Developing a task force
When Roye-Horn alerted the CDC to the changes in C. diff patients at Hunterdon, she discovered that it was among the first hospitals in the United States to develop the NAP1 strain. At the time there was very little literature and best practices regarding how to minimize this kind of C. diff, so Roye-Horn met with Marita Nash, Hunterdon's director of environmental services and linen, to develop a plan of attack.
The pair identified what products were working from a chemical cleaning perspective and what was not. They also discussed medical and nonmedical surfaces that may have been previously overlooked by cleaning crews.
Chemically, they landed on a hypochlorite bleach solution. As for surfaces, Roye-Horn and Nash decided cleaning crews should wipe down computer keyboards and mice, medical record chart covers, telephones, and other nonmedical devices—in addition to other medical devices regularly cleaned. Hunterdon also washes cubical curtains and instructs staff to use soap and water rather than hand sanitizer.
A task force was established and developed specific cleaning protocols after observing staff cleaning routines. As changes were implemented, the task force grew.
"It became bigger because it really required more staff, and a more consistent approach to cleaning and changing products," Roye-Horn says. "It resulted in a lot of changes in how things were being cleaned and who was cleaning, not just environmental services staff, but the clinical staff that needed to clean things that previously hadn't been cleaned."