It used to be that the only way to check the cleanliness of a patient room was to give it the “white glove” test. However, due to the risk of hospital acquired infections, a visual or “white glove” inspection of patient rooms is no longer enough.
At Mon General Hospital, the Environmental Services Department recently purchased a computer program and special gel to help ensure the cleanliness of patient rooms and treatment areas. “The Encompass Monitoring Program enables us to check and make sure that we are cleaning as effectively as we can,” said Michele Blackhurst, Director of Environmental Services.
The system uses an essentially invisible transparent gel, called DAZO®, which becomes visible only when a UV (black) light is shined on it. The DAZO® gel dries rapidly on surfaces, resists abrasion and is readily and thoroughly removed by all disinfectants.
“Environmental Services managers and supervisors randomly go into patient rooms before they are cleaned and mark high-touch objects with the gel,” Blackhurst said. High-touch objects include sinks, light switches, door knobs, telephones, bed rails, bedside tables and other items that patients typically come in contact with.
After the room has been cleaned by a housekeeper, the supervisor or manager returns to the room and inspects it with the black light. “The goal is that after the room is cleaned, we won’t be able to see any residue from the gel,” she said. “If it’s nice and clean, that tells us that the room and the high-touch objects have been cleaned.”
If the high-touch objects have not been cleaned, little white dots appear when the black light is focused on the object. “That tells us that the room has not been cleaned and disinfected properly,” Blackhurst said.
“Rooms either pass or fail,” she said. “If a room fails, the supervisor will then talk to the housekeeper who cleaned the room and help the housekeeper understand what was missed and how to improve. The room is then re-cleaned.
A certain number of rooms are marked with the gel each quarter. Housekeepers do not know in advance whether or not a room has been marked. “The DAZO® gel can be applied at any time, on any shift,” Blackhurst said. As rooms pass or fail, the information is entered into an application that runs on handheld iPads. That information is sent to EchoLab, the company that provides soap and hand sanitizer products to the hospital.
“EchoLab compiles the data into graphics and information that indicates which high-touch objects we need to concentrate on and how many pass and fails we have had,” she said. The data indicates if there are any trends, such as any specific high-touch objects being missed.
Mon General began using the Encompass Monitoring Program in early October. “We are one of only a few hospitals in West Virginia that is using the program and has it up and running,” Blackhurst said.
Staff has been very positive about the program. “The housekeepers care about the cleaning they do at Mon General,” Blackhurst said. “They realize how important it is to disinfect the patient rooms to prevent hospital acquired infections.
“Initial results show that the housekeepers are doing very well in some areas, but there is room for some improvement,” she said. The first quarter results will set initial benchmarks. “Our goal is to always be better than the benchmark starting point.”
It is estimated that hospital acquired infections cost hospitals in the United States $20 billion dollars each year. Studies have documented that certain pathogens, such as MRSA, are readily transmitted from environmental surfaces to healthcare workers hands. In addition, it has been shown that patients admitted to rooms previously occupied by individuals with infections are at risk of acquiring these organisms from surfaces infected by the previous patient.
The DAZO® gel and Encompass Monitoring Program was developed based on these studies and Centers for Disease Control Guidelines for Environmental Infection Control in Healthcare Settings. The DAZO® program is a way to evaluate the thoroughness of the cleaning of patient areas. Data shows that hygienic practice and patient safety can be improved substantially through a program of Environmental Services interventions and the use of DAZO® to objectively assess and improve cleaning practices.
When first developed, a voluntary group of hospitals used DAZO® along with standardized education and process improvement interventions to determine if the thoroughness of environmental cleaning could be improved. In all of the studies using DAZO®, thoroughness of disinfection scores improved from an average of 39% to 81%, and the rate of hospital acquired pathogen transmission decreased.
Earlier this year, in a survey of 27 West Virginia hospitals, Mon General Hospital was ranked number one for Hospital Cleanliness, using Hospital Compare data from July 2010 to June 2011. This data was compiled by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) through the Centers of Medicare and Medicaid Services and the Agency for Health Care Research and Quality.