New housekeeping practices help staff cut dirt, waste, infection

Housekeeping personnel may not top the charts in terms of prestige and pay, but their role in infection control and patient safety should certainly command a hearty dose of respect.

Not only must staff work round the clock to clean the facility and maintain on environment that meets the stringent demands of regulatory agencies, healthcare personnel, patients and visitors, they also bear the burden of knowing that the health of others relies heavily on the effectiveness of their practices.

"Environmental services truly sets the standard for environmental excellence," said Patti Costello, executive director for the American Society for Healthcare Environmental Services, Chicago. "The environment is everything people see when they walk through a door and everything the patient sees during their stay--from the floors to the walls to the tables and everything in between. The manner in which environmental services [staff] maintain that healthcare environment is absolutely critical to patient care."

When looking at statistics on hospital infections, it becomes clear just how important effective housekeeping practices and dedicated, well trained staff are in healthcare organizations. According to the Centers for Disease Control and Prevention, nearly two million patients each year acquire on infection during their hospital stay, which accounts for more than 5% of all hospital patients and costs roughly $5 billion to treat.

The CDC estimates that one-third to one half of such nosocomial infections is preventable--primarily by following proper hand disinfection and cleaning protocols. And while the agency is careful to point out that the environment is rarely implicated in disease transmission, except in immunocompromised patients, "inadvertent exposures to environmental opportunistic pathogens or airborne pathogens may result in infections with significant morbidity and/or mortality."

Vendors are acknowledging the need for more effective, user friendly products geared toward the environmental services discipline. A growing number of manufacturers are offering a range of innovative products and services that promise to not only increase the effectiveness of facility cleaning and disinfection, but also maximize efficiencies and simplify the most routine--and often taxing--tasks.

Mops get a makeover

Among the most promising products to infiltrate the healthcare environmental services sector are those that incorporate microfiber technology.

Microfibers, which are densely constructed, split polyester and nylon fibers that are approximately 1/16 the thickness of human hair, can hold six times their weight in water. The positively charged microfibers also attract dust and can penetrate the microscopic surface pares of most flooring materials. Not surprisingly, more and more healthcare facilities are saying goodbye to their conventional loop mops for routine cleaning and replacing them with microfiber mopping systems.

"There are many benefits of using microfiber mop heads," said William Hielscher, marketing director, Tuway American Group, Rockford, OH. "They can be used for dusting, wet mopping and floor finish application. They clean exceptionally well, require much less solution and eliminate the need for wheeling a dirty bucket and wringer around." Microfiber mopheads, which are flat, also prevent dirt backsplashing on baseboards--a common complaint associated with cotton loop mops.

Perhaps the greatest selling point, however, is the fact that microfiber mop heads can be easily removed and laundered hundreds of times, which means each patient room can be cleaned with its own mop head and clean solution. Doing so helps prevent room-to-room contamination--a legitimate concern with traditional wet mopping where a dirty cotton loop mop head is dipped numerous times into a bucket of water and cleaning solution. With conventional mopping, facilities are required to change cleaning solution after every third room to reduce the risk for cross contamination. "Obviously, if you are using a new mop head for each room, room-to-room contamination isn't going to be a problem," said Hielscher.

The U.S. Environmental Protection Agency cites other benefits as well, including less physical strain and a drastic reduction in chemical and water use. In its publication "Using Microfiber Mops in Hospitals," the agency refers to a case study from Sacramento's University of California Davis Medical Center, which noted that a full bucket of cleaning solution can weigh 30 pounds or more and must be lifted an average of seven times a day. UCDMC first began pilot testing microfiber mops in 1999 and completely replaced their cotton loop counterparts within one year for all patient care areas.

Although the initial cost to implement the program was significant (microfiber mops can cost more than three times as much as conventional cotton loop models), the microfiber mop heads' launderability, durability and overall effectiveness led to substantial savings. UCDMC reported 60% lifetime cost savings for mops, a 95% reduction in chemical costs associated with mopping tasks and 20% labor savings per day.

Better system designs

Vendors of microfiber mops are now incorporating them into more innovative mopping systems.

The MopKing Mopping System from AmKing Technologies, Manchester, NH, for example, couples a flathead mop with an all-in-one, stainless steel design that uses only clean solution, places precisely measured solution on the mop head and can clean 6,000 to 8,000 square feet before refilling.

"Another key benefit over conventional mopping," noted AmKing's COO William Diversi, "is that MopKing was also designed to clean both walls and floors." Beyond that, the enclosed design safely contains the water and cleaning solution--an important feature, Diversi said, because of concerns about the possibility of open mop buckets serving as a reservoir to spread ricin of anthrax.

Smaller units are also being offered to help facilities maximize savings, without having to forfeit the key benefits and features of the larger flagship models. The MopKing Jr., for example, retails for $495, versus $1,980 for the MopKing, and is small enough to fit on existing housekeeping carts.

"Hospitals didn't want to change their carts. They wanted a [product] that would allow them to continue using what they already had. We unveiled the MopKing Jr. this April and the response has been overwhelming," said Diversi.

Tuway's Zipline Bucketless Mopping System can also be used on floors and walls, and features a solution reservoir that's built into the mop's handle. Muskegon, MI-based Geerpres offers a completely self-contained cleaning system as well--the GPS 2000--which holds enough fluid to cover up to 2,000 square feet.

Hospitals also want product diversity and vendors are rapidly rising to the occasion. Although microfiber technology in and of itself is designed to be more user friendly, the need for hand wringing of mop heads has raised some concerns about hand strain. As a result, vendors such as Rubbermaid Commercial Products and Royce Rolls Ringer Co. have developed microfiber presses to eliminate the need for hand wringing. Royce Rolls' Mpress holds 25 pads as they soak in solution and then squeezes excess solution from the pad prior to use. Rubbermaid Commercial Products offers a plastic microfiber press ring bucket that's both durable and lightweight.

To further meet customer demand, manufacturers are offering an array of microfiber cleaning mitts and cloths in various sizes, and are incorporating special features to further boost the effectiveness of microfiber mopping. Since Rubbermaid Commercial Products entered the microfiber market a little more than one year ago, its product portfolio has expanded significantly. In addition to regular wet pads, Rubbermaid offers a unique finish and scrubbing pad that allows for easier grout line cleaning. Aside from that, the vendor offers a range of microfiber cleaning cloths and is about to introduce numerous "specialty items," such as a larger 24-inch wet pad, an 11-inch wall/stair pad and all purpose mitts with thumbs.

Also proliferating the market are color-coded cloths and mitts designed to further reduce the risk for contamination. Rubbermaid's green cloths are for all-purpose cleaning, yellow ones are for bathrooms and blue are for mirrors and glass. A line of color-coded mop pads are currently under development, noted Judy Cline, director of microfiber and carpet care for Rubbermaid Commercial Products, Winchester, VA.

According to Mark Regna, director of healthcare services, Jani King, Addison, TX, color-coding serves as an immediate visual cue to staff and managers, and helps reduce the likelihood of using the same cloth to clean bathrooms and countertops, for example. "A manager can immediately look and see if the right cloth is being used for the right purpose," he noted.

Mixing cleaning protocols

While microfiber technology has the power to revolutionize healthcare cleaning, it does have its limitations. By and large, experts agree that microfiber products are not the best solution for cleaning blood and body fluids.

"I don't believe there's an adequate comfort level with either the absorbency of microfiber mops or the [practice of] laundering and reusing pads that were contaminated with blood and body fluids," Cline said. For these reasons, she said that microfiber mopping doesn't usually extend to the operating room-at least not yet. "Right now, the biggest gains relate to patient room cleaning, although the industry is looking at ways to extend the benefits of microfiber cleaning into the OR."

Because conventional mopping still has its place in healthcare, it's little wonder that manufacturers of traditional mopping equipment are also doing their part to reduce room to room contamination by offering models with provisions for clean and dirty solutions.

"A double bucket eliminates the need to wring out dirty mop into clean solution," said Bill Swartz, marketing director, Royce Rolls Ringer Co, noting that such a practice also does not convey a positive image of cleanliness to patients, visitors and caregivers.

Diversi agreed. "People are drawn to dirty water. When they can see and smell it, they understandably become concerned about cleanliness. A simple switch of products and [protocols] can go a long way in improving the effectiveness of overall cleaning and in creasing the comfort levels of patients and staff."

EVS outsourcing picks up speed

Healthcare organizations struggling to meet their evolving and increasingly demanding environmental service requirements may find relief by handing the duties over to a quality outsourcing firm.

In fact, an estimated 27% of the nation's facilities have already boarded the outsourcing bandwagon to at least some degree, and the industry is experiencing a more than 10% annual growth rate--up from just 2% three years ago.

"Outsourcing continues to gain momentum because facilities are looking for ways to become more efficient and focus on their core business, which is caring for patients," said Deborah Hetrick, senior director of product development, ARAMARK Healthcare Management Services, Philadelphia, PA.

High staff turnover rates, dwindling resources and more stringent regulatory requirements related to environmental services have also made it more difficult for some facilities to maintain an effective in-house EVS department, sources noted.

"Contractors can often do the job more effectively, and with fewer people," noted Mark Regna, director of healthcare services, Jani-King, Dallas, TX.

Outsourcing companies generally have more experience and buying power, he said, which means healthcare facilities will have access to highly qualified EVS staff who will likely be using the very latest in cleaning technology--key factors that will help facilities gain more control over the practice.

"It's interesting. Some hospitals feel that they will lose control by outsourcing, but the reality is, they have already lost control if they are even considering it," Regna explained "If an in-house EVS program is working great for a hospital, it doesn't need to change its approach. If it isn't, they may find that outsourcing is their best solution."

How do facilities know when it's time to seek help? Hetrick said employee turnover and patient satisfaction are good indicators. "Employee satisfaction equals patient satisfaction," she noted, adding that if either is lagging, it may be time to consider making a change. ARAMARK's average turnover rate for EVS staff is approximately 22%, which is "significantly lower than the industry average," she said.

Customizable solutions

That's not to say that outsourcing is only for facilities with less than stellar environmental services departments. Thanks to more customizable solutions, virtually any hospital can find an outsourcing solution that fits its needs.

"Some hospitals may want a total turnkey solution where the management, staff and entire process is outsourced. Others may want to outsource only certain areas of the hospital, or perhaps just the third shift," Regna explained. He added that outsourcing may also be a good option for facilities in warmer regions of the country that see an influx of elderly patients in the winter.

"Many hospitals find it is difficult to staff in this situation, and they may not want to rely on agencies for temporary labor that may not be adequately trained to clean hospitals," he continued. "Jani King has created a service and staffing program to help in-house managers meet their fluctuating staffing needs."

ARAMARK also prefers not to take a one-size fits-all approach to outsourcing. Although the company routinely provides a management team for its hospital partners, it takes a best practices approach to find solutions that best meet each facility's own needs--whether it's providing a few staff of an entirely outsourced department.

"We leverage the lessons learned from our best practice accounts and use them to create the best solution for each [customer]," said Hetrick. "What works for one hospital may net work for another."

Look before leaping

Although outsourcing can be a terrific option for many healthcare organizations, both Regna and Hetrick encouraged facilities to de their homework and hammer out specific details before inking an agreement with any outsourcing firm.

According to Regna, it's important for both parties to know which will be responsible for cleaning certain areas and equipment, such as IV poles, carts and wheelchairs. "Whether it will be the plant management's job or the outsourcing company's, it just needs to be addressed upfront to avoid any problems of surprises later," he noted.

He also stressed the importance of practicing due diligence when selecting an outsourcing firm.

Not all outsourcing companies are created equal. If a company has [great credentials], well-trained staff that is up on all the regulations and knows how to properly clean all areas of the hospitals--including the OR suite--and can provide a procedures manual that outlines its [practices], then great. If not, beware."

COPYRIGHT 2004 Healthcare Purchasing News
COPYRIGHT 2004 Gale Group