Environmental Management Services Project Enhances Infection Control Program

ISSUE: In 2003, the Veterans Healthcare Administration (VHA) initiated a “Goalsharing” employee incentive program. This program was designed to improve performance and communication, enhance teamwork, increase quality, and promote pride in work. Teams were asked to identify a process improvement goal consistent with one of the objectives of VA Region 10, the local division, or VA national. PROJECT: The Environmental Management Services (EMS) team set its goal to establish a VA standard by having the most effective and efficiently trained housekeeping aides in the nation. Their goal was consistent with the overall goal to “provide easy access to medical knowledge, expertise and care.” The team created individual flipcharts that attached to each housekeeping cart and outlined the six most common procedures that housekeeping aides encountered. Topics included universal precautions, cleaning procedures for pediculosis and scabies, tuberculosis (TB) control program, terminal vancomycin-resistant Enterococci (VRE) cleaning procedure, terminal cleaning of the Clostridium difficile unit, and terminal cleaning methicillin-resistant Staphylococcus aureus (MRSA) procedure. Cards described the medical center policy, daily and terminal cleaning procedures, special detergent/disinfectants, if required, and the personal protective equipment (PPE) required to safely perform each procedure. Cards were placed on all housekeeping carts after an inservice program was conducted to explain the team project and introduce the cards to all members of EMS. RESULTS: Implementation of the cards as a “ready reference” standardized practice throughout the department. This, in turn, increased the effectiveness of the nursing staff by minimizing the time required to get a room ready for the next patient, a decrease of about 30 minutes per room. Use of the reference cards decreased the number of infection control or EMS supervisor man-hours required to rectify incorrect, unproductive, or inappropriate procedures. EMS-related calls to infection control or incidents requiring infection control intervention decreased from approximately one a week to one a month. Infection Control has also observed a decrease in the overall number of confirmed Clostridium difficile–infected patients since implementation of these reference cards. Whether this is a result of the new procedure remains to be determined. A master log of policies has since been created and can be used to customize the reference card set required for specific housekeeping aides depending on their working locations.