Environment and Experience

Enhancing Cleanliness to Boost Satisfaction and Promote Healing

People associate cleanliness with quality and safety, now even more than pre-pandemic.[1] A clean environment builds trust and shows excellence. This affects patients’ overall perception of medical care. A clean facility is associated with higher opinions of staff responsiveness and nurse attentiveness.[1]

Achieving patient satisfaction in a clean environment is not a vanity measure. Hospitals that score lower on cleanliness on HCAHPS also have higher infection rates and worse outcomes.[1]

A Clean Environment Is a Safe Environment

Numerous studies show that cleanliness contributes to patient safety. Patients are more likely to contract certain infections if the patient who stayed in their room before them was infected.

Environmental transmission spreads 30% to 50% of hospital-associated infections (HAI), with serious consequences.[2] The World Health Organization estimates 1 out of 10 people who get an HAI die.[3] Hospitals can improve safety and reduce the transmission of infections by focusing on environmental cleanliness.

How to Enhance Cleanliness

The response to COVID-19 brought an avalanche of measures to stop the spread. In the post-pandemic world, it may be hard to imagine finding more ways to clean, but focusing on cleanliness is more important now than ever. Staff are burned out and need support. As restrictions lift, it can be easy to relax too much.

Protocols

Examine your cleaning protocols for updates and create protocols if you don’t have them. Staff turnover is high. As entry-level staff fill open positions, having clear guidelines for cleaning is crucial.

Monitoring

Monitor cleanliness regularly to identify opportunities for improvement. In one study, researchers evaluated high-touch surfaces in 36 hospitals and found that less than half had been adequately cleaned.[4] Monitoring should go beyond visual inspection. Ultraviolet fluorescence and adenosine triphosphate (ATP) surface testing can identify organic residue left after cleaning.[5]

Innovation

New technologies, such as robotic cleaning, steam cleaners,[6] and UV-C disinfection can lighten the load on your staff, helping them clean more efficiently and effectively.

Culture

Make prioritizing cleanliness part of your organizational culture. If the CEO stops to pick up a piece of litter and dispose of it, it sets the tone for the whole organization.

Don’t Miss a Spot

Remember that every minute in your facility influences the patient experience. One dirty waiting room can make patients forget that the facility is sparkling everywhere else.

Consider professional image beyond clean waiting rooms. Providing neatly bound, high-quality education materials on admission leaves a better first impression than giving patients a stack of papers.

Environmental Services: The Heart of the Healing Environment

Without the tireless work of environmental services (EVS) staff, hospitals could not provide safe care, but EVS staff don’t often get the same recognition as clinical staff.[7]

Recognize expertise. Virtually every part of an EVS worker's job demands applying expertise. Staff must select the correct chemicals for each pathogen and use them correctly for effective disinfection. Operating rooms have special cleaning requirements, as do isolation areas. EVS staff are experts in all of this, as well as the proper handling of infectious, hazardous, and chemical waste. They may not realize they are experts. Consider a department-specific award to let them know they are.
Offer professional growth. Training and certification programs build job satisfaction, give recognition, and can be a means for enforcing quality standards. Implement a leveling system for EVS staff as they move from entry-level to complex tasks.
Focus on inclusion. Include one or more EVS representatives in discharge planning huddles. Medical specialties need to recognize the EVS staff's role as vital team members. Anticipating discharges will also help EVS prioritize work. Other teams could benefit from EVS representation, including Infectious disease[8] and environmental image committees.
Give them a voice. Ask for feedback from EVS staff and listen to it. Make changes if something is not working in their processes. Engaged, empowered employees are likelier to take ownership of their work and do well. [9]

Communication

Encourage trust by letting patients know how you keep your facility clean and safe. Communicate cleaning processes and the results of quality checks. If you regularly highlight healthcare workers in marketing campaigns, include EVS workers to show pride in their expertise and your commitment to cleanliness.

Conclusion

Make a clean environment a top priority. Not only is cleanliness covered in HCAHPS, but it is also critical to healthy outcomes and patient safety. When improving the cleanliness of your facility, examine processes and look for innovation. Most of all, celebrate your EVS team: the heroes who make it happen.

References:

[1] Addressing the changing patient perceptions of clean. Pressganey.com. Published January 26, 2022. Accessed October 9, 2023. https://info.pressganey.com/press-ganey-blog-healthcare-experience-insights/addressing-the-changing-patient-perceptions-of-clean

[2] Peters A, Otter J, Moldovan A, Parneix P, Voss A, Pittet D. Keeping hospitals clean and safe without breaking the bank; summary of the Healthcare Cleaning Forum 2018. Antimicrob Resist Infect Control. 2018;7(1). doi:10.1186/s13756-018-0420-3

[3] WHO launches first ever global report on infection prevention and control. Who.int. Accessed October 9, 2023. https://www.who.int/news/item/06-05-2022-who-launches-first-ever-global-report-on-infection-prevention-and-control

[4] Carling PC, Parry MM, Rupp ME, et al. Improving cleaning of the environment surrounding patients in 36 acute care hospitals. Infect Control Hosp Epidemiol. 2008;29(11):1035-1041. doi:10.1086/591940

[5] Department of Public Health. Environmental Cleaning: Monitoring Cleaning. Cdph.ca.gov. Accessed October 9, 2023. https://www.cdph.ca.gov/Programs/CHCQ/HAI

[6] Three reasons steam cleaning will transform healthcare cleaning. Intercleanshow.com. Accessed October 9, 2023. http://www.intercleanshow.com/news/innovation/three-reasons-steam-cleaning-will-transform-healthcare-cleaning

[7] Sine D, Duplechan L. Roles of environmental services workers’ wages and status in patient safety. AMA J Ethics. 2022;24(9):E876-882. doi:10.1001/amajethics.2022.876

[8] Yanke E, Moriarty H, Carayon P, Safdar N. “the invisible staff”: A qualitative analysis of environmental service workers’ perceptions of the VA Clostridium difficile prevention bundle using a human factors engineering approach. J Patient Saf. 2021;17(8):e806-e814. doi:10.1097/PTS.0000000000000500

[9] Bekirogullari Z. Employees’ empowerment and engagement in attaining personal and organisational goals. Eur J Soc Behav Sci. 2019;26(3):389-306. doi:10.15405/ejsbs.264