By Dan Hounsell, Senior Editor, Facility Market

The nation’s healthcare systems have more than had their hands full since February 2020 fighting the COVID-19 pandemic. Now the delta variant of the coronavirus threatens to extend the fight into the fall and possibly further. But well before the pandemic forced healthcare facility managers to revisit and rethink many infection control procedures, hospitals already faced another major challenge.

Every year, millions of hospital patients acquire healthcare-associated infections (HAI) while receiving medical treatment. On any given day, one in 31 patients has at least one HAI, with 75,000 associated deaths in U.S. hospitals each year.

Gillette Children’s Specialty Healthcare in St. Paul faced the challenge of reducing HAIs by undertaking a strategic approach involving the use of ultraviolet (UV) technology that eventually helped reduce HAIs by 65 percent in its facilities over a three-year period.

Facing an outbreak

Gillette Children’s Specialty Healthcare includes a 60-bed children’s hospital on its main campus in St. Paul and additional sites in the surrounding metropolitan area.

“We're 24 hours, seven days a week,” says Paul Yee, Gillette's specialty healthcare supervisor of environmental services and environment of care. “We deal with a lot of patient rooms and patient care as far as end-of-day cleanings when a patient gets discharged. We get the room ready for the next patient. We also are in the surgery OR site where we actually get the rooms ready for the next procedure.”

Prior to Yee’s arrival three years ago the hospital had suffered a large outbreak of C diff.

“We had a lot of hospital acquired infections and C diff. outbreak, which led to trying to find some type of tool to make sure we're cleaning everything right,” he says. The hospital partnered with Ecolab, an infection prevention company, to implement a program to help the environmental services workers monitor and standardize cleaning procedures for patient rooms in order to reduce HAIs.

Initial testing to determine the department’s efficiency in cleaning surfaces determined that it did, in fact, need improvement.

“When we first started, I believe we were at 37 percent as far as cleaning surfaces, so not very good,” Yee says. “When we partnered with Ecolab, they brought in their training, and they brought in their professionals to help train our staff members.

“Ever since then, we've been using their training for all of our new people, and we continue to clean in that way. Because of that and because of the fluorescent marking system and reporting system that we use, we went from 37 percent to 93-97 percent as far as cleanliness. That's much better. There have been a couple of quarters where we're at 100 percent.”

The improvement process required more than just a change in procedures and included staffing changes.

“It took a little bit of cleaning house,” Yee says. “We had to find individuals who really wanted to do what they were supposed to. Once we got that and they were willing to learn, we were able to move forward with their training.”

How it works

The system Gillette uses to improve cleaning and infection control and reduce HAIs involves the use of fluorescent markings placed in key locations in a patient room. 

 “We have someone who is not a cleaner go in a patient room and mark surfaces prior to our housekeeper going in there,” Yee says. “Our housekeeper does not know that the room has been marked already. Several minutes later, the housekeeper goes in there and does their cleaning.

“Before our housekeeper leaves, the individual who did the marking comes back with a black light and shows all the areas that were marked. If there are any areas the housekeeper has missed, it'll show up as dots (under the black light), and we clean those areas. Our team actually treats it as a game, so then they actually try to do better.”

Yee also takes part in the efforts to improve housekeeper performance.

“I don't want to put my staff in a situation that I'm not willing to be in myself,” he says. “When we have a patient who comes in, either myself or one of my shift leaders will actually do the UV-ing of the room before we send a staff member to do the cleaning and disinfecting.

“We will actually UV disinfect the room, so the housekeeper will go in knowing the environment is safe for them to clean. Then they're not going to skip any corners or do anything like that in order to get out of the room faster. Even after the housekeeper gets done, we'll come back in and UV the room again. So we do two doses of UV before the housekeeper goes there and once after.”

Despite the monumental challenges that COVID-19 has presented Gillette and most hospitals, Yee says it also has contributed to the department’s efficiency and performance.

“It actually has helped us get better,” he says.” The pandemic has actually made our efforts stronger. We have this pandemic that's highly contagious, and if you're not doing what you're supposed to be doing, like getting all the surfaces cleaned and disinfected, then one of our kids is going to get sick.”

Team effort

Gillette’s supportive and collaborative work environment also has contributed to the improved performance of Yee’s department and the overall effectiveness of Gillette’s efforts to minimize HAIs.

“The environment here at Gillette is very conducive to our success,” he says. “I've been at different hospital systems that have silos and where the doctors treat the nurses differently. Then the nurses treat the nursing assistants differently to the point where you have maintenance and environmental services at the bottom of the food chain.

“It's not that way here. The nurses and the doctors respect what we do, and because of that, my staff feel like they can do their job properly.”

The collaborative approach also extends to the critical role of infection control.

“We really partner with our infection prevention person,” Yee says. “She's like my second boss. If she says this needs to get done, even though she is not my superior, I treat it as, this needs to get done. My staff feels the same way.”