Compliance Monitoring and Feedback- Critical Components to Environmental Cleaning and Disinfection
In the previous blogs of the layered approach series, we discussed building high-reliability systems within healthcare systems alongside human factors engineering to minimize hazards and ensure good patient/quality outcomes and highlighted the importance of Infection Prevention (IP) and environmental services (EVS) partnership. The Institute for Healthcare Improvement (IHI) bundle for cleaning and disinfection includes monitoring compliance with feedback1; this important component of the bundle has been validated by multiple studies in the published literature.
McGarity, et al., provide insight into the struggles with sustaining healthcare environment cleaning and disinfection practices. They detailed how compliance auditing, performance feedback to EVS and clinical staff, education and hospital, and EVS leadership support can result in significant improvements over time2. Fluorescent marker audits served as the intervention employed to validate cleaning and disinfection practices. The researchers found that compliance rates were significantly improved in both the EVS and clinical teams when processes were validated and performance feedback provided2. This study highlights the successes that can result when IP and EVS teams collaborate and share their findings with the end-users.
Parlaying compliance monitoring and feedback to a layered approach where UVC technology is employed in addition to manual cleaning and disinfection practices, Fleming, et al., highlight the wins that can result. A multidisciplinary team introduced an enhanced cleaning protocol (manual disinfection supplemented with UVC technology) for terminal cleaning of rooms with known C. difficile incidences. Education was provided to EVS staff, alongside structured audits and performance feedback, resulting in increased compliance with UVC technology deployment within the facility3.
Sani-Cloth® wipes inherently support ease of use (and therefore compliance!) due to the fact they are pre-saturated wipes intended to be conveniently placed throughout the healthcare environment. PDI provides compliance tools in the form of wall mounts, tabletop caddies, and hallway stands to effectively remove any barriers to successful use. Support teams provide bracket assessments to offer feedback on appropriate product placement and type (based on chemistry, wipe size and compatibility profiles). When employing a layered approach to disinfection with UVC technology, the Tru-D device generates real-time data through a portal with customizable visual data highlighting device usage, run times, report generation as well as consultative calls to review usage and compliance goals.
These examples serve to underscore the importance of compliance auditing, complete with feedback to the EVS and nursing staff, as well as ongoing education. The sharing of “wins” helps to bolster good practice, and the partnership between EVS and IP leadership is critical for sustaining good practice.
- Rutala, William A., and David J. Weber. “Best practices for disinfection of noncritical environmental surfaces and equipment in health care facilities: A bundle approach.” American Journal of Infection Control47 (2019): A96-A105.
- McGarity, Adrienne L., and Cassandra Salgado. “Improving and sustaining environmental cleaning compliance in a large academic hospital using fluorescent targeting audits, education, and feedback.” American Journal of Infection Control6 (2019): S20.
- Fleming, Michele, et al. “Deployment of a touchless ultraviolet light robot for terminal room disinfection: The importance of audit and feedback.” American journal of infection control2 (2018): 241-243.