Environmental Staff Cuts Expose HAI Risk

Hospital-acquired infections are back in the news of late, not that they ever really go away.

Recently, the federal government told Parkland Memorial Hospital in Dallas to come up with a correction plan for a litany of safety issues that include infection control. If the feds aren't happy with the action plan, Parkland's Medicare payments could be in jeopardy.

Also, Infection Control Today reports on Chicago hospitals' battle with an outbreak of the bacterium Clostridium difficile. According to ICT, an investigation suggests that patients transferred from one hospital to another have helped to spread a strain of the bacterium.

Daily media reports remind us that the threat of HAI demands constant diligence, even while another wave of layoffs at hospitals across the nation. This time, Medicaid is identified as the primary culprit, although other issues like lower admissions, reductions in Medicare reimbursements, and a general uncertainty about the nation's economic future, have been cited.

Whatever the reasons for the layoffs, hospital executives making the difficult cuts stress that patient care will not be compromised. They assure the public that as best they could they preserved nurses and other critical bedside staff. If the cuts are coming from environmental services – maids, janitors, and other cleaning staff – it seems only logical that hospitals are exposing themselves to a greater risk of HAI.

"It is a reason for concern. If a hospital decides to make those cuts in environmental services staff that will make it much more challenging to keep rooms clean," says Ann Marie Pettis, RN, BSN, director of Infection Prevention for the University of Rochester Medical Center, and a senior advisor with the Association for Professionals in Infection Control and Epidemiology.

"It is already a challenge given the fact that throughput is such an issue – the quicker they can turn the room over for the next patient. There is pressure on environmental services to do that. If you start cutting their staffing it is just going to exponentially add to that challenge for them," Pettis says.

Pettis says that for years hospitals have downplayed the role of environmental services in controlling HAI.

"Historically I don't think the respect and attention have been paid to the importance of environmental services," she says. "For many years we were fairly convinced that hand hygiene was the main thing we had to worry about and maybe the environment was something we didn't need to focus on."

Pettis mentions that leadership attitude has changed with new studies linking the prevalence of HAIs to environment. "The research has shown us that it is more than a single-prong approach. We need clean hands, clean patients and a clean environment. I see it as a three pronged approached to preventing infections," she says. "None of those three things are necessarily more or less important than the others."

There is also the uncomfortable issue of respect for environmental services staff. Whether consciously or not, some people in healthcare either look down upon cleaning staff, or don't bother looking at all. Cleaning staff might be first targets for layoff cuts because they occupy the bottom step of a hospital hierarchy and many of them haven't built seniority.

"They have not gotten their due," Pettis says. "The workers are typically some of the lowest paid workers in the organization, and there is turnover because of that."

This is where HR can help, primarily by lifting the profile of cleaning staff with other hospital employees. "Building that bridge between administration and infection preventionists and environmental services is key," Pettis says.

A little recognition for a job well done is an inexpensive way to build staff loyalty. Most of all, the recognition has to be coupled with training to build competence and efficiency and professional pride. "There is a constant need for training. Not just training but observing to ensure the training has been effective," Pettis says.  

The C-suite may need some training, too. "We're trying to make admitting and the C-suite understand that you cannot put pressure on environmental services to take short cuts because we all understand how important through put is but you can't shortchange the cleaning process."

If your senior leadership needs more convincing about the importance of a quality cleaning crew, you can point out that starting in 2012, HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) will include a query on hospital cleanliness.

"Of the questions on the survey for patients is 'How would you rate the cleanliness of your room when you were hospitalized?' And by the way, you don't get partial credit for this. The patients have to say 100% of the time it was good or your hospital gets dinged," Pettis says. "It helps explain why a lot of C-suites are paying so much attention to this."

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