Vert Mont Vert Mont Chapter Chapter

““KEEPING THE BUGS OUT”KEEPING THE BUGS OUT”

Presented by: Penny Thompson, FAHCPresented by: Penny Thompson, FAHC

&&

Brandon Hier, L&R Pest ControlBrandon Hier, L&R Pest Control

FLETCHER ALLEN HEALTH FLETCHER ALLEN HEALTH CARE’SCARE’S

ENVIRONMENTAL SERVICES ENVIRONMENTAL SERVICES DEPARTMENTDEPARTMENT

F.I.G.H.T.S. F.I.G.H.T.S.

HOSPITAL ACQUIRED INFECTIONSHOSPITAL ACQUIRED INFECTIONS

F.I.G.H.T.S.F.I.G.H.T.S.

F F ollow isolation practices ollow isolation practices I I n-service training for staff n-service training for staff G G auging disinfectant efficacyauging disinfectant efficacy

H H and hygieneand hygiene

T T esting environmental surfacesesting environmental surfaces

S S tandardized cleaning procedurestandardized cleaning procedures

COLLEGESCOLLEGES

HIGH SCHOOLSHIGH SCHOOLS

PRE-SCHOOLSPRE-SCHOOLS

HOMEHOME

GYMSGYMS

GROCERY STORESGROCERY STORES

HOTELSHOTELS

TRANSPORTATIONTRANSPORTATION

BUSESBUSES

AIRPLANESAIRPLANES

AIRPORTSAIRPORTS

The BeginningThe BeginningOctober 2008October 2008

The Environmental Services’ Department The Environmental Services’ Department Trainer determined the need to increase the Trainer determined the need to increase the

department’s orientation program to dedicate department’s orientation program to dedicate ½ day on infection control in a health care ½ day on infection control in a health care

environment.environment.This was to educate new hires on: This was to educate new hires on:

Hand Hygiene PracticesHand Hygiene Practices What are HAI’s What are HAI’s

How are they spreadHow are they spread What role do we play in the reduction of What role do we play in the reduction of

HAI’s.HAI’s.

FFOLLOWING ISOLATION OLLOWING ISOLATION PRACTICES PRACTICES

We started with purchasing new tools for the hand We started with purchasing new tools for the hand hygiene part of the program, to include glitter bug hygiene part of the program, to include glitter bug potion (which simulates germs on your hands), a timer, potion (which simulates germs on your hands), a timer, educational posters, and black lights. These tools educational posters, and black lights. These tools brought a great visual awareness to staff that re-brought a great visual awareness to staff that re-enforced “time does make a difference” when enforced “time does make a difference” when performing hand hygiene.performing hand hygiene.

We also purchased informational DVD’s on MRSA, VRE, C-We also purchased informational DVD’s on MRSA, VRE, C-

Diff and hand hygiene to help educate new & existing Diff and hand hygiene to help educate new & existing staff on the most common infections that they are staff on the most common infections that they are likely to encounter.likely to encounter.

HHAND HYGIENNEAND HYGIENNE

BRINGING “LIGHT” BRINGING “LIGHT” TO INFECTION CONTROLTO INFECTION CONTROL

November 2008November 2008

As the department moved forward working with our As the department moved forward working with our glowingglowing hand washing tools, we discovered, by reading hand washing tools, we discovered, by reading the label, that the glitter bug potion could be used on the label, that the glitter bug potion could be used on environmental surfaces too!!! environmental surfaces too!!!

We realized that this would be a great tool to help us re-We realized that this would be a great tool to help us re-assure our customers and ourselves that we were assure our customers and ourselves that we were indeed disinfecting surfaces. We then started looking at indeed disinfecting surfaces. We then started looking at what would a quality improvement program look like if it what would a quality improvement program look like if it was centered around environmental surface markings?? was centered around environmental surface markings??

TESTING OF SURFACESTESTING OF SURFACES

WHO,WHAT,HOW, WHEN, & WHY WHO,WHAT,HOW, WHEN, & WHY December 2008December 2008

We needed to determine:We needed to determine:

WhoWho was going to apply the potion to the surfaces? was going to apply the potion to the surfaces?

WhatWhat surfaces were going to be marked surfaces were going to be marked

How How to apply the glitter bug potion on the surfaces?to apply the glitter bug potion on the surfaces?

WhenWhen were the surfaces going to be marked? were the surfaces going to be marked?

How would we present How would we present WhyWhy we were using this new program to our staff. we were using this new program to our staff.

..

HOW TO APPLY IT??HOW TO APPLY IT??

The supervisors started applying the glitter bug The supervisors started applying the glitter bug potion to surfaces in a patient room with Q-tips potion to surfaces in a patient room with Q-tips before the ESW started cleaning the room. After before the ESW started cleaning the room. After the room was cleaned, the supervisor would then the room was cleaned, the supervisor would then review the marked surfaces with a hand held review the marked surfaces with a hand held black light to see if all of potion was removed. If it black light to see if all of potion was removed. If it still glowed, it needed to be cleaned again.still glowed, it needed to be cleaned again.

The potion was messy to use, so we trialed invisible The potion was messy to use, so we trialed invisible markers in place of the potion. The markers were markers in place of the potion. The markers were not washing offnot washing off after a period of time being left after a period of time being left on the surfaces. So we went back to the potion on the surfaces. So we went back to the potion and our Q-tips.and our Q-tips.

WHO & WHEN??WHO & WHEN?? We developed a policy for Environmental We developed a policy for Environmental Surface Marking (ESM) which establishedSurface Marking (ESM) which establishedthat our 5 supervisors were responsible that our 5 supervisors were responsible to mark and record the results of 140 to mark and record the results of 140 surfaces weekly. surfaces weekly.

700 surface markings a week!!!700 surface markings a week!!!

WOW!!WOW!!

WHAT TO MARK??WHAT TO MARK??

Our Infection Control Manager, Sally Hess, introduced us to Our Infection Control Manager, Sally Hess, introduced us to the 14 high touch environmental surfaces in a room the 14 high touch environmental surfaces in a room recommended by the CDC where infection is most likely to recommended by the CDC where infection is most likely to be transmitted from.be transmitted from.

IIN-SERVICING STAFFN-SERVICING STAFF January 2009January 2009

We introduced our intentions of Environmental Surface We introduced our intentions of Environmental Surface Markings and why we were implementing the program Markings and why we were implementing the program to our employees in our January staff meetings. to our employees in our January staff meetings.

We used a theme around “GERM BUSTERS” for our in-We used a theme around “GERM BUSTERS” for our in-servicing in February that would be focused on the servicing in February that would be focused on the reduction of HAI’s, which included;reduction of HAI’s, which included;

The method of application for our disinfectantThe method of application for our disinfectant The importance of dwell timeThe importance of dwell time Environmental Surface Markings Environmental Surface Markings Proper flipping/folding techniques of our cleaning Proper flipping/folding techniques of our cleaning

cloths cloths

““JESSE THE GERM”JESSE THE GERM”

$250.00 REWARD

Jesse Germs

GGAUGING DISINFECTANT AUGING DISINFECTANT EFFICACYEFFICACY

As we were testing surfaces, we noticed smearing of the As we were testing surfaces, we noticed smearing of the potion. This prompted us to look at our application potion. This prompted us to look at our application method for the disinfectant.method for the disinfectant.

we focused on the saturation of our cloths and started we focused on the saturation of our cloths and started testing the efficacy of our disinfectant in the buckets testing the efficacy of our disinfectant in the buckets that we using to immerse our cleaning cloths in. that we using to immerse our cleaning cloths in.

We were getting negative results!!We were getting negative results!!

We tested many different methods of application and We tested many different methods of application and discovered that we were putting too many cloths into discovered that we were putting too many cloths into the chemical at one time. the chemical at one time.

We now needed to start using only one cloth at a time.We now needed to start using only one cloth at a time.

Now we require our Lead staff to test 25 disinfectant Now we require our Lead staff to test 25 disinfectant buckets per week.buckets per week.

250 BUCKET TEST PER WEEK!!250 BUCKET TEST PER WEEK!!

““BUCKET TESTING”BUCKET TESTING”

TIME TO TAKE ACTIONTIME TO TAKE ACTIONFEBRUARY FEBRUARY 20092009

We now needed to come up with a baseline to We now needed to come up with a baseline to give us a starting point. We determined that give us a starting point. We determined that the results that were gathering during the the results that were gathering during the first quarter of the year would be a sufficient first quarter of the year would be a sufficient time to establish we were at and get the time to establish we were at and get the “bugs worked out” of our process. We used “bugs worked out” of our process. We used our trial data to establish our baseline @ our trial data to establish our baseline @ 75%. 75%.

Our goal for July 1, 2009 would be to reach Our goal for July 1, 2009 would be to reach 82.5%.82.5%.

Then again another 10% increase for January Then again another 10% increase for January 1, 2010 which would bring us to 90%.1, 2010 which would bring us to 90%.

NEW TECHNOLOGYNEW TECHNOLOGYMARCH 2009MARCH 2009

While experimenting with our disinfectant While experimenting with our disinfectant application process, we realized that the cotton application process, we realized that the cotton cloths that we were using, in addition to putting cloths that we were using, in addition to putting many cloths into our solution, also compromised many cloths into our solution, also compromised the effectiveness of our disinfectant.the effectiveness of our disinfectant.

We developed a plan to purchase the micro fiber We developed a plan to purchase the micro fiber cleaning system to include cloths, wet mops, dry cleaning system to include cloths, wet mops, dry mops and high dusters. mops and high dusters.

We implemented the use of the micro fiber We implemented the use of the micro fiber cleaning tools in our daily cleaning.cleaning tools in our daily cleaning.

MICRO FIBER MICRO FIBER The “cleaner” cleaning The “cleaner” cleaning

systemsystem

RESULTSRESULTSOur Press Ganey patient satisfaction results for Our Press Ganey patient satisfaction results for

the “cleanliness of the room” reached 84.2 the “cleanliness of the room” reached 84.2 which is the highest that we have every which is the highest that we have every achieved.achieved.

Our WERC physical capacity screening for our Our WERC physical capacity screening for our light housekeeper position is being evaluated light housekeeper position is being evaluated due to the ease and the light weight of the due to the ease and the light weight of the micro fiber cleaning system.micro fiber cleaning system.

Moral of the housekeepers has improved due to Moral of the housekeepers has improved due to their voice on the selection of the micro fiber their voice on the selection of the micro fiber and the ease of using the system.and the ease of using the system.

We know we are not spreading infections with the We know we are not spreading infections with the micro fiber process.micro fiber process.

NO DOUBLE DIPPING!!NO DOUBLE DIPPING!!

STANDARDIZATION OF STANDARDIZATION OF PROCEDURESPROCEDURES

Now it was time to hit the books and Now it was time to hit the books and

put all of our new programs in a put all of our new programs in a procedural based format to have procedural based format to have available for our staff to resource available for our staff to resource when needed. Also to provide when needed. Also to provide consistency in the delivery of our consistency in the delivery of our training material.training material.

We dedicate weekly mini in-services to We dedicate weekly mini in-services to infection prevention strategies, such infection prevention strategies, such as our high touch surfaces and other as our high touch surfaces and other programs.programs.

MOVING FORWARDMOVING FORWARD

We developed a recognition program just for We developed a recognition program just for our surface marking. We have met our first our surface marking. We have met our first goal at 82.7% and are now working on our goal at 82.7% and are now working on our next goal of 90%.next goal of 90%.

Our department has purchased a quality Our department has purchased a quality tracking program, that we can gather tracking program, that we can gather input on E.S.M., chemical testing, QA input on E.S.M., chemical testing, QA inspections, and training. Grant money inspections, and training. Grant money was given to the department from our CEO was given to the department from our CEO to fund this program in appreciation for to fund this program in appreciation for the work that our department has done.the work that our department has done.

Our WERC screening for a light housekeeper Our WERC screening for a light housekeeper has been changed to reflect our use of the has been changed to reflect our use of the micro fiber system.micro fiber system.

Reward ProgramReward Program Monthly RecognitionMonthly Recognition

The employee with the 1The employee with the 1stst, 2, 2ndnd and 3 and 3rdrd highest highest disinfection percentage receives a disinfection percentage receives a monetary reward. monetary reward.

In the event of a tie, names will be drawn In the event of a tie, names will be drawn until all awards are gone. For example, if until all awards are gone. For example, if two employees received 100% scores and a two employees received 100% scores and a third employee received 90%. The two third employee received 90%. The two employees with 100% will go into a hat for employees with 100% will go into a hat for a drawing of 1st and 2nd place. The a drawing of 1st and 2nd place. The employee with the 90% score will receive employee with the 90% score will receive the third place award.the third place award.

SURFACE SCORES 1/11/09SURFACE SCORES 1/11/09Surface DisinfectionWeek Ending 1/11/09

Bed

Pan

Cle

aner

, 0%

Bed

Side

Rai

l, 58

%

Tele

phon

e, 3

5%

Bed

Side

Tab

le, 8

3%

Rem

ote

Con

trol

, 22%

Tray

Tab

le, 7

8%

Patie

nt C

hair,

56%

Pt. R

oom

Doo

r Han

dle,

22%

Bat

hroo

m D

oor H

andl

e, 6

%

Bat

hroo

m L

ight

Sw

itch,

24%

Sink

/Cou

nter

Top

, 63%

Toile

t Sea

t, 70

%

Toile

t Han

dle,

41%

Toile

t Sup

port

Rai

ls, 3

1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Surface

Perc

enta

ge o

f Sur

face

s Di

sinf

ecte

d Pr

oper

ly

Average Score: 42%

SURFACE SCORES SURFACE SCORES 12/06/0912/06/09

Surface DisinfectionWeek Ending 12/06/09

Bed

Side

Rai

l, 81

%

Tele

phon

e, 9

6%

Bed

Side

Tab

le, 9

6%

Rem

ote

Con

trol

, 76%

Tray

Tab

le, 9

4%

Patie

nt C

hair,

83%

Pt. R

oom

Doo

r Han

dle,

92%

Bat

hroo

m D

oor H

andl

e, 9

5%

Bat

hroo

m L

ight

Sw

itch,

86%

Sink

/Cou

nter

Top

, 85%

Toile

t Sea

t, 93

%

Toile

t Han

dle,

98%

Toile

t Sup

port

Rai

ls, 9

3%

Bed

Pan

Cle

aner

, 100

%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Surface

Perc

enta

ge o

f Sur

face

s Di

sinf

ecte

d Pr

oper

ly

Average Score: 90%

PRESS GANEYPRESS GANEYPatient Satisfaction

Quarterly Mean Score

84.3 84.4

86.1 85.9

83.7

80.3 80.3 80.481.3 81.6

82.9

87.4

85.284.2

74

76

78

80

82

84

86

88

90

Jan - March 2008 April - June 2008 July - Sept 2008 Oct - Dec 2008 Jan - March 2009 April - June 2009 July - Sept 2009

Mea

n S

core

RoomCleanliness

Courtesy ofpersoncleaningroom

Vancomycin-Resistant Vancomycin-Resistant EnterococciEnterococci(VRE)(VRE)

Methicillin-resistant Staphylococcus aureus Methicillin-resistant Staphylococcus aureus (MRSA) (MRSA)

Clostridium difficile Clostridium difficile

(C-DIFF)(C-DIFF)

Respiratory syncytial virus Respiratory syncytial virus

(RSV) (RSV)

Influenza A virus subtype H1N1 Influenza A virus subtype H1N1

NOW ANOTHER NOW ANOTHER “TWIST”“TWIST” ON ON BUGS…………BUGS…………

Brandon Hier fromBrandon Hier fromL & R Pest ControlL & R Pest Control