Infection: often ranked the #1 fear among patients, and it is
the sixth leading cause of death.
Simply stated, poor cleanliness equals Hospital Acquired
Infections (HAI). HAIs lead to unnecessary readmissions, and unnecessary
readmissions are not being reimbursed by CMS or insurance companies. Why would
they?
The priority focus has to be that cleanliness and hygiene
issues receive immediate care.
Consider This
Nearly 1 in 5 Medicare
patients discharged from the hospital are readmitted within 30 days - at a cost
of over $15 billion every year (CMS Report, 2012). The cost of HAIs impact
approximately two million patients and cause about 100,000 related deaths every
year, and an estimated $30.5 billion dollars in unnecessary costs.
This is a critical issue, and one that requires a shift in
culture. If no housekeepers are immediately available and a cleanup needs to be
performed, all staff must be prepared to grab a mop and address the situation.
Hospital Acquired
Conditions (2013): On the Hit List for CMS…and They Aren’t Happy About It
1.
Foreign Object Retained After Surgery
2.
Air Embolism
3.
Blood Incompatibility
4.
Stage III and IV Pressure Ulcers
5.
Manifestations of Poor Glycemic Control
6.
Catheter-Associated Urinary Tract Infection
7.
Vascular Catheter-Associated Infection
8.
Surgical Site Infection Following Specified
Procedures
9.
Coronary Artery Bypass Graft
10.
Bariatric Surgery
11.
Orthopedic Procedures
12.
Cardiac implantable Electronic Device
13.
Deep Vein Thrombosis
14.
Iatrogenic Pneumothorax with Venous Catheterization
Risk Factors for Bacterial Infections
Contact between the patient
and a microorganism does not by itself necessarily result in the development of
clinical disease—other factors influence the nature and frequency of nosocomial
infections (HAIs). Factors like urinary tract infections, respiratory tract
infections, skin sepsis/wounds and gastro intestinal infections.
The problem is that drug
resistance to these nosocomial infections is rather strong and the risk of
bacterial infections awaits the patient within hours of admission.
1.
Iatrogenic Risk: From medical staff, if ventilation
lines are not clear, if vascular lines are perhaps not sterile, if catheters
are not sterile.
2.
Organizational Risk Factors: Contaminated air-conditioning
systems or water systems, infection spread due to short-staffing, not enough
people on the floor, or AVS people to take care of vital functions. Physical
layout of the facility: how far are rooms from the nursing station?
3.
Patient Associated Risks: Severity of illness
contributes to more infection. Underlying immune-compromised state of the
patient. Consider the length of the visit: the longer they stay, the more
vulnerable the patient might be.
So what are some of the
routes of transmission of these infections?
1.
Air-borne: anything in the atmosphere of the
hospital
2.
Contact: hands, clothing, catheters, food trays
3.
Food-borne: kitchen may have insects, rodents, or
other unsanitary conditions
4.
Blood-borne: needle sticks, spills
5.
Self-Infection: i.e., operation in the lower bowel
where bacteria is already present
It really goes without
saying that daily cleaning of machines, equipment and materials used is vitally
important in the fight against HAIs.
Best Practices: Tools, Equipment and Resources
Job number one for management is to make sure your staff has
the non-negotiable tools for cleanliness; this is critical.
1.
Obviously,
patient rooms are to be kept infection-free.
2.
Regular
in-sink hand-washing is performed by all hospital personnel. One study reports
60% of healthcare workers do not maintain good hand hygiene!
3.
Take
extra care in disinfecting a room previously occupied by a patient with a
“pathogen of interest”. Remember those curtains that pull around - infections
can live on the fabric.
4.
Alcohol-based
hand-sanitizers are located throughout the hospital and are constantly filled
and in use.
5.
Care-givers’
uniforms/scrubs/lab coats are fresh daily. If soiled in the course of work-day,
these garments are exchanged for clean issue.
So what are critical housekeeping tasks?
1.
Cleaning
patient rooms daily.
2.
Performs
twice-daily cleanings of patient bathrooms.
3.
You
are not a snitch when you share the things you’ve heard from patients that they
haven’t yet told their doctors or nurses. It is critical that this information
be passed along to ensure the best patient care and experience.
4.
Utilize
a housekeeper calling-card that includes the time and date the patient’s room
and bathroom were cleaned. Patients are impressed and their perception of
safety and comfort is greatly increased (and so is your HCAHPS Score!).
Immediate, clear and continuous action must be taken to
transform the culture of your hospital to a cleanliness culture.
The Take Away
Discuss this post with your staff and agree upon a Standard
Operating Procedure (SOP) for your hospital. Have a two-way conversation about
it, and decide what needs to be done differently or better. It is the process
of creating ownership that changes the shift in culture to “Everyone a
Housekeeper”.
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