The 3 Legged Stool: People, Process and Technology–Part 2

The 3 Legged Stool: People, Process and Technology--Part 2

In Part 1 of this three-part blog, I discussed the all important role that people play in delivering a safe, clean and disinfected environment for patients to recuperate in.  Although I was writing with hospitals in mind, I didn’t intend for it to be about hospitals ONLY.  The lessons are there for every segment of the business of cleaning public spaces; be they schools, early childcare facilities, extended care, corporate space, assisted living, vacation rentals or hospitality spaces. 

The vast majority of microorganisms pose no threat to human kind.  In fact, we need them to support life on earth.  But a small subset of microorganisms can cause disease and death.  A pathogen is any disease-producing agent, esp. a virus, bacterium, or other microorganism.  Pathogens are not limited to the four walls of a hospital; they are virtually in every public space and making people sick.

In Part 2, I want to discuss the second leg of this 3 legged stool, the PROCESS that will prevent infections as they relate to contaminated environmental surfaces.  By definition a process is a series of actions or steps taken in order to achieve a particular end. You probably thought I would be discussing cleaning steps in this blog. You won’t be disappointed.

But before I talk about the Process of reducing the numbers and types of pathogens from  a room or surface, let me warn you of the consequences of performing the Process poorly;

  1. If the cleaning cloth and/or mop were used in a previous room, there is danger of cross-transmission of disease from one room to the next.
  2. If the Hygiene Specialist (see Part 1) is not given enough time to process the room, improperly cleaned surfaces will remain a source of possible transference of pathogens from surface to hands or gloves.
  3. If a cleaning cloth is used improperly, the Hygiene Specialist might be picking up the soil from the first surfaces wiped and transferring the soil (e.g., pathogens) to other surfaces being wiped. If the Hygiene Specialist starts with the “dirtiest” part of the room and ends up at the “least soiled” part of the room, he or she has created fomites (def.-an object [as a hand-touch surface] that may be contaminated with infectious organisms and serve in their transmission).
  4. Mal-odors may still be present from one of these sources- a. Urine in the rest room grout and under/around the toilet are not removed; b. The carpet is dirty and in need of extraction; c. Sanitary napkin and trash receptacles need to be thoroughly cleaned and deodorized; d. Medical waste remains unattended to.
  5. Floors, horizontal and vertical surfaces have visible soil remaining.  Visible soil might include- a. Trash remaining on the floor, behind doors and under furniture; b. Liquids (such as urine, blood or other body fluids) dried on rest room walls, fixtures or furniture; c. Television is streaked and/or dusty appearing; d. Outsides of trash receptacles don’t appear to be clean; e. Privacy curtains, blinds, shades and furniture upholstery have spots and stains that could be blood, urine, BM or other body fluids.
  6. Although the room is odor-free and appears to be surface cleaned, neat and orderly, there are items needing cycle or project cleaning- a. Carpet or upholstery need to be shampooed or extracted; b. VCT or other finished flooring needs to be buffed or refinished; c. Privacy curtains need to be replaced with clean and spot/stain-free curtains; d. Grouted tile or wax-free floors needed to be machine scrubbed to restore them to “like new” condition; e. Windows and glass need to be washed;  f. Ceiling tiles, grid work (for suspended ceilings), recessed lighting, painted ceilings and HVAC vents in the ceiling need to be vacuumed and/or washed.
  7. Although the room appears to be cleaned, neat and orderly and there are no visible cycle or project cleaning needs, there are obvious maintenance needs.  Here are just a few of the maintenance items that give the room a “tired” or unkempt appearance- a. Walls are in need of “patch and paint” or repairing damaged wall covering; b. Lights are not functional; c. Sink, toilet and tub appear to drain slowly or are stopped up; d. Corner guards (protecting wall corners) are damaged or missing; e. Thermostat cover is missing; f. Ceiling tiles are stained; g. Upholstery is clean but is ripped or need of repairs.  h. Furniture legs are missing metal or plastic caps that protect the floor from being damaged; i. Telephone, bed or remote controls are damaged or missing; j. In general, things that should be tight are loose, things that should work, don’t work, things that should be quiet (free of squeaks) are noisy, etc.

By now, you are getting the picture that a properly processed room, no matter where it is in your facility should be sanitized, orderly and properly maintained.  While a clean room isn’t necessarily a sanitized room, a SANITIZED ROOM IS A CLEAN ROOM.

Finding the one best way to process a room, department or building means analyzing the facility’s needs and the tasks involved in meeting those needs. It means assessing method and equipment options and available workforce and then putting it all together in a systematic program that runs like a finely crafted watch.

Just as every wheel or gear in a fine watch performs a specific integrated function, so should every part of a viable cleaning and disinfection program. By designing a plan, selecting the finest parts and fitting them all together in synchronized fashion, the watchmaker creates an accurate timepiece. Finding the one best way to clean begins much the same way – with a carefully devised plan.

A needs analysis, including the desired level of clean and the frequency of cleaning necessary to reach that level, can serve as the groundwork for such a plan. This often keys on the building’s use, traffic flow and outside influences such as weather conditions.

In conclusion, the process should entail daily and terminal disinfection, removing mal-odors, placing things in a prescribed orderly appearance (think about the last time you stayed in an upscale hotel) and cycle or project cleaning as well as a physical plant that is well-maintained.

 In Part 3, I will discuss the TECHNOLOGY leg of our three-legged stool.


About Darrel Hicks

J. Darrel Hicks, B.A., is the author of Wiley Publishing's "Infection Prevention For Dummies", and is nationally recognized as one of the top experts in infection control. Darrel Hicks is also the Past President of the IEHA and is an active member in AHE where he holds the designation of CHESP. View all posts by Darrel Hicks

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