A Case for Merging Infection Prevention with Environmental Services

?

More than half of respondents agreed with my recent suggestion to merge the Infection Prevention and EVS departments to improve patient care. This article includes more extensive research and data in support of this recommendation.

?

“HAIs are a leading cause of death in the United States and cause needless suffering and expense.” National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination

For more than two decades, researchers publishing peer-reviewed studies and journalists writing for various healthcare publications have been quoting data the report, “Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002,” by R. Monina Klevens, DDS, MPH, et al. At the time, Klevens was conducting research at the CDC. The report states: “We estimate that 1.7 million HAIs occurred in U.S. hospitals in 2002 and were associated with approximately 99,000 deaths. The number of HAIs exceeded the number of cases of any currently notifiable disease,13?and deaths associated with HAIs in hospitals exceeded the number attributable to several of the top ten leading causes of death…,” and, “These estimates are sobering and reinforce the need for improved prevention and surveillance efforts.”

?

So, what’s changed? Nothing and everything! Recently Healthcare Purchasing News published an article quoting the exact same statistics, “…1.7 million infections annually in the USA and ninety-nine (99) thousand HAI deaths. These are the very same statistics Klevens reported derived from data from the late 1990s. Since then, U.S. healthcare facilities have seen the proliferation of a plethora of new multidrug-resistant organisms (MDROs), including Carbapenem-resistant Enterobacterales (CRE); pan drug-resistant Klebsiella; multi-drug resistant Acinetobacter; and, of course, a COVID pandemic; and the latest threat – antibiotic-resistant Candida auris. In the wake of the COVID pandemic, one would think every healthcare worker understands the importance of proper personal protective equipment (PPE) and hand hygiene. Regrettably, this is not the case.

?

According to The Leapfrog Group’s Spring 2023 Hospital Safety Grade data, the average risk of three HAIs spiked to a five-year high in U.S. hospitals and remains high. The average MRSA, CAUTI standard infection ratio increased by 37% and 60%, respectively; 32 states saw a significant increase in CLABSI, and 18 states had a significant increase in MRSA. These increases occurred during the COVID pandemic, when hand hygiene and PPE compliance were at an all-time high.

?

Following IP Talk, an online community hosted for members of the Association for Professionals in Infection Control and Epidemiology (APIC), frequent requests for guidance in developing hand hygiene compliance programs continue. An example follows:

Subject: In search of references & supportive material on...

"I am putting together a proposal for my hospital on the importance of hand hygiene programs (not just why HH is important to preventing the spread of infection, but the importance of the program itself) in a healthcare setting..."?

It is disheartening that in 2023, following a pandemic, infection preventionists (IPs) continue to struggle with convincing hospital staff and colleagues of the importance of hand hygiene.

?

In 2009, the Joint Commission Resources urged healthcare CEOs to lead the fight against drug-resistant infections and published the toolkit, What Every Health Care Executive Should Know: The Cost of Antibiotic Resistance. The document details the cost of HAIs by individual organisms (i.e., Acetobacter costs more than $203,000 per infection. The toolkit gives the example of an HAI that transmits from the index patient, Mr. Johnson, and involves Mr. Andrews and Mr. McDonald. The cost of hospital care for the three patients at the institution exceeds $1 million. The hospital suffers huge losses in patient referrals and millions of dollars in legal fees.

?

During the APIC 2023 Spring Leadership Forum, there was some discussion about the ongoing perception that IPs are not valued, though we did learn that they are increasingly being heard in the C-suite. IPs want to expand their influence, particularly on the financial side. Clearly, we must further engage and influence key healthcare leaders on the value of infection prevention and the IP profession.

?

The reduction of preventable healthcare-associated infections (pHAIs) hinges on a multi-modal intervention approach. This must start with healthcare leadership, which ensures all departments take responsibility for supporting both hand hygiene compliance and environmental hygiene – one without the other is a waste of time and money.

?

Because Environmental Services (EVS) departments do not generate direct revenue for the hospital, many consider them to be second-class healthcare citizens. In fact, they are the first line of defense against pHAIs. Responsible for day-to-day cleaning and processing of all patient care environments, EVS workers contribute significantly to the financial success of the enterprise. UMF|PerfectCLEAN has supported frontline EVS staff for more than a decade with reward and recognition programs, including our annual Hygiene Specialist Award. We see first-hand the diligence, care, and pride EVS staff take in their profession and the frustration they endure.

?

There is no point in demanding and monitoring hand hygiene compliance if the first environmental surface encountered or touched (ie: door handle, light switch, privacy curtain, etc.) is contaminated, often grossly so, with any number of pathogens.

?

The diagram above, published by the CDC, details the inextricable relationship between environmental hygiene and hand hygiene – in other words, Infection Control and Environmental Services – or, we love acronyms – ICE.

CDC: Core Components of Environmental Cleaning and Disinfection in Hospitals

?

To fully understand the impact of pHAIs on the financial condition of a healthcare facility, a comprehensive financial report should be compiled and made available to managers of all departments. This report would accurately account for all physical and medical services provided to the pHAIs patient, including the cost of incremental patient days as a result of the pHAI; additional support staff; cost to treat; potential litigation costs; loss of goodwill and harm to hospital brand; etc. Such reporting would offer an accurate perspective on the true cost savings potential delivered by EVS and IPs, and would detail their contribution to the bottom line.

?

Improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores requires a multi-modal intervention approach that involves EVS and IP. Patients perceive cleanliness and a well-maintained environment as indicators of quality care. EVS and IP are critical in mitigating the risk of potential fines or lack of reimbursement for pHAIs that are no longer covered by Medicare. Hospitals already collect data on the number of infections; we simply are not applying a financial cost to those numbers, other than penalties. If the goal of infection prevention is zero pHAIs, then every infection prevented is a cost savings, and IP and EVS should be credited with this financial benefit to the hospital.

Benefits of merging IP with EVS in acute-care hospitals

?

Improved communication: Better communication and collaboration between EVS and IP, resulting in a more cohesive approach to infection control and environmental surface processing.

?

Increased efficiency: Streamlined processes and reduction in duplication of efforts would yield cost savings and increased efficiency. Reducing penalties related to HCAHPS scores requires sustained efforts in enhancing patient satisfaction and safety. By merging infection control and environmental services, healthcare facilities can improve their overall performance, reduce penalties, and provide a better experience for patients.

?

Improved staff training: More opportunities for cross-training and sharing of knowledge and expertise, resulting in improved infection control measures. Training is not a one-time event; hospitals should constantly reinforce process quality improvements while updating our training as new hires are added.

?

Consistent processing (cleaning and disinfection) and infection prevention protocols: Establish consistent processes for cleaning and disinfection across the many different patient care environments that are closely aligned with infection control guidelines. The result would be more effective programs and a reduction in pHAIs. And, EVS and IP speaking as one voice will have greater influence throughout the hospital.

?

Enhanced quality control: Greater oversight of cleaning processes and infection control measures, leading to improved quality control. Using advanced tools, hospitals can quickly and efficiently offer quality assurance monitoring, corrective actions, and education to improve results. Without regular daily monitoring, standards will decline.

?

Improved accountability: Improved accountability for maintaining high standards of cleanliness and infection control, resulting in higher levels of compliance with regulations and standards.

?

Enhanced training and education: More comprehensive training and education for staff members would lead to improved knowledge and skills related to infection prevention and control.

?

By merging IP and EVS departments, hospitals can enhance collaboration, streamline processes, and create an enterprise wide culture of infection prevention. This integrated approach will help reduce pHAI’s, improve patient safety, and mitigate financial penalties associated with poor infection control outcomes.

?

?