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      Clinical intelligence for supply chain leadership

 
 

INSIDE THE CURRENT ISSUE

September 2012

Special Focus

 
 
 
 
 

Environmental services fit to be tied into clinical operations

Healthcare reform may require reformed attitudes, impressions

by Rick Dana Barlow

Between environmental services and just about every other clinical and administrative department in a healthcare facility a dotted line exists.

Some may argue that these dotted lines represent artificial boundaries that downplay the vital role environmental services plays in a facility’s ability to deliver high-quality, but cost-effective patient care.

That’s because the variety of functions within environmental services (ES) — ranging from biomedical engineering to facilities management to housekeeping — directly affects infection prevention, sterile processing and distribution, and surgical services, including clinical specialties.

All of these functions help the patient, who enters the facility to be repaired from some physical ailment or injury, leave the facility without any hospital-acquired ailments or injuries that can harm patient outcomes and satisfaction as well as threaten reimbursement.

Unfortunately, a familiar perception lingers in that a vital group of professionals fails to receive the recognition and respect it feels they deserve and have earned for their direct contributions to patient care. Such contributions include:

• Reducing waste

• Conserving energy

• Effectively decontaminating rooms, surfaces and tools

• More efficiently managing product usage

• Using recycled content anywhere possible

• Investing in ergonomic storage and workspaces

• Maintaining existing equipment

• Investing in products coated with antimicrobials, copper, silver, etc.

Why ES matters

So how can environmental services make the case for its fundamental impact and legacy? Some argue passionately that they really shouldn’t have to do that.

"[Environmental services] professionals shouldn’t have to persuade anyone to take them or the department seriously," contended Patti Costello, executive director of the Chicago-based Association for the Healthcare Environment (AHE). "ES requires specialized competencies with a credentialing program just like clinicians and other support serviced disciplines, ES professionals possess a knowledge base as compelling and powerful as the engineer, supply chain executive, infection preventionist or the perioperative professional. They are not housekeeping managers, custodians or janitorial supervisors. Housekeepers work in hotels, janitors and custodians in schools, office buildings and sports arenas. The custodians are cleaning for health but not in an environment for the infirmed.

"Environmental services professionals, however, are hygiene specialists," Costello continued. "They have to know the science of cleaning, the research and how to operationalize the best of the research — implementation science. They manage the work of the healthcare ES teams and their role affects patient or resident outcomes and the quality of the care environment. Professionals that underestimate their knowledge base, competencies or commitment are doing a disservice to their peers, but more of a disservice to the patients and residents they serve."

Linda Homan

Linda Homan, R.N., BSN, CIC, senior manager, clinical and professional service, Ecolab Healthcare, St. Paul, MN, indicated that the prevalence of infectious pathogens is drawing ES professionals into the clinical realm, specifically, infection prevention.

"The role ES plays in infection prevention is rapidly gaining recognition as a result of a growing body of research that links infections with the patient environment," Homan told Healthcare Purchasing News. "Pathogens such as Clostridium difficile, MRSA, and VRE can survive on surfaces for extended periods of time and are difficult to eliminate. Studies published within the past decade have shown that many patient areas are not well-cleaned, cleaning can be programmatically improved, and that improved cleaning decreases the transmission of pathogens to patients. This clinical evidence further supports the frontline role of ES in safe patient care."

Jane Hart

Jane Hart, sustainability leader, Kimberly-Clark Health Care, Roswell, GA, connected the dots, too.

"Approximately 1 out of every 20 hospitalized patients will contract a healthcare-associated infection (HAI)," Hart said. "Healthcare environmental services departments play a critical role in supporting safety initiatives and furthering the goals of their institutions in reducing HAIs."

That’s why her company works with AHE on a multimedia educational campaign, titled, "The Heart of Healthcare," promoting the importance of ES, recognizing its "pivotal contributions to patient safety" and encouraging education and training.

Lee Camp

ES’ participation in successful operations should not be minimized or overlooked, according to Lee Camp, president and CEO of St. Louis-based Delta Management Group LLC, an affiliate of MDR Inc., which is a network of "best practice resources" used to solve business problems in healthcare.

"ES has a great responsibility in the perception of the hospital in the patients’ eyes," Camp emphasized, "as ES workers are the first line of defense for patients in preventing complications resulting from infection. They are a critical member of the patient care team."

Further, Camp challenged that ES professionals owe the stakeholders at their medical centers the benefit of their experience and should work with epidemiology professionals on the hospital team to play a more visible, high-profile role in the planning and operation of the medical center, particularly in the face of increasing government regulations and reimbursement pressures.

Charles Roberts

Charles Roberts, MS, RM (AAM), director of research, Microbiology and Chemistry, Advanced Sterilization Products, Irvine, CA, concurred. Regulatory and reimbursement challenges, coupled with clinical research, reinforce the symbiotic relationship that should exist between ES and infection prevention.

"Hospitals now face increased incentive to reduce preventable infections, since the Centers for Medicare and Medicaid Services ceased reimbursement for certain healthcare-associated conditions as of October 2008," Roberts said. "Concurrently, there is a growing scientific consensus that the patient environment is a key source in the transmission of HAIs. In fact, studies have confirmed that patients admitted to rooms previously occupied by patients with hospital pathogens have a substantially greater risk of acquiring the same pathogen than patients not occupying such rooms.1

As a result, the industry seems to be stepping up to the plate, according to Roberts.

"With the growing understanding of the role of the healthcare environment in infection transmission, the industry has begun to provide additional education and resources to those responsible for ensuring the infection protection of the healthcare environment," he observed. "In addition to providing training and measurement to promote better adherence to cleaning and disinfection protocol, hospitals now also have new infection prevention tools to safely and effectively disinfect the patient environment, which can help keep patients safe."

Recommendations for achieving
ES ROI, success

Six industry leaders share their recommendations for how Environmental services professionals can reap short-term benefits and long-term returns-on-investment by implementing a variety of processes and thinking. Five industry professionals share their recommendations.

• One of the most effective ways for an environmental services department to see both short-term and long-term improvements is to monitor high-touch object cleaning effectiveness. Monitoring cleaning outcomes and then using that data to identify areas for improvement helps drive immediate cleaning improvements and can help sustain improvements over time.

– Linda Homan, R.N., BSN, CIC, senior manager, clinical and professional service, Ecolab Healthcare, St. Paul, MN

• At STERIS, we recommend aggressively following the CDC’s guidelines for proper terminal cleaning of noncritical equipment, furniture and environmental surfaces, as found in the "Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008."

• In the short term, properly training staff in manual cleaning protocols can help prevent the spread of environmental contamination as well as set the stage for introduction of a secondary disinfection process. STERIS highly recommends augmenting manual cleaning with a secondary process such as vaporized hydrogen peroxide or UVC light. Such technologies have been documented to help minimize the risk of human error for both coverage and contact time on environmental surfaces, equipment and furniture.

Jim Dacek

• Long-term, a sustainable process which incorporates advanced technologies in addition to proper manual cleaning protocols will likely result in a reduction in environmental contamination. By reducing the risk of contamination, hospitals will be less likely to be adversely affected by changing legislation regarding preventable healthcare-associated infections and insurance reimbursement.

– Jim Dacek, senior market development manager, STERIS Corp., Mentor, OH

• Use ec-H2O technology, which converts water into an effective cleaning solution that reduces chemical costs, improves safety and reduces the environmental impact because you are not using chemicals to clean and it uses less water than other methods of scrubbing floors.

• A well-planned floor mat system on the hospital campus will prevent dirt, dust, salt, sand and other materials from being dragged throughout your facility. This will not only enhance the appearance of the facility, but also reduces time and expense spent cleaning affected areas and the wear and tear on the facility.

• A linen awareness program can reduce waste by raising the awareness of all care providers of the expense that goes into the gowns, pillows, blankets, sheets, etc. that are used during a patient’s stay.

• Investing in training/retraining housekeepers on the proper cleaning methods, steps and protocols.

• Instill a culture that values environmental services workers as professionals in their area of expertise.

– Lee Camp, president, Delta Management Group, St. Louis

• Ultimately, healthcare workers are looking to provide safe care to their patients — that means preventing HAIs. But they also have to contend with the realities: Pressures to keep costs down, the need to quickly and thoroughly clean and disinfect rooms, as well as the rise of multi-drug resistant organisms (MDROs). Automated systems can augment manual cleaning and disinfection to provide healthcare facilities and patients with increased confidence that the patient environment has been thoroughly and properly disinfected against many pathogens that cause HAIs.

– Charles Roberts, MS, RM (AAM), director of research, Microbiology and Chemistry, Advanced Sterilization Products, Irvine, CA

• Network with peers nationally and locally.

• Invest in professional development through membership in the Association for the Healthcare Environment (AHE). Leverage the membership by sharing best practice in processes.

• Read and be informed on the very latest research on new products and technologies. Leverage the research to assist supply chain and clinicians with making informed decisions. Technology does not replace staff. It augments staff. Knowledge is power and the more environmental services knows the greater value to their organization and the better the outcomes.

• Challenge the status quo. Take on additional responsibilities that will increase your value to your organization. Departments like transport, valet, parking, landscape, hospitality services, sustainability and other support service functions. Most already have dedicated staff. Learning new roles keeps professionals fresh and in demand.

– Patti Costello, executive director, Association for the Healthcare Environment, Chicago

In fact, Roberts predicted that the attitude and viewpoint shift toward ES is here to stay.

"In coming years, there will continue to be an evolution in the way both healthcare practitioners and patients think about HAIs and infection prevention solutions," Roberts noted. "As we move toward a philosophy of zero tolerance in terms of HAIs, healthcare facilities will systematically address the gaps in infection prevention protocols and demand new technologies and solutions. There is no doubt that additional focus will be on consistent, effective disinfection of the healthcare environment, including more prescriptive guidelines and new, enhanced technologies."

Look for patients to jump into the game as well, Roberts indicated.

"Patients will also become better educated about infection prevention practices and empowered to demand safe care," he said. "This change is already starting to take place. A recent consumer survey conducted by Harris Interactive on behalf of ASP found that 64 percent of Americans do not think they would be better protected from germs in the hospital than in their daily lives, and 75 percent of Americans say it would be more important to choose a hospital based on lower infection rates rather than on convenience when in a non-emergency situation."2

Leadership beckoning

While providers, by and large, may recognize the importance of ES as a "crucial part of the patient care team," these facilities must motivate and move ES into leadership roles, Camp insisted.

"In the midst of operating in a very complex healthcare business environment they need to challenge the ES experts to join the ranks of the hospital leadership team and support them in their role in creating an outstanding hospital environment with outstanding clinical outcomes," Camp said. He added that regulations and reimbursement issues may keep ES in the forefront but patient clinical outcomes matter more.

"The most effective method to mitigate ignorance is to get your target audience informed somehow, even if it might be without their awareness," he added. "Regular handwashing always shows increased compliance with the two-week period following demos, such as a colorful display of high-touch surfaces and samples of particular pathogens that have name recognition, such as C. diff, pseudomonas, MRSA, E Coli, etc."

Still, Costello cautioned against any kind of regulation driving recognition, respect and justification.

"Increasing regulatory burden costs more money, increased costs result in deeper cuts in areas that are in greatest need of resources," Costello said. "I’m also not convinced providers don’t take ES seriously. In my opinion they do.

"ES hasn’t garnered the level of respect they deserve, but we are making progress, and AHE is committed to getting that word out," she continued. "However, negative talk related to research outcomes often paints an unflattering picture of ES — one that basically says teams aren’t doing the job properly. Problem is, science doesn’t tell the entire story or discuss the obstacles to performance. ES has to take the lead in implementing practical strategies that support the ES process. This is why it is critical for ES professionals to be on top of the latest research science to determine applicability, what is practical and appropriate for their facility."

Roberts concurred that strides are being made.

"At many hospitals, ES representatives are now — for the first time — an integral part of the infection prevention team," she said. "Not only will this help to elevate the role played by ES staff and educate them on the importance of their work, but also it will help empower them to address some of the challenges they face. This may take the form of additional education, changes to cleaning or monitoring protocols, or requests for new, easy-to-use products or technologies."

But effectively managing the environment shouldn’t be left to ES professionals alone, Camp urged.

"One of the most important things facility leadership can do is effectively communicating the message and setting the expectation that all staff have to do their part in keeping the hospital clean and holding them accountable for it," he said. "Picking up a paper dropped on the floor in a hallway, reporting maintenance issues like stained carpet, saying something to a coworker who eats or drinks on the unit and doesn’t clean up after themselves. From physician to nurse, to pharmacist, to clergy, volunteers and service workers themselves, no one is exempt from maintaining a clean, safe environment."

Camp also emphasized that ES should fully engage their technological capabilities.

"Too often, very robust software systems and ES programs are in place and not utilized maximally," he said. Camp recommended ES leaders to recruit "fresh eyes from other support services departments" to audit and monitor ES staff production levels as well as to verify [data] accuracy, furniture density, square footage, workload parameters and productivity of high speed machinery.

Where does ES drop the ball?

What are some of the common environmental services mistakes and oversights that impact bottom-line expenses and top-line revenues? Four industry leaders offer their observations.

• Space issues — Space is at a premium in the hospital setting and often impacts product selection. Hard cases or rigid containers are being considered as replacement items for sterilization wrap. Additional equipment for washing those large bulky containers may be needed to provide the same volume and speed the facility currently expects. Water commitments are also a consideration in selecting sterilization packaging. The selection of rigid containers means that a choice has also been made to increase washing needs. This pairing of the impact of that choice is often overlooked.

• Wasting supplies — Maintenance of materials, such as the over dispensing of materials and the overconsumption of cleaning supplies, can lead to additional costs. These typical obstacles can be regulated through new sustainable technologies, such as innovative glove dispensing systems (SmartPULL Packaging Technology) and closed-bucket disinfection systems (KIMTECH WETTASK Disinfection System).

• Utility and energy overuse — Hospitals are some of the heaviest consumers of energy and water in every community. As demand for resources increases with population growth, these facilities are being challenged to reduce their impact.

– Jane Hart, sustainability leader, Kimberly-Clark Health Care, Roswell, GA

• For ES departments, the most important considerations when choosing a disinfectant are product efficacy and product efficiency. Is the product effective against the organisms of concern in the facility with minimal cleaning steps? However, for supply chain managers, product efficacy and use may not necessarily be the first consideration when making a purchasing decision. In some cases, supply chain managers may prioritize cost or sustainability ahead of efficacy. While those are important factors, particularly when looking at the overall goals of a healthcare facility, efficacy should always be the first consideration when making a disinfectant purchase.

• In addition purchasing managers should be aware of any additional cleaning steps required to deliver the appropriate level of cleaning and disinfection, which impacts EVS operational efficiency.

• Investing time in ongoing training on proper cleaning and disinfection techniques is one of the most effective, low-cost strategies that ES departments can implement. Keeping ES workers trained and up-to-date on high-touch object cleaning, cross-contamination prevention, the proper cleaning process and how pathogens travel from room to room helps them maintain and improve cleaning outcomes.

• ES departments should also periodically review their portfolio of disinfectants to ensure the products are being used appropriately for their intended application. For example, it’s important for ES workers to be aware of the contact time required to kill the organisms they are trying to combat in their facility, particularly for sporicides to combat Clostridium difficile.

– Linda Homan, R.N., BSN, CIC, senior manager, clinical and professional service, Ecolab Healthcare, St. Paul, MN

• A healthcare facility’s ES staff has a significant role in infection prevention. Yet, they are continually facing pressure to turn rooms and ensure throughput. Under this pressure, it is not surprising that sometimes steps get missed. In fact, evidence suggests that current practice in environmental cleaning is often insufficient, and many surfaces are not cleaned on a routine basis.1 Studies show that pathogens that cause healthcare-associated infections (HAIs) can continue to live on surfaces despite healthcare facilities’ efforts to properly clean and disinfect patient and operating rooms.

• Effective use of infection prevention interventions can also provide healthcare cost savings ranging from $5.7 billion (20 percent of infections preventable) to $31.5 billion (70 percent of infections preventable).2

– Charles Roberts, MS, RM (AAM), director of research, Microbiology and Chemistry, Advanced Sterilization Products, Irvine, CA

• Skimping on maintaining/upgrading equipment is a mistake that sometimes looks attractive in the short term. However, without the best tools to do the job, quality can be negatively impacted, and it can actually hurt productivity, not to mention the message it sends to the staff who may be using equipment that is beyond its useful life. This can be interpreted by the service worker as the facility doesn’t value the job we do. You can draw a similar parallel in any profession. How would you feel about a surgeon operating on you who was using outdated tools of the trade?

• Also, hospitals sometimes make purchasing decisions on items like hand sanitizer, paper towels and big ticket items like flooring, without involving the ES experts from their facility in the decision. This often causes problems after the fact as the ES team struggles through how to stock, maintain and care for these purchasing decisions.

• Finally, ES prudent buyer purchasing justification should weigh "greening issues" as importantly as cost differences.

– Lee Camp, president, Delta Management Group, St. Louis

  1. Carling PC, Parry MM, Rupp, ME, Po, JL, Dick B, Von Beheren S. Improving cleaning of the environment surrounding patients in 36 acute care hospitals. Infect Control Hosp. Epidemiol. .2008; 29:1035-1041.

  2. Scott II RD. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. March 2009. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/
    Scott_CostPaper.pdf. Accessed April 12, 2011.

Breaching boundaries

Providers as well as supply chain management must recognize the complex underpinnings of ES operations.

"To understand the complexity of ES, you must understand what it takes for an ES leader to be successful," Camp said before reciting a litany of justifications. "An ES leader must be multi-skilled and versatile; they must be knowledgeable of hospital operations — what happens, where — and healthcare regulatory agency standards; they must be technically knowledgeable of the products used to clean and sanitize, the equipment used to clean, the methods, processes and steps to cleaning and infection prevention, not to mention pest control; they must be human resource experts to ensure a well-trained, competent, motivated staff that have a clear understanding of their responsibilities; they must have acute customer service skills in dealing with staff, patients and families and a passion for service; they have to be financially astute to manage multimillion-dollar budgets while continuing to improve service, quality, cost and employee satisfaction.

"Supply chain leaders need to respect the link that connects it all in EVS," Camp added.

If ES conceived ways to save or make money through some creative thinking then providers may view them in a different light, according to Hart.

"This could include taking a critical look at deliveries," she said. "Can the vehicles delivering materials return with a load of recyclables? Can a linen truck also become a recycling vehicle? There may be neighboring facilities that a hospital could partner with to gain enough volume of recyclables to be attractive to a recycling vendor."

But this should not be construed as ES reaching into supply chain territory.

"Supply chain professionals need to understand that input affects output," Hart noted. "Working together to make smart decisions with the entire process in mind can save time and money. Environmental services serves as a key segment in the success of a hospital. Supply chain professionals can aid in the success of this division by understanding how input affects output and doing their part to help create positive end results. By working together and making smart decisions throughout the process, whether it is providing environmental service professionals with specific surface disinfection systems or a way in which to recycle materials, supply chain professionals can save time and money resulting in a successful and profitable facility."

ES offers critical expertise in relevant product selection, Homan noted.

"With the disinfectants currently available in the market multiple products are often required to effectively clean critical patient areas, such as the patient room or operating room," she said. "Selecting the right product mix, using disinfectants for their intended application, and understanding which disinfectants can help improve cleaning efficiency can make a big impact on ES processes and productivity. There is ample clinical evidence to demonstrate that environmental hygiene plays a key role in healthcare infection prevention. A programmatic approach to environmental hygiene that incorporates effective processes and products can decrease the transmission of pathogens to patients and help increase ES effectiveness."

Costello agreed.

"Caring for the healthcare environment is a science that requires specialized tools, resources and peer support," she insisted. "One size doesn’t fit all, and purchasing and contracting decisions require collaborative input and discussion. While priorities may differ, discussing them may actually result in finding the sweet spots for considerable cost savings in the longer term."

References

1. Carling PC, Bartley JM. Evaluating hygienic cleaning in health care settings: what you do not know can harm your patients. Am J Infect Control. 2010;38(5 Suppl 1):S41-S50.

2. The survey was conducted online within the United States by Harris Interactive on behalf of Advanced Sterilization Products from April 8-12, 2011 among 2,483 U.S. adults ages 18 and older. Respondents for this survey were selected from among those who have agreed to participate in Harris Interactive surveys. This online survey is not based on a probability sample and therefore no estimate of theoretical sampling error can be calculated. For complete survey methodology, including weighting variables, please contact Katie Sweet at ksweet@its.jnj.com.
 

Horizon scanning for environmental services

What are some of the key environmental services (ES) trends that supply chain professionals should keep in the forefront of their minds? Six industry leaders share their insights with Healthcare Purchasing News.

• Environmental services (ES) is responsible for the removal and management of waste including management of and solid waste recyclable materials. A major goal is reduce the size and amount of packaging coming from suppliers. A key priority and an opportunity for ES, supply chain and group purchasing organizations (GPOs) to collaborate on is to reduce product and supply packaging to reduce solid waste. Doing so can increase productivity and reduce costs.

• ES and supply chain can dramatically influence the culture around proper disposal of all forms of waste. Particular emphasis on collaboration with clinical staff is key, but ES cannot positively impact outcomes alone. Clinicians are also stretched for time and resources so recycling is not necessarily a high priority. Simple activities related to strategic placement of waste and recycling receptacle will encourage nursing in particular to embrace segregation. Decreasing the distance between recycling containers and color coding them also helps.

• There is a growing need for ES and supply chain to work together on integrated waste agreements. Price is a primary focus for supply chain executives but service, better response times, and rebates going back to the facility should also be a priority. Waste contracts may save money in the short term but over the longer term ES deals with the sporadic price increases, a lack of training support for staff and not receiving the services promised during a sales presentation. All these factors negate the cost savings by compromising staff productivity, efficiency and effectiveness. Leveraging the knowledge base of ES and outlining contract requirements through detailed planning discussions between ES and supply chain executives will go a long way toward solving a myriad of problems after the contracts are signed. Bottom line is there is no such thing as a free lunch. What appears to be a great deal during negotiation and contract signing very well may cost significantly more. Maintain the multi-disciplinary discussions and checking in on progress and whether terms are being met.

• Supply chain executives and ES professionals have vastly different priorities related to purchasing, particularly as they relate to GPOs. Again, a good collaborative relationship based on trust and leveraging one another’s knowledge makes for better contracting.

• As the demand for maximizing savings through sustainable operations increases, efficiencies in environmental sustainability will fall squarely on the shoulders of ES. However, unless the collaborative relationship between supply chain and ES grows, ES will be poorly positioned to make a big impact on cost savings.

– Patti Costello, executive director, Association for the Healthcare Environment, Chicago

• Objective measurement of cleaning outcomes — Overall, we are seeing much more of a focus on measurement to gain insight towards improving patient outcomes as care delivery transitions to focus more on value versus volume. In fact, objectively monitoring cleaning outcomes is one of the most notable and important trends we see impacting environmental services. Several studies in recent years have shown that a programmatic approach to environmental hygiene that includes objective monitoring improves cleaning. Additional studies have linked improved cleaning outcomes to reduced infection rates.

• New sporacidal chemistries — The use of new sporicides is another important trend for environmental services because of the increasing prevalence of Clostridium difficle infections. Historically, bleach has been the only option for environmental services workers cleaning isolation rooms. However, in recent years EPA-approved, non-bleach sporicides have been introduced which have better material compatibility qualities than bleach (e.g., no chalky residue, surface corrosion or bleached uniforms). Supply chain managers may be particularly interested in the material compatibility of these non-bleach products because of the opportunity to save costs associated with replacing supplies damaged by bleach. In some cases these products do not require a pre-cleaning step which also saves time and improves efficiency for the environmental services workers.

• Sustainability — Being better stewards of the environment is a trend that healthcare facilities are embracing. Hospitals are looking for ways to do more with less, which includes reducing use of water and energy, generating less waste and improving operational efficiency and safety.

– Linda Homan, R.N., BSN, CIC, senior manager, clinical and professional service, Ecolab Healthcare, St. Paul, MN

One trend is a focus on the challenges of manual cleaning for specific types of patient care items, and the available alternatives. Manual cleaning efficacy is a simple equation consisting of surface coverage times the contact time of the liquid disinfectant. Unfortunately, there are multiple challenges associated with effective disinfection of high-touch patient care equipment. These include:

• Noncritical furniture, such as wheelchairs, have many surfaces to cover, simply due to their design and construction. It is next to impossible to validate proper wipe-down coverage without the use of challenge media (such as biological or chemical indicators used for high-level disinfection and sterilization processes).

• Difficulty in keeping multiple surfaces wet for the required contact time of the disinfectant. Most liquid disinfectants evaporate on surfaces before the proper contact time can be achieved. In addition, hospital environmental service staffs are under tremendous pressure to turn patient rooms over quickly so time becomes a rare commodity.

• Material compatibility challenges when wiping down or spraying sensitive electronics.  Computers on wheels, SCD pumps, blood pressure pumps, or other equipment containing sensitive electronics can be damaged by certain types of liquid disinfectants.

• Staff safety must be considered when employees are being constantly exposed to potentially harmful chemistries that require personal protective equipment such as gloves, goggles and respiratory protection.

– Jim Dacek, senior market development manager, STERIS Corp., Mentor, OH

• Cleanliness is one of the top drivers of patients’ perception of a hospital, which speaks to the level of priority focus on environmental services issues required to maintain a positive perception.
The need for a more productive work force requires tools, equipment, chemicals and processes, all of which can reduce time, steps, rework, etc.

• The desire to reduce carbon footprint in a cost-sensitive economy requires tools, equipment, chemicals and processes, all of which can achieve that result without driving up costs.
Highly sophisticated, better-educated, globe-trotting, aging baby boomers with ever increasing expectations means we need to employ and leverage technology, challenge the status quo and always deliver exceptional service.
Another is patients’ awareness of infection control measures, i.e., hand disinfection, because they are very aware of those who care for them and the attention staff pay to protecting our patients from infection.

• Supply chain needs to continue being sensitive to the "greening" of environmental services’ mandate to move to totally environmentally friendly lines of chemicals and processes.

– Lee Camp, president, Delta Management Group, St. Louis, MO

• Becoming an environmentally friendly facility is a key environmental services trend that can help a hospital prosper.

• Waste is a new and emergent resource consideration for next generation products. As the healthcare industry, like other industries, becomes more focused on environmental issues, the first opportunity lies with the trash can.

• For example, Kimberly-Clark’s wrap recycling program, Blue ReNew, allows facilities to participate in an environmental action to harvest resources for another generation of products rather than being land-filled. Purchasing decisions are now being weighed not only on clinical efficacy, cost and availability, but also on additional sustainability considerations. Blue ReNew is designed to help hospitals organize the process of recycling their wrap into five achievable stages and can be customized to meet the specific needs of each facility. The Kimberly-Clark Blue ReNew Team works with hospitals to identify key recycling partners, train OR teams and measure results to achieve a sustainable wrap recycling program.

• Further, Kimberly-Clark’s SmartPULL packaging process offers a glove dispensing system featuring features two separate openings on the box. The first, smaller opening is used when the box is full to reduce multiple dispensing, which often results in exam glove waste when gloves become unusable after falling on the floor. When the box is half empty, the second, larger opening allows for easier access to the gloves.

• Finally, the KIMTECH WETTASK Disinfection System, a compact, enclosed wet wiping system, consists of dry KIMTECH Wipers, dispensed individually from a closed canister, to which any preferred, disinfecting solution is added. The system optimizes disinfecting by maintaining the target disinfectant concentration over a prolonged period of time. The wipers were specially designed for use with quaternary amines, bleach or other disinfectants to ensure the disinfectant is released onto the intended surface, as opposed to the disinfectant binding to the wiper fibers, as is often the case with cotton rags.

• Recycling, composting and salvaging will become an expected norm in the industry.

• Supply chain professionals should look to purchase with the end-value in mind, which will prove cost effective and work to increase top-line revenue.

• Additionally, with other resources such as water and power continuing to become more valuable and more costly, these savings can really help hospitals in the long run.

– Jane Hart, sustainability leader, Kimberly-Clark Health Care, Roswell, GA

• A key environmental services trend that supply chain professionals should be aware of is the availability of new technologies. Automated technologies are now offered to augment manual cleaning and disinfection of the healthcare environment. This is particularly exciting because these new technologies have the potential to take the variability out of the disinfection process — to effectively ensure patients receive thoroughly disinfected procedure rooms, including operating suites or patient rooms, every time.

• Advanced Sterilization Products (ASP) is leading the way with GLOSAIR Healthcare Environmental Decontamination, an automated technology that creates a fog of 5 percent hydrogen peroxide that is uniformly dispersed to disinfect hard nonporous surfaces, including difficult-to-reach areas. Use of GLOSAIR Systems to augment manual cleaning processes has been shown to be more effective in the reduction of HAI pathogens as compared to cleaning alone.

• This technology was studied by the Centro Hospitalar do Nordeste in week-long practical study in Braganca, Portugal, to compare healthcare-associated infection (HAI) rates in three locations, both before and after the application of GLOSAIR Technology. Results demonstrated that there was a 92-100 percent reduction in pathogens across all examined areas after GLOSAIR Technology was used to augment manual cleaning practices. Since adopting GLOSAIR Systems as a preemptive approach to disinfection and consistent cleaning, the facility compared HAI rates for a six-month period in 2009 when utilizing GLOSAIR Systems and data showed a 77 percent decline in HAIs. No additional changes in traditional cleaning routines occurred during this time.1

Source: ASP data on file.

– Charles Roberts, MS, RM (AAM), director of research, Microbiology and Chemistry, Advanced Sterilization Products, Irvine, CA