The importance of a layered approach to disinfection

This includes establishing policies and protocols, choosing disinfectants and technology, educating staff, and building a compliance standard

September 16, 2021 – By Marc-Oliver Wright, Clinical Science Liaison for PDI Healthcare

*Editor’s Note: This blog is taken from a JHC podcast hosted by Publisher John Pritchard with Marc-Oliver Wright of PDI Healthcare discussing the importance of a layered approach to disinfection. Listen to the podcast in its entirety here.

A layered approach to disinfection requires a recognition that technology in the absence of utilization is not a recipe for success. You can’t just purchase your way out of a problem. It’s rooted in human factors. The discipline focuses on optimizing the elements of the external environment or work system to lead to better processes and, therefore, better outcomes.

How does that work as it pertains to the healthcare setting?

First, you must identify the goal. It is not to render the healthcare environment sterile. That’s unattainable and unsustainable. It’s about reducing the environmental bio-burden – the number of organisms in the environment – to a safe and sustainable level.

The first step is an objective review of policies and procedures – who is supposed to clean what, when, how often and in what order? It can be helpful to have an outside pair of eyes review this process as well as the end users who are supposed to be doing the work. Does the protocol reflect practice? If not, why not and how can we make it better?

Then, select the right tools to meet the needs. Many facilities may use a multitiered approach, but adding a step introduces system complexity. Complexity increases variability and variability leads to a lack of compliance. After you determine the chemical agents that you’re going to use for manual cleaning disinfection, you need to decide if and what type of supplemental disinfection you’re going to use. But even that might not be enough.

It’s not enough to say we’re going to clean the environment with the right agent or we’re going to bring in a new technology like UV robots to supplement our efforts. You must go back to the first step. How are you going to use this?

Let’s say there’s a 500-bed facility that wants to use supplemental disinfection and 10% of the patients transfer or discharge from their rooms every day. That’s 50 patients. If a conservative estimate of 20% are on isolation, then 10 rooms need to be disinfected.

Easy, right? Ten rooms and two machines should accomplish the task. But were those 10 discharges evenly distributed throughout the day? Probably not.

Most facilities see a spike in discharges somewhere during the day. If a facility is aggressive with discharges before noon, then it will see a spike around 11 am. If not, there will probably be a spike in the late afternoon. Plus, a 500-bed facility needs to locate machines where they’re needed. Patient units might be spread out, so there must be high compliance with initiatives to see improved outcomes.

So, what do you need? If the focus is on isolation patients, how many isolation patients are discharged or transferred per day? When and where is that spike? Where can the machines be placed? If the supplemental disinfection equipment is charging or stored in the basement with the rest of environmental services, the battle is already lost. They can’t be located there.

Also, the staff must know how to use the machine technology. Educate the end user conveying the urgency and importance of doing things right.

In hospitals, Environmental Services (EVS) departments are often understaffed. They can be subject to high turnover rates, so it’s not just about the initial education but also the ongoing feedback. The newest hire needs to know how to do their job well and feel a sense of ownership as much as the most tenured member. Monitor and provide feedback to the people that make the difference.

Lastly, put compliance on a corporate scorecard. Not only do EVS supervisors and staff see it, but also CEOs, medical executive boards and clinical leadership teams. Show compliance with process measures like UV utilization and patient outcomes, for example. When both improve, it instills a sense of pride across the organization.