Make support staff part of infection control

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Although plenty of infection control (IC) training and practices focus on clinical procedures, a substantial part of preventing healthcare-associated infections relies on staff members without a RN at the end of their name.

The support services area of IC, including housekeeping and the janitorial staff, plays a significant behind-the-scenes role in protecting patients and staff members from infections. Northumberland Hills Hospital in Cobourg, a community in Ontario, Canada, recognized this. The hospital also realized that without proper training and education, support services staff members would not be able to sufficiently fulfill their duties, and IC would suffer as a result.

Which is why Northumberland created the Support Services Infection Control Framework, a new program designed to train and educate the housekeeping and janitorial sections of the hospital on the importance of IC and the role they play. Essentially, the facility didn’t do anything other hospitals were neglecting; it simply standardized the approach and process to ensure that support staff members were receiving the proper training.

After a vancomycin-resistant enterococci (VRE) outbreak in 2007, it became apparent that a more detailed and consistent approach to cleaning needed to be implemented, says Bev Adamson, RD, director of materials management and food services at Northumberland.

“Room cleanliness is definitely a factor in the transmission of infections,” Adamson says. “Organisms can survive on surfaces for days or weeks. Therefore, a thorough cleaning of all rooms must be done daily.”

In November 2008, the program was featured as a leading practice in the Ontario Hospital Association’s Patient Safety: Leading Practice in Ontario, Improvements, Ideas and Innovations, 2008 booklet.

The training

Training was developed and then released in a four-module program, says Adamson. The support services program alternated between classroom education and practical demonstration.

The first module served as a classroom introduction to the importance of IC in support services procedures such as cleaning. The second module took staff members out of the classroom to practical demonstration of procedures such as hand washing and donning and doffing personal protective equipment.

The third and fourth modules followed the same pattern, first reviewing the cleaning routine and additional precautions, and then following up with a hands-on demonstration of the practices and cleaning routine for isolation and nonisolation rooms, as well as cough etiquette.

“As every support services worker involved in housekeeping was required to go through the program, there were costs associated with replacement staff,” Adamson says. “Approximately 65 staff members have been trained to date, at an approximate cost of $7,000.”

The hospital saw immediate results. By December 2007, its VRE rates went from one per 1,000 admissions to zero cases per 1,000; Northumberland also maintained a rate of zero healthcare-associated MRSA cases per 1,000 patients. (See “Northumberland Hills Hospital VRE infection rates” below.)

“The infection rates have gone down, and we attribute it to the support services framework and to the great job that our cleaning staff does on a day-to-day basis and to their efforts to maintain high standards,” says Myonne Allan, MLT, CIC, Northumberland’s director of laboratory services and IC.

Staff reaction

Although training can sometimes mean long, boring hours in the classroom, the support services staff members at Northumberland found the training to be helpful in both their understanding and practices related to IC, says Adamson. The hospital faced little resistance from its support staff and even had requests from staff members in other departments to participate. In addition, the hospital saw an increase in staff satisfaction and pride because support staff members realized the importance of their jobs and had a clear understanding of what they needed to do. This also resulted in a decreased reliance on supervisors, says Adamson.

“Our staff members are more confident in their knowledge and are now much more willing to speak up if they see a potential problem or if they identify a process that needs to be improved,” Adamson says. “They ask very important questions, and we have all learned from investigating the issues that they have raised.”

Northumberland Hills Hospital VRE infection rates

The following statistics were recorded by Northumberland Hills Hospital in Cobourg, Ontario, between December 2006 and September 2007. The data show the increase in vancomycin-resistant enterococci (VRE) outbreaks before and after implementing a support services framework, which provided regimented education regarding IC practices. The numbers below are calculated per 1,000 patient days.

  • Dec. 2006 2.7
  • Jan. 2007 5.8
  • Feb. 2007 37.2
  • Mar. 2007 11.6
  • Apr. 2007 26.8
  • May 2007 45.5 (support services framework introduced)
  • June 2007 8.5
  • July 2007 0
  • Aug. 2007 0
  • Sept. 2007 2.8

Source: Data adapted from Northumberland Hills Hospital infection statistics.