Cleanliness Is Everyone's Business – a Multi-disciplinary Approach to Improving Environmental Cleanliness in an Acute Care Medical Center

Abstract

Background According to the Centers for Disease Control and Prevention, environmental cleanliness is a significant mitigating factor for healthcare associated infections and disease transmission. The purpose of this performance improvement (PI) initiative was to improve hospital cleanliness, using a multi-disciplinary approach, following a regulatory visit that revealed several opportunities for improvement. Methods The setting was a 397 bed, acute-care medical center. The project focused on inpatient units representing the highest risk to patient safety. A 90% benchmark was established as a measure of success following process implementations and remediation efforts. The goal was to improve cleanliness as measured and reflected through compliance audits focused on regulatory findings. A multi-disciplinary approach was used to address the findings. Once a corrective action plan was implemented, action items were established. These included rounding on inpatient units by Infection Prevention (IP) and leaders from environmental services (EVS), nursing, facilities, medical equipment, and supply chain to establish cleaning expectations; formulating a riskstratification matrix tool to assess damaged IV poles for a phased replacement strategy; creating an audit tool to assess compliance; formulating a cleanliness campaign; and establishing a cleaning responsibility grid and procedural policy. Point-prevalence audits were conducted over 8 weeks and sustained through hospital-wide quarterly audits to assess compliance and track success. Findings were disseminated to unit leaders and placed into an online tracking system that required timely follow-up. Results Initial compliance improved from 63% to 100% over the course of 8 weeks. Sustained quarterly audit compliance rates averaged 92% over a 4 quarter period. The hospital's annual accreditation survey resulted in 0 non-conformities related to cleanliness, with the previous year's non-conformity resolved. Conclusions This PI initiative found that by engaging a multi-disciplinary team, hospital cleanliness can be improved and sustained through a culture of shared responsibility and accountability. According to the Centers for Disease Control and Prevention, environmental cleanliness is a significant mitigating factor for healthcare associated infections and disease transmission. The purpose of this performance improvement (PI) initiative was to improve hospital cleanliness, using a multi-disciplinary approach, following a regulatory visit that revealed several opportunities for improvement. The setting was a 397 bed, acute-care medical center. The project focused on inpatient units representing the highest risk to patient safety. A 90% benchmark was established as a measure of success following process implementations and remediation efforts. The goal was to improve cleanliness as measured and reflected through compliance audits focused on regulatory findings. A multi-disciplinary approach was used to address the findings. Once a corrective action plan was implemented, action items were established. These included rounding on inpatient units by Infection Prevention (IP) and leaders from environmental services (EVS), nursing, facilities, medical equipment, and supply chain to establish cleaning expectations; formulating a riskstratification matrix tool to assess damaged IV poles for a phased replacement strategy; creating an audit tool to assess compliance; formulating a cleanliness campaign; and establishing a cleaning responsibility grid and procedural policy. Point-prevalence audits were conducted over 8 weeks and sustained through hospital-wide quarterly audits to assess compliance and track success. Findings were disseminated to unit leaders and placed into an online tracking system that required timely follow-up. Initial compliance improved from 63% to 100% over the course of 8 weeks. Sustained quarterly audit compliance rates averaged 92% over a 4 quarter period. The hospital's annual accreditation survey resulted in 0 non-conformities related to cleanliness, with the previous year's non-conformity resolved. This PI initiative found that by engaging a multi-disciplinary team, hospital cleanliness can be improved and sustained through a culture of shared responsibility and accountability.