needs to be based on logic. Which is the most appropriate department/person(s) to handle a task? In the end, no matter who is assigned the responsibility, it is important that the entity carrying it out is properly trained in cleansing techniques and uses the right cleaning products.
“The good news is that once you get the process owners in the room and come to a consensus about a change in process, there is usually much less resistance,” Pizzi says. This is important in terms of getting unit and department leaders on the same page and in agreement.
“In the end, staff buy-in and ownership comes from that all-important sense that everyone has the same goals at the end of the day: safe delivery of quality healthcare,” she adds. “We strive to create the kind of healthcare experience for our patients that we would expect for our loved ones or ourselves.”