Environmental Services aka Housekeeping Baerbel Merrill

1. Environmental Servicesaka Housekeeping Baerbel Merrill

2. Housekeeping during Florence Nightingales Time

3. EVS Housekeeping refers to the general cleaning of the facility, whether it is a hospital, LTC, ASC or other healthcare facility Cleaning including the floors, walls, and certain type of equipment, tables, and other surfaces You are reducing the number of microorganisms that may come in contact with patients, visitors and staff. In some facilities Linen Service, Waste Management, and Pest control are part of the EVS

4. Housekeeping components

5. EVS Healthcare facilities are one of the most important organizations of society Housekeeping one of whose responsibilities is the control of infection and sanitation Housekeeping services include activities to maintain a healthy, clean, orderly, safe, and pleasant environment Your job contributes on a daily basis to the morale and welfare of the patients The EVS department has a distinctive role in your facility

6. EVS Hospital Environmental Services is more than just cleanliness Your facilities appearance is your first opportunity to make an impression on patients and visitors A clean and safe facility builds confidence , improves satisfaction, which is critical to reimbursement Your work directly impact the operations of your facility Your work improves efficiency, throughput solutions speeding discharge and maximizing resources Good housekeeping is an asset and a powerful tool for public relations

7. Good housekeeping

8. EVS • Dress Code for EVS service staff: • Hair should be neatly combed, cut short or tied back • No make-up, perfume, no artificial fingernails • Uniform should be neat and clean • No jewelry, expect watch and wedding band • Clean footwear • Men should be clean-shaven or well trimmed facial hair( if area of work allows facial hair) • Remember you are the picture of your facility

9. EVS High Risk Areas

10. EVS Training for healthcare facilities housekeeping position: This is not a position at the local hotel, your knowledge requires more in-depth understanding of the healthcare environment, disease transmission, personal protective equipment, chemical mixture, exposure control, environmental spill clean-up, cleaning agents, special cleaning needs for blood and body fluid, nurseries, operating rooms, kitchens, how often certain areas must be cleaned, and so much more!!!!

11. Disinfectants Know your institutions disinfectants Before you mix, know your manufacturer instructions, read your MSDS sheet for that specific chemical Know where your PPE is located, and wear appropriate PPE Mix only per manufacture instruction If you have never had instructions on the use of the chemicals, report it to your supervisor Don’t bring your favorite cleaner from home!!!!

12. Disinfectants Store according to Manufacturer guidelines If flammable, must store in flame proof cabinet Disinfectant must be FDA approved for healthcare use Different disinfectant may be needed for use in Kitchens and Nursery areas

13. EVS

14. EVS- High Touch Surfaces Horizontal surfaces Doorknobs in patient rooms and bathrooms Bed rails Tray tables Bedside tables Chairs Light switches Telephones TV remote Call buttons

16. High Touch Surfaces Toilet seat Flush handles Sinks Bathroom hand rails Bathroom pull cords Blood pressure cuffs Knobs, handles on medical equipment

17. EVS Some resources available: CDC Environmental Checklist for Monitoring Terminal Cleaning CDC Environmental Cleaning Eval Worksheet Infection Control Today: Define high-touch surfaces in Hospitals

18. Friends? • Let me introduce you to some “ friends”!!!

19. A. fumigatus

20. Aspergillus fumigatus

21. Friends????? These two Aspergillums cause a severe and deadly pneumonia, especially in cancer patients,

22. Friends • Let’s meet some specific friends who always hang around us! • Are everywhere and pay no rent!

23. Dust Mites

24. Legionella

25. WHAT IS THAT “STUFF” IN MY AIR??

26. EVS 80% is dead human skin and the rest isn’t any better! On each skin cell live two bacteria. Floating skin cells are the means of movement of bacteria

27. EVS Our Bodies Shed 40,000 flakes of skin per hour Your skin makes up about 16% of your body weight We have about 10 trillion cells in our body Do the math!

28. EVSMy Friends????? The average US home collects 40 pounds of dust per year, home to at least 15 species of mites that live about 45 days.

29. “My Friends” 80% of dust is dead skin, the other 20% are dust mite carcasses and feces. Bacteria need a host to stay airborne

30. EVS 42,000 dust mites can live in only one ounce of dust. Up to 25% of the weight of our pillows, stuffed animals, or blankets is dust mite fecal matter.

31. EVS Forty pounds of dust is generated per year per 1,500 square feet of space hosting fifteen different species of dust mites. Airborne dust mite feces cause allergies, ear-eye-nose-throat infections, asthma attacks, fatigue and depression.

32. EVS Mites constantly eat and excrete; remove the food source and they die

33. Something else to think… MRSA

34. MRSA • 99,000 invasive MRSA infections in the U.S. • 19,000 people with MRSA infections died during their initial hospitalization • Most invasive MRSA disease occurs in persons with exposures to hospitals or healthcare settings

35. MRSA • 368,600 hospital stays in 2005 were from MRSA infections • Principle mode of MRSA spread is via contaminated hands of healthcare workers • MRSA can live a long time on fabric • MRSA lives in the nares, axilla and groin

36. EVSNasal Carrier of MRSA 5 to 15%

37. MRSA • MRSA was recovered in the inanimate environment after terminal cleaning of a patients room with known MRSA • Think about the rooms of patients we don’t know they have MRSA!

38. MRSA • PCR testing at CCMH for community MRSA • October 2009 11.6 % • November 4.5% • December 13% • January 2010 4.8% • February 4.7% • March 12.1% • April 7.5% • May 6.3% • June 7.0% • We have stabilized at about 5% to 8% average.

39. MRSA For 2012 our positive rate for screening MRSA for patients meeting the screening criteria was: 9%

40. MRSA • So what is the extent of the problem? • Who is at risk? • How is this spread to others? • Hands, Hands, Hands • Clothes, Equipment, Environment • Why is this bacteria different from the regular staph?

41. MRSA • Has been around since 1959 • First cases in the US in 1960’s • Identified and established risk factors: • Recent hospitalization • Recent surgery • Resident in LTC • Dialysis • Indwelling catheters

42. Community acquired MRSA • Most are skin infections • May be very serious including pneumonia, bloodstream infections or bone infections • Skin lesions can look like spider bites

43. MRSA • How is it spread? • 5 C’s • Crowding • Cutaneous (skin-to-skin) • Compromised skin • Contaminated equipment • Lack of Cleanliness

44. Clostridium difficile CDI • Increase in CDI • Increases in mortality due to CDI • Require Contact Precaution for patients with CDI • Incubation period unknown • Highly resistant to normal cleaning methodologies

45. Clostridium Difficile Special attention by EVS Soap and Water hand washing required Special attention to cleaning processes Hypochloride ( Bleach) C.diff stays on the inanimate objects for weeks!

46. CDI • Hand washing: • Soap and water is required • Alcohol Sanitizers not effective in killing spores of CD • Spores can live for several month in the environment

47. Pandemic Influenza • What do we know? • Influenza vaccination give us immunity, but not absolute immunity, as its efficacy is anywhere between 50-75% • At present time we are encouraged to get immunized each year for the specific flu • Working on vaccine on a molecular basis which would cover all varieties.

48. Pandemic Influenza • What do we do to protect ourselves? • Vaccination • Stay home if you are ill with flu • Do it in your sleeve! • Wash hands, wash hands,

49. Pandemic Influenza • What may happen if ????? • Have you heard about the H7N9 virus? • Did you see Contagion?????????

50. Questions?