ENVIRONMENTAL ASSESSMENT PROTOCOL TRAINING PACKAGE€¦ · TRAINING PACKAGE Tasmanian Infection Prevention & Control Unit . SUMMARY OF THE PROTOCOL . ... quarter

ENVIRONMENTAL ASSESSMENT

PROTOCOL TRAINING PACKAGE

Tasmanian Infection Prevention & Control Unit

SUMMARY OF THE PROTOCOL

Background

2011 - TIPCU reviewed literature on methods of assessing environmental cleanliness

2012 - findings presented at state-wide forum – Consensus to develop a standardised method of

evaluating environmental cleanliness in Tasmania

2013 - literature review published in a peer reviewed journal - Healthcare Infection (2013), 18 (1).

Why do we need a standardised approach?

• Commitment to preventing healthcare associated infections

• Local feedback to help improve cleaning practices • Evaluating changes in cleaning practice • Identifying high compliance • Benchmarking between hospitals • National accreditation standards

Methods of assessment

Evaluating environmental cleanliness in Tasmania will involve two assessments:

1. Ultraviolet (UV) gel & fluorescent light assessment 1. To be done on 8 UV sites in Patient Care Areas

2. Visual inspection 1. To be done in Patient Care Areas 2. To be done in General Ward Areas

Definitions

Term Definition

Cleaning A process that removes dirt and debris from an object or a surface.

Discharge clean A clean that is done in a patient’s bed area after transfer to another ward or unit or after discharge.

Fluorescent light Source of ultraviolet (UV) light.

Fluorescent gel marker A clear, non-toxic gel, designed for assessing environmental cleanliness, that fluoresces under ultraviolet (UV) light

Definitions

Term Definition

Patient care area The space temporarily dedicated to an individual patient for that patient’s stay.

High risk areas Wards containing patients who are at a higher risk of developing a healthcare associated infection

UV gel sites Specific sites on items within the patient care area that have been chosen to have fluorescent gel applied to them for the purposes of assessing cleaning using an ultraviolet (UV) light source

General ward areas Areas that adjoin patient care areas. These are areas where assessment and/or treatment of patients are not directly occurring

Frequency of assessments

• Patient care areas – Fluorescent gel assessments done quarterly – Visual assessment done quarterly

• General ward assessment – Visual assessment only with frequency

determined locally

Frequency of assessments

The data from both assessments is provided to the TIPCU quarterly:

Quarter Any data collected during these dates:

1 1st January – 31st March

2 1st April – 30th June

3 1st July – 30th September

4 1st October – 31st December

What is not covered in this protocol?

• Cleaning product(s) and the circumstances of when certain products should be used

• How to clean or types of cleaning methods • Frequency of cleaning • Models of cleaning, including staffing • Actions required to be taken as a result of the

assessment

ONLINE ASSESSMENT TOOL

Data entry on iPad Click on Enviro…entry’ icon on iPad

Click on TIPCU to go directly to the TIPCU website

Click on TIPCU-Enviro to go directly to the Evaluating environmental cleanliness page.

Online assessment tool

Enter the audit period, your name, date, ward and the type of audit you are doing. Record the results of both the fluorescent gel and visual assessments.

FLUORESCENT LIGHT AND GEL ASSESSMENT

Fluorescent gel and light assessment

• Only assess patient care areas that are undergoing a discharge clean

• Only trained personnel should perform the assessment

• Only objects outlined in the protocol should be assessed

Number of assessments Hospital size Minimum number of rooms

assessed each quarter (equates to approximately

10% of beds)

Minimum number of rooms assessed from a high risk

area

<15 beds 2 0

15-50 beds 3 0

50-100 beds 8 2

100-150 beds 10 3

150-250 beds 15 4

250-400 beds 25 7

400-500 beds 40 8

How is fluorescent gel applied?

• Fluorescent gel is applied to surfaces in patient areas

• Please visit the TIPCU website - Evaluating Environmental Cleanliness page to view video demonstrations on: – How to open the fluorescent gel marker – How to apply the fluorescent gel marker


Solution dries and resists dry abrasion but is easily removed with light abrasion after wetting


Gel is visible only under UV light


Thoroughness of cleaning is determined by seeing if any gel remains after cleaning

PASS FAIL

Fluorescent gel use

• Use the fluorescent gel once on each of the specified UV gel sites.

• Use the gel applicators up to 30 times (30 ‘dots’) or a minimum of 3 rooms.

UV gel sites

Patient tray table

Patient call bell/button

Bed rails Bedside locker/patient storage unit

Patient chair Toilet/bathroom door handle

Tap handle Door handle inside patient room

Patient bedside call bell

Apply to the call bell itself, not to any attachment such as the cord

Patient overbed tray table

Apply gel to the top of the overbed tray table and/or to one of its sides.

Bedrails

Apply to one of the bed rails that are attached to the sides of the patient’s bed.

Bedside locker/patient storage unit

Apply gel to the top of the locker or to the top half of one of the sides or the front.

Patient chair

Apply gel to one of the arm rests or to the seat.

Toilet/bathroom door handle

Apply gel to any part of the door handle of a patient en-suite or shared bathroom This does not refer to facilities outside patient rooms such as in a corridor

Tap handle Apply gel to one of the tap handles. The sink must be in the patient room or an en-suite that is for patient or clinical use This does not refer to facilities outside patient rooms such as in a corridor

Door handle (inside patient room)

Apply gel to any part of the inside door handle This applies only to single rooms.

FLUORESCENT LIGHT AND GEL ASSESSMENT

PROCEDURE IN DETAIL

The Procedure – Step 1

Identify the patient care area that requires a discharge clean


Break the seal of the fluorescent gel marker by squeezing the button on the tube just below the sponge


Apply a dot of gel once to each of the outlined 8 UV gel sites you wish to assess. If all areas are not available or relevant, apply to as many as possible.

The Procedure – Step 3 UV Gel Site Where to apply gel

Patient bedside bell Call bell itself, not the cord

Patient tray table Top of table/tray or to one of the sides

Bed rails Bed rail on side of patients bed or cot or to access hatch on neonatal incubator

Bedside locker Top of locker or one side or front

Patient chair One of the arm rests or the seat

Toilet/bathroom door handle

Any part of handle; only for en-suites or where toilet is shared by patients in the same area

Tap handle One of the tap handles; only sinks in patient room or en-suite

Door handle inside patient room

Any part of handle; only single rooms


Shine the UV light onto the dot to ensure the application is successful Note which UV gel sites have had the UV gel applied to them


Allow time for the gel to dry which will take approximately 3 minutes


Return to the patient care area on the same day and after the discharge cleaning has occurred Use the fluorescent light to determine whether the area has been cleaned.

Clean – all UV gel removed

Not clean – not all UV gel removed


Complete the results of the assessment using the online tool


Feedback the results to the supervisor and/or cleaner as determined locally

VISUAL ASSESSMENT

Visual Assessment

• Most common method for evaluating the cleanliness of healthcare environments

• Satisfies aesthetic obligations • Does not reliably assess the infection risk to

patients • Used in isolation, visual assessment is not a

reliable indicator of standards of cleanliness

Tasmanian visual assessment

• Two visual assessments – One for patient care areas – One for general ward areas

• Assess patient care areas that have had either a routine OR a discharge clean

• Assess general ward areas after routine cleaning

Tasmanian visual assessment – The two types of areas

Patient Care Area General Ward Area

Number of assessments Patient Care Area

Hospital size Minimum number of rooms assessed each quarter

(equates to approximately 10% of beds)

Minimum number of rooms assessed from a high risk

area

<15 beds 2 0

15-50 beds 3 0

50-100 beds 8 2

100-150 beds 10 3

150-250 beds 15 4

250-400 beds 25 7

400-500 beds 40 8

Number of assessments General Ward Area

Hospital size Minimum number of areas assessed each quarter

<15 beds To be determined locally

15-50 beds To be determined locally






Areas to be asessed Patient Care Areas General ward areas

- External features, fire exits and stairwells

Walls, skirting, ceilings Walls, skirting, ceilings

Windows Windows

Doors & door frames, broken into handle inside patient room; toilet/bathroom door handle; all other

Doors & door frames

Floors - hard Floors - hard

Floors - carpeted Floors - carpeted

Ducts, grills and vents Ducts, grills and vents

Areas to be assessed Patient Care Areas General Ward Areas

Electrical fixtures and appliances

Furnishings and fixtures, broken into bedside table/tray; bedside table/locker; patient chair; bed rail; patient call bell/button; tap handle/s; patient bed curtains; blinds and drapes; all other

Furnishings and fixtures

Pantry fixtures and appliances

Toilet and bathroom fixtures, broken into toilet, sink/s, shower, bath

Toilet and bathroom fixtures - toilet,

Patient equipment Patient equipment

Cleaning equipment

General tidiness General tidiness

Determination of cleanliness

• Description used include: – Free from – grease, dust, grit, lint, marks,

marks caused by furniture or equipment, spots, soil, fingerprints, smudges, smears, scratches, litter

• Exact descriptor used will depend on area that is being assessed.

Tasmanian visual assessment

• Only trained personnel should perform the assessment

• Only objects outlined in the protocol should be assessed

VISUAL ASSESSMENT

PROCEDURE IN DETAIL

Patient Care Areas


Identify a patient care area to be assessed. Assess after the room has had either a routine or a discharge clean.



For each item mark “Clean” or “Not clean”

If an item is not present or cannot be assessed mark “Not applicable”


Feedback of the results should be to the supervisor and/or cleaner as determined locally

General Ward Areas


Identify a general ward area to be assessed. Assess after the area has been routinely cleaned.



For each item mark “Acceptable” or “Not acceptable”

If an item is not present or cannot be assessed mark “Not applicable”


Feedback of the results should be to the supervisor and/or cleaner as determined locally

ASSESSORS

Assessors

• Assessors must be trained to undertake the assessments in this protocol

• Training includes completion of this presentation and an exam – Online exam – 80% result required to be added to the

online assessor list by TIPCU – Assessors notified of results – Successful assessors names will appear in on-line tool

ACCESSING AND USING DATA

Accessing data

• Reports can be run locally by a nominated person

• Each THO/hospital will be provided with a unique password protected web link to access data from their own organisation

• Report can be downloaded into Excel for further manipulation

Using data

• Data can be used for: – Evaluating changes in cleaning processes – Education / feedback – Evaluating changes in cleaning practice – Identifying high compliance – Benchmarking between hospitals – National accreditation standards

Using data

• Review data locally for trends • Data will be also be reviewed at a state level • Can’t be used for individual performance

management as no data on the person responsible for cleaning is collected

Summary

• Health care associated infections are linked to environmental cleanliness

• Assessing environmental cleanliness is an important strategy in preventing health care associated infections, thus improving patient safety

Documents

ENVIRONMENTAL ASSESSMENT PROTOCOL TRAINING PACKAGE€¦ · TRAINING PACKAGE Tasmanian Infection Prevention & Control Unit . SUMMARY OF THE PROTOCOL . ... quarter