Infection prevention and collaboration
As the saying goes, “two heads are better than one.” This old adage is especially applicable for the prevention of healthcare-associated infections. According to the CDC, about 1 in 25 hospital patients has at least one HAI on any given day1. However, studies show collaborative working relationships between infection prevention and control and environmental services professionals can reduce rates of infection transmission, as well as improve facility outcomes, reduce redundancies in processes, improve patient, or resident, satisfaction and reduce costs 2. Despite these promising results, collaboration is especially challenging in long-term care facilities, for a variety of reasons.
First and foremost, many long-term care facilities don't have a designated infection preventionist, which presents a systemic barrier to collaboration. Oftentimes, an employee is charged with IP on top of his or her normal duties, and that person usually doesn't receive complete training or possess a background in infection prevention and control. Thus, facility leadership must first address this root challenge that leaves IP representatives unequipped to succeed, especially when it comes to rolling out a joint strategy with environmental services. Infection prevention must be a shared responsibility of all associates working within the long term care setting.
The nature of staffing in a long-term care environment provides additional challenges unique to this setting. According to a 2010 Survey from the American Health Care Association, retention rates in these facilities for registered nurses was roughly 69.7% and 72.5% for Directors of Nursing 3. Additionally, many employees work across different buildings, all of which have their own IP policies. Therefore, practices are less ingrained in the minds of staff due to a lack of routine. This is particularly apparent in assisted living facilities, as employees may be cleaning several different brands of equipment with varying degrees of compatibility in a single day.
The final major barrier to IP and environmental services collaboration in long-term care facilities stems from the varying levels of acuity. Residents range from dependent to independent, which results in different care methods and shifting IP procedures. Residents also may move freely around the facility, leave the facility for periods of time and have regular visits from outside visitors. Additionally, environmental services staff may never have regular interactions with long-term care residents, unlike in acute care settings.
The ultimate goal of collaboration should be to create a bond between clinical nurses and environmental services, so that infection prevention becomes a priority for the entire facility. In order to achieve this objective, leadership must assign the task of IP to someone with the time, tools and training to implement an effective strategy in conjunction with environmental services.
Once a policy is developed, clinical decision makers should drive down procedures to all staff, emphasizing the importance of compliance, as well as consequences for a lack thereof. Staff should be empowered to follow protocol using education as well as compliance accessories, such as bracketed wipes on rolling machinery, that make compliance second nature.
Positive communication between the two departments is also a key factor for cooperative success. One common practice among facilities that have achieved collaboration is to appoint an “IP unit-based champion,” someone passionate about the cause, in each department. The team attends a monthly meeting to discuss numbers, pain-points and solutions, and is also responsible for communicating initiatives back to their respective departments. In addition, both clinical nursing and environmental services – two departments that are often firmly divided – should encourage complete transparency of their processes and protocols, which could ultimately lead to the development of new ideas. Finally, IP and environmental services shouldn't hesitate to loop-in outside departments, such as the dietary department, to tackle specific infection prevention scenarios. Infection prevention should be a priority for the entire facility.
An Investment in the Future
Having infection control and environmental services “at the table” together allows for conversations and understanding by both parties. Often, the environmental services team better understands rationale, while infection control better understands efficacy of disinfectants and processes in cleaning and disinfection. Collaboration contributes to meaningful improvements in resident care, as well as better business outcomes, both of which are imperative as we look toward the future.
Joel Rich is the director of long-term care and alternate care at PDI Healthcare.
1HAI Prevalence Survey, electronically accessed from http://www.cdc.gov/HAI/surveillance/index.html, July 7, 2015, US Centers for Disease Control and Prevention.
2Adams, Audrey B.; Armellino, Donna M.; Calfee, David; Jalon, Hillary; Smith, Barbara A. (2009).The Role of Environmental Services in a Collaborative Infection Prevention Model to Reduce Clostridium difficile in the Greater New York Region. American Journal of Infection Control Volume 37, Issue 5 , Pages E189-E190, June 2009.