Diane G Dumigan RN BSN CIC FAPIC
Consultant DGDumigan Consulting LLC
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
Enhancing Leadership and
Facilitation Skills
8TH ANNUAL ILLINOIS
STATEWIDE CONFERENCE ON
HEALTHCARE-ASSOCIATED
INFECTIONS
SESSION ONE
CREATING EFFECTIVE AND SUSTAINABLE HOSPITAL
POLICIES THE WHO WHAT WHEN AND HOW
This session will discuss ways to facilitate policy
development educational programs and methods to
sustain success
Learning objectives
At the completion of this session participants will be able to
Describe at least two quality tools used to analyze healthcare
environmental cleaning problems
Create effective policy development teams
Adapt methods to sustain success
FOCUS-PDCA
bull Find a process to
improve
bull Organize a team that
knows the process
bull Clarify current
knowledge of the
process
bull Understand sources
of process variation
bull Select the process
improvement(s)
Plan
Improvement(s)
Do
data collection
data analysis
Check
data analysis
team voiceopinions
lessons learned
Act
to hold gain
to continue
improvement(s)
QUALITY TOOL 1
SYSTEM SKILLS
Use data to find failures
Opportunities to improve
Devise solutions
Staff responsibilities standardize process
measure for results
Implementation
The great challenge
FIND A PROCESS TO IMPROVE
Use data to find failures
Be Brave bring data to CEO CFO CNO
andor Medical Director
Need support from the very top of the organization
to make change
000
100
200
300
400
EXAMPLE OF A PROCESS TO IMPROVE
ENVIRONMENTAL CLEANING
Infect Control Hosp Epidemiol 2007 Oct28(10)1142-7 Epub
2007 Aug 3
Widespread environmental contamination associated
with patients with diarrhea and methicillin-resistant
Staphylococcus aureus colonization of the
gastrointestinal tract
Boyce JM1 Havill NL Otter JA Adams NM
Infect Control Hosp Epidemiol 2008 Aug29(8)723-9 doi
101086589906
Impact of hydrogen peroxide vapor room
decontamination on Clostridium difficile environmental
contamination and transmission in a healthcare setting
Boyce JM1 Havill NL Otter JA McDonald LC Adams
NM Cooper T Thompson A Wiggs L Killgore G Tauman
A Noble-Wang J
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
MEDIAN RELATIVE LIGHT UNIT (RLU) READINGS
AFTER DAILY CLEANING PHASES I
0
100
200
300
400
500
600
700
800
Bedrail OverbedTable
TVRemote
Grab bar ToiletSeat
Re
lati
ve
Lig
ht
Un
its
Phase I
Boyce JM et al ICHE 200930678
ORGANIZE A TEAM THAT KNOWS THE PROCESS
Facilitator - IP- Manage logistics keep team on task
Chair - Hospital Epidemiologist Chief Medical or Nursing
Officer CEO CFO-Someone with AUTHORITY to make
change
Directors of departments that will be affected by change
Frontline workers that know the problems and how the
system ldquoreallyrdquo works ldquothe tip of the spearrdquo
Caveat Diversify donrsquot be afraid of complainers you will
learn the most about yourself as a leader from them
A FEW WORDS ABOUT
PLANNING EFFECTIVE MEETINGS
Who will do what Pre-plan so roles are clear
IP as facilitator
Set goals and communicate clearly
Get agreement from team on frequency of meetings
Weekly or bi-weekly to start
Use sub-committees for effective time management
Get commitment from sub-committee chairs
Plan agendas
Assign speakers
Assign time for each topic (and a timekeeper)
HOUSEKEEPING TEAM
CLARIFY CURRENT KNOWLEDGE OF THE PROCESS
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
QUALITY TOOL 2
CHOSE A QUALITY IMPROVEMENT MODELISHIKAWA DIAGRAM CAUSE AND EFFECT DIAGRAM FISHBONE DIAGRAM
CHOSE A QUALITY IMPROVEMENT MODEL
AFFINITY DIAGRAM QUALITY TOOL 3
UNDERSTAND SOURCES OF PROCESS VARIATION
Easy to use
Handout post-it notes
Everybody gets to participate
Done in silence
Take about 15 minutes to write out each concern One concern per post-it note
Sort and group concerns
Get agreement from group they are sorted correctly
Vote on most important concerns to work on first
Who cleans
what
What gets
cleaned
what product
will be used
How much time
will be allowed for
cleaning
How will everyone
be trained in
process
How will we
know if
equipment is
clean or soiled
bull Is it nursing
or EVS
bull What about
pumps and
special
equipment
bull What if pt
doesnrsquot want
us to touch
their bedside
equipment
bull What about
the OR
bull Do we make our
own solutions
bull How often are
mops changes
bull When do we use
bleach
bull Can we use
bleach wipes
bull How many
wipes or rags do
we use
bull Where in room
do we start
cleaning
bull We donrsquot have
enough time to
clean now
bull We donrsquot have
enough staff
bull Do we change
curtains When do
we change them
Will we be given
enough time
bull How will managers
allow extra time if
needed
bull How will everyone
be trained to do
the same thing
bull Where will soiled
ldquorollingrdquo
equipment be
cleaned
bull How will we
know if
equipment is
clean or soiled
bull How will our
cleaning be
rated
bull Will we be fired
SELECT THE PROCESS IMPROVEMENTS
EXPANDED TEAM
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
Biomedical Engineers
Pharmacist (Manager of Infusion Pumps)
Materials Management Personnel
OR Personnel
TYPE OF
CLEANING
RESPONSIBLE
SERVICE
ITEMS TO BE CLEANED PRODUCTS USED TO
CLEAN
COMMENTS
ROUTINE DAILY
CLEANING OF
PATIENT ROOM
Environmental
Services
1dust window ledge
2spot clean furniture (chairs)
3wipe down over-bed table
4wipe down side rails
5wipe down TV control
6wipe down bathroom fixtures (faucets grab bar
shelf etc)
7clean sink and toilet
8wipe down door handles (room and bathroom)
9mop bathroom and patient floor
10remove trash
1 ndash 9 EPAICC hosp quat
or
1 - 8 EPAICC hosp
bleach wipe for Contact
CD and Enteric
Precautions
9 EPAICC hosp quat
8 Step daily
cleaning process
TRANSFER
DISCHARGE
CLEANING OF
PATIENT
ROOM AND
ANY PATIENT
ROOM AT
NURSErsquoS
REQUEST
(WHEN ROOM
IS EMPTY)
Environmental
Services
1clean bed frame side rails mattress (after nursing
has stripped bed of all linen)
2clean bedside table over bed table phone call bell
TV control
3wipe down flow meters
4wipe down regulators
5dustclean lighting fixtures
6clean outside canister (clean) of suction container
7clean and wipe down IV poles and pumps that need
to remain on the unit apply sani-strip para
8wipe down furniture
9dust all ledges
10clean around sharps containers and glove boxes
11wipe down step stools
12wipe down walkers
13wipe down canes
14clean bedside commode (once emptied by
nursing) apply sani-strip
15clean bathroom fixtures sink shower and toilet
apply sani-strip
16mop bathroom and patient floor
17pull trash
18change out privacy curtains if soiled or on request
1 - 16 EPAICC hosp
quat
or
1-15 EPAICC hosp bleach
wipe for Contact CD and
Enteric Precautions
16 EPAICC hosp quat
para see cleaning
instructions provided by
Clinical Engineering
below
apply sani-strip see
notes below
8 Step
Discharge
cleaning process
CLEANING CHART FOR ENVIRONMENTAL AND
NURSING SERVICES
Dumigan DG et al AJIC 200938387
EQUIPMENT TAG
Method Advantages Disadvantages
Visual inspection Simple Not reliable measure
of cleanliness
Fluorescent
marker system
Inexpensive
Minimal equipment
needed
Can improve practices
Must mark surfaces
before cleaning and
check them after
cleaning
Aerobic colony
counts
Relatively simple
Detects presence of
pathogens
More expensive
Results not available
for 48 hrs later
ATP
bioluminescence
assay systems
Provides quantitative
measure of cleanliness
Quick results
Can improve practices
More expensive
Requires special
equipment
ACT TO CONTINUE TO IMPROVE PROCESS
Methods for Assessing Cleaning Practices
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
Fluorescent Marker System
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
SESSION ONE
CREATING EFFECTIVE AND SUSTAINABLE HOSPITAL
POLICIES THE WHO WHAT WHEN AND HOW
This session will discuss ways to facilitate policy
development educational programs and methods to
sustain success
Learning objectives
At the completion of this session participants will be able to
Describe at least two quality tools used to analyze healthcare
environmental cleaning problems
Create effective policy development teams
Adapt methods to sustain success
FOCUS-PDCA
bull Find a process to
improve
bull Organize a team that
knows the process
bull Clarify current
knowledge of the
process
bull Understand sources
of process variation
bull Select the process
improvement(s)
Plan
Improvement(s)
Do
data collection
data analysis
Check
data analysis
team voiceopinions
lessons learned
Act
to hold gain
to continue
improvement(s)
QUALITY TOOL 1
SYSTEM SKILLS
Use data to find failures
Opportunities to improve
Devise solutions
Staff responsibilities standardize process
measure for results
Implementation
The great challenge
FIND A PROCESS TO IMPROVE
Use data to find failures
Be Brave bring data to CEO CFO CNO
andor Medical Director
Need support from the very top of the organization
to make change
000
100
200
300
400
EXAMPLE OF A PROCESS TO IMPROVE
ENVIRONMENTAL CLEANING
Infect Control Hosp Epidemiol 2007 Oct28(10)1142-7 Epub
2007 Aug 3
Widespread environmental contamination associated
with patients with diarrhea and methicillin-resistant
Staphylococcus aureus colonization of the
gastrointestinal tract
Boyce JM1 Havill NL Otter JA Adams NM
Infect Control Hosp Epidemiol 2008 Aug29(8)723-9 doi
101086589906
Impact of hydrogen peroxide vapor room
decontamination on Clostridium difficile environmental
contamination and transmission in a healthcare setting
Boyce JM1 Havill NL Otter JA McDonald LC Adams
NM Cooper T Thompson A Wiggs L Killgore G Tauman
A Noble-Wang J
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
MEDIAN RELATIVE LIGHT UNIT (RLU) READINGS
AFTER DAILY CLEANING PHASES I
0
100
200
300
400
500
600
700
800
Bedrail OverbedTable
TVRemote
Grab bar ToiletSeat
Re
lati
ve
Lig
ht
Un
its
Phase I
Boyce JM et al ICHE 200930678
ORGANIZE A TEAM THAT KNOWS THE PROCESS
Facilitator - IP- Manage logistics keep team on task
Chair - Hospital Epidemiologist Chief Medical or Nursing
Officer CEO CFO-Someone with AUTHORITY to make
change
Directors of departments that will be affected by change
Frontline workers that know the problems and how the
system ldquoreallyrdquo works ldquothe tip of the spearrdquo
Caveat Diversify donrsquot be afraid of complainers you will
learn the most about yourself as a leader from them
A FEW WORDS ABOUT
PLANNING EFFECTIVE MEETINGS
Who will do what Pre-plan so roles are clear
IP as facilitator
Set goals and communicate clearly
Get agreement from team on frequency of meetings
Weekly or bi-weekly to start
Use sub-committees for effective time management
Get commitment from sub-committee chairs
Plan agendas
Assign speakers
Assign time for each topic (and a timekeeper)
HOUSEKEEPING TEAM
CLARIFY CURRENT KNOWLEDGE OF THE PROCESS
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
QUALITY TOOL 2
CHOSE A QUALITY IMPROVEMENT MODELISHIKAWA DIAGRAM CAUSE AND EFFECT DIAGRAM FISHBONE DIAGRAM
CHOSE A QUALITY IMPROVEMENT MODEL
AFFINITY DIAGRAM QUALITY TOOL 3
UNDERSTAND SOURCES OF PROCESS VARIATION
Easy to use
Handout post-it notes
Everybody gets to participate
Done in silence
Take about 15 minutes to write out each concern One concern per post-it note
Sort and group concerns
Get agreement from group they are sorted correctly
Vote on most important concerns to work on first
Who cleans
what
What gets
cleaned
what product
will be used
How much time
will be allowed for
cleaning
How will everyone
be trained in
process
How will we
know if
equipment is
clean or soiled
bull Is it nursing
or EVS
bull What about
pumps and
special
equipment
bull What if pt
doesnrsquot want
us to touch
their bedside
equipment
bull What about
the OR
bull Do we make our
own solutions
bull How often are
mops changes
bull When do we use
bleach
bull Can we use
bleach wipes
bull How many
wipes or rags do
we use
bull Where in room
do we start
cleaning
bull We donrsquot have
enough time to
clean now
bull We donrsquot have
enough staff
bull Do we change
curtains When do
we change them
Will we be given
enough time
bull How will managers
allow extra time if
needed
bull How will everyone
be trained to do
the same thing
bull Where will soiled
ldquorollingrdquo
equipment be
cleaned
bull How will we
know if
equipment is
clean or soiled
bull How will our
cleaning be
rated
bull Will we be fired
SELECT THE PROCESS IMPROVEMENTS
EXPANDED TEAM
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
Biomedical Engineers
Pharmacist (Manager of Infusion Pumps)
Materials Management Personnel
OR Personnel
TYPE OF
CLEANING
RESPONSIBLE
SERVICE
ITEMS TO BE CLEANED PRODUCTS USED TO
CLEAN
COMMENTS
ROUTINE DAILY
CLEANING OF
PATIENT ROOM
Environmental
Services
1dust window ledge
2spot clean furniture (chairs)
3wipe down over-bed table
4wipe down side rails
5wipe down TV control
6wipe down bathroom fixtures (faucets grab bar
shelf etc)
7clean sink and toilet
8wipe down door handles (room and bathroom)
9mop bathroom and patient floor
10remove trash
1 ndash 9 EPAICC hosp quat
or
1 - 8 EPAICC hosp
bleach wipe for Contact
CD and Enteric
Precautions
9 EPAICC hosp quat
8 Step daily
cleaning process
TRANSFER
DISCHARGE
CLEANING OF
PATIENT
ROOM AND
ANY PATIENT
ROOM AT
NURSErsquoS
REQUEST
(WHEN ROOM
IS EMPTY)
Environmental
Services
1clean bed frame side rails mattress (after nursing
has stripped bed of all linen)
2clean bedside table over bed table phone call bell
TV control
3wipe down flow meters
4wipe down regulators
5dustclean lighting fixtures
6clean outside canister (clean) of suction container
7clean and wipe down IV poles and pumps that need
to remain on the unit apply sani-strip para
8wipe down furniture
9dust all ledges
10clean around sharps containers and glove boxes
11wipe down step stools
12wipe down walkers
13wipe down canes
14clean bedside commode (once emptied by
nursing) apply sani-strip
15clean bathroom fixtures sink shower and toilet
apply sani-strip
16mop bathroom and patient floor
17pull trash
18change out privacy curtains if soiled or on request
1 - 16 EPAICC hosp
quat
or
1-15 EPAICC hosp bleach
wipe for Contact CD and
Enteric Precautions
16 EPAICC hosp quat
para see cleaning
instructions provided by
Clinical Engineering
below
apply sani-strip see
notes below
8 Step
Discharge
cleaning process
CLEANING CHART FOR ENVIRONMENTAL AND
NURSING SERVICES
Dumigan DG et al AJIC 200938387
EQUIPMENT TAG
Method Advantages Disadvantages
Visual inspection Simple Not reliable measure
of cleanliness
Fluorescent
marker system
Inexpensive
Minimal equipment
needed
Can improve practices
Must mark surfaces
before cleaning and
check them after
cleaning
Aerobic colony
counts
Relatively simple
Detects presence of
pathogens
More expensive
Results not available
for 48 hrs later
ATP
bioluminescence
assay systems
Provides quantitative
measure of cleanliness
Quick results
Can improve practices
More expensive
Requires special
equipment
ACT TO CONTINUE TO IMPROVE PROCESS
Methods for Assessing Cleaning Practices
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
Fluorescent Marker System
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
FOCUS-PDCA
bull Find a process to
improve
bull Organize a team that
knows the process
bull Clarify current
knowledge of the
process
bull Understand sources
of process variation
bull Select the process
improvement(s)
Plan
Improvement(s)
Do
data collection
data analysis
Check
data analysis
team voiceopinions
lessons learned
Act
to hold gain
to continue
improvement(s)
QUALITY TOOL 1
SYSTEM SKILLS
Use data to find failures
Opportunities to improve
Devise solutions
Staff responsibilities standardize process
measure for results
Implementation
The great challenge
FIND A PROCESS TO IMPROVE
Use data to find failures
Be Brave bring data to CEO CFO CNO
andor Medical Director
Need support from the very top of the organization
to make change
000
100
200
300
400
EXAMPLE OF A PROCESS TO IMPROVE
ENVIRONMENTAL CLEANING
Infect Control Hosp Epidemiol 2007 Oct28(10)1142-7 Epub
2007 Aug 3
Widespread environmental contamination associated
with patients with diarrhea and methicillin-resistant
Staphylococcus aureus colonization of the
gastrointestinal tract
Boyce JM1 Havill NL Otter JA Adams NM
Infect Control Hosp Epidemiol 2008 Aug29(8)723-9 doi
101086589906
Impact of hydrogen peroxide vapor room
decontamination on Clostridium difficile environmental
contamination and transmission in a healthcare setting
Boyce JM1 Havill NL Otter JA McDonald LC Adams
NM Cooper T Thompson A Wiggs L Killgore G Tauman
A Noble-Wang J
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
MEDIAN RELATIVE LIGHT UNIT (RLU) READINGS
AFTER DAILY CLEANING PHASES I
0
100
200
300
400
500
600
700
800
Bedrail OverbedTable
TVRemote
Grab bar ToiletSeat
Re
lati
ve
Lig
ht
Un
its
Phase I
Boyce JM et al ICHE 200930678
ORGANIZE A TEAM THAT KNOWS THE PROCESS
Facilitator - IP- Manage logistics keep team on task
Chair - Hospital Epidemiologist Chief Medical or Nursing
Officer CEO CFO-Someone with AUTHORITY to make
change
Directors of departments that will be affected by change
Frontline workers that know the problems and how the
system ldquoreallyrdquo works ldquothe tip of the spearrdquo
Caveat Diversify donrsquot be afraid of complainers you will
learn the most about yourself as a leader from them
A FEW WORDS ABOUT
PLANNING EFFECTIVE MEETINGS
Who will do what Pre-plan so roles are clear
IP as facilitator
Set goals and communicate clearly
Get agreement from team on frequency of meetings
Weekly or bi-weekly to start
Use sub-committees for effective time management
Get commitment from sub-committee chairs
Plan agendas
Assign speakers
Assign time for each topic (and a timekeeper)
HOUSEKEEPING TEAM
CLARIFY CURRENT KNOWLEDGE OF THE PROCESS
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
QUALITY TOOL 2
CHOSE A QUALITY IMPROVEMENT MODELISHIKAWA DIAGRAM CAUSE AND EFFECT DIAGRAM FISHBONE DIAGRAM
CHOSE A QUALITY IMPROVEMENT MODEL
AFFINITY DIAGRAM QUALITY TOOL 3
UNDERSTAND SOURCES OF PROCESS VARIATION
Easy to use
Handout post-it notes
Everybody gets to participate
Done in silence
Take about 15 minutes to write out each concern One concern per post-it note
Sort and group concerns
Get agreement from group they are sorted correctly
Vote on most important concerns to work on first
Who cleans
what
What gets
cleaned
what product
will be used
How much time
will be allowed for
cleaning
How will everyone
be trained in
process
How will we
know if
equipment is
clean or soiled
bull Is it nursing
or EVS
bull What about
pumps and
special
equipment
bull What if pt
doesnrsquot want
us to touch
their bedside
equipment
bull What about
the OR
bull Do we make our
own solutions
bull How often are
mops changes
bull When do we use
bleach
bull Can we use
bleach wipes
bull How many
wipes or rags do
we use
bull Where in room
do we start
cleaning
bull We donrsquot have
enough time to
clean now
bull We donrsquot have
enough staff
bull Do we change
curtains When do
we change them
Will we be given
enough time
bull How will managers
allow extra time if
needed
bull How will everyone
be trained to do
the same thing
bull Where will soiled
ldquorollingrdquo
equipment be
cleaned
bull How will we
know if
equipment is
clean or soiled
bull How will our
cleaning be
rated
bull Will we be fired
SELECT THE PROCESS IMPROVEMENTS
EXPANDED TEAM
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
Biomedical Engineers
Pharmacist (Manager of Infusion Pumps)
Materials Management Personnel
OR Personnel
TYPE OF
CLEANING
RESPONSIBLE
SERVICE
ITEMS TO BE CLEANED PRODUCTS USED TO
CLEAN
COMMENTS
ROUTINE DAILY
CLEANING OF
PATIENT ROOM
Environmental
Services
1dust window ledge
2spot clean furniture (chairs)
3wipe down over-bed table
4wipe down side rails
5wipe down TV control
6wipe down bathroom fixtures (faucets grab bar
shelf etc)
7clean sink and toilet
8wipe down door handles (room and bathroom)
9mop bathroom and patient floor
10remove trash
1 ndash 9 EPAICC hosp quat
or
1 - 8 EPAICC hosp
bleach wipe for Contact
CD and Enteric
Precautions
9 EPAICC hosp quat
8 Step daily
cleaning process
TRANSFER
DISCHARGE
CLEANING OF
PATIENT
ROOM AND
ANY PATIENT
ROOM AT
NURSErsquoS
REQUEST
(WHEN ROOM
IS EMPTY)
Environmental
Services
1clean bed frame side rails mattress (after nursing
has stripped bed of all linen)
2clean bedside table over bed table phone call bell
TV control
3wipe down flow meters
4wipe down regulators
5dustclean lighting fixtures
6clean outside canister (clean) of suction container
7clean and wipe down IV poles and pumps that need
to remain on the unit apply sani-strip para
8wipe down furniture
9dust all ledges
10clean around sharps containers and glove boxes
11wipe down step stools
12wipe down walkers
13wipe down canes
14clean bedside commode (once emptied by
nursing) apply sani-strip
15clean bathroom fixtures sink shower and toilet
apply sani-strip
16mop bathroom and patient floor
17pull trash
18change out privacy curtains if soiled or on request
1 - 16 EPAICC hosp
quat
or
1-15 EPAICC hosp bleach
wipe for Contact CD and
Enteric Precautions
16 EPAICC hosp quat
para see cleaning
instructions provided by
Clinical Engineering
below
apply sani-strip see
notes below
8 Step
Discharge
cleaning process
CLEANING CHART FOR ENVIRONMENTAL AND
NURSING SERVICES
Dumigan DG et al AJIC 200938387
EQUIPMENT TAG
Method Advantages Disadvantages
Visual inspection Simple Not reliable measure
of cleanliness
Fluorescent
marker system
Inexpensive
Minimal equipment
needed
Can improve practices
Must mark surfaces
before cleaning and
check them after
cleaning
Aerobic colony
counts
Relatively simple
Detects presence of
pathogens
More expensive
Results not available
for 48 hrs later
ATP
bioluminescence
assay systems
Provides quantitative
measure of cleanliness
Quick results
Can improve practices
More expensive
Requires special
equipment
ACT TO CONTINUE TO IMPROVE PROCESS
Methods for Assessing Cleaning Practices
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
Fluorescent Marker System
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
SYSTEM SKILLS
Use data to find failures
Opportunities to improve
Devise solutions
Staff responsibilities standardize process
measure for results
Implementation
The great challenge
FIND A PROCESS TO IMPROVE
Use data to find failures
Be Brave bring data to CEO CFO CNO
andor Medical Director
Need support from the very top of the organization
to make change
000
100
200
300
400
EXAMPLE OF A PROCESS TO IMPROVE
ENVIRONMENTAL CLEANING
Infect Control Hosp Epidemiol 2007 Oct28(10)1142-7 Epub
2007 Aug 3
Widespread environmental contamination associated
with patients with diarrhea and methicillin-resistant
Staphylococcus aureus colonization of the
gastrointestinal tract
Boyce JM1 Havill NL Otter JA Adams NM
Infect Control Hosp Epidemiol 2008 Aug29(8)723-9 doi
101086589906
Impact of hydrogen peroxide vapor room
decontamination on Clostridium difficile environmental
contamination and transmission in a healthcare setting
Boyce JM1 Havill NL Otter JA McDonald LC Adams
NM Cooper T Thompson A Wiggs L Killgore G Tauman
A Noble-Wang J
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
MEDIAN RELATIVE LIGHT UNIT (RLU) READINGS
AFTER DAILY CLEANING PHASES I
0
100
200
300
400
500
600
700
800
Bedrail OverbedTable
TVRemote
Grab bar ToiletSeat
Re
lati
ve
Lig
ht
Un
its
Phase I
Boyce JM et al ICHE 200930678
ORGANIZE A TEAM THAT KNOWS THE PROCESS
Facilitator - IP- Manage logistics keep team on task
Chair - Hospital Epidemiologist Chief Medical or Nursing
Officer CEO CFO-Someone with AUTHORITY to make
change
Directors of departments that will be affected by change
Frontline workers that know the problems and how the
system ldquoreallyrdquo works ldquothe tip of the spearrdquo
Caveat Diversify donrsquot be afraid of complainers you will
learn the most about yourself as a leader from them
A FEW WORDS ABOUT
PLANNING EFFECTIVE MEETINGS
Who will do what Pre-plan so roles are clear
IP as facilitator
Set goals and communicate clearly
Get agreement from team on frequency of meetings
Weekly or bi-weekly to start
Use sub-committees for effective time management
Get commitment from sub-committee chairs
Plan agendas
Assign speakers
Assign time for each topic (and a timekeeper)
HOUSEKEEPING TEAM
CLARIFY CURRENT KNOWLEDGE OF THE PROCESS
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
QUALITY TOOL 2
CHOSE A QUALITY IMPROVEMENT MODELISHIKAWA DIAGRAM CAUSE AND EFFECT DIAGRAM FISHBONE DIAGRAM
CHOSE A QUALITY IMPROVEMENT MODEL
AFFINITY DIAGRAM QUALITY TOOL 3
UNDERSTAND SOURCES OF PROCESS VARIATION
Easy to use
Handout post-it notes
Everybody gets to participate
Done in silence
Take about 15 minutes to write out each concern One concern per post-it note
Sort and group concerns
Get agreement from group they are sorted correctly
Vote on most important concerns to work on first
Who cleans
what
What gets
cleaned
what product
will be used
How much time
will be allowed for
cleaning
How will everyone
be trained in
process
How will we
know if
equipment is
clean or soiled
bull Is it nursing
or EVS
bull What about
pumps and
special
equipment
bull What if pt
doesnrsquot want
us to touch
their bedside
equipment
bull What about
the OR
bull Do we make our
own solutions
bull How often are
mops changes
bull When do we use
bleach
bull Can we use
bleach wipes
bull How many
wipes or rags do
we use
bull Where in room
do we start
cleaning
bull We donrsquot have
enough time to
clean now
bull We donrsquot have
enough staff
bull Do we change
curtains When do
we change them
Will we be given
enough time
bull How will managers
allow extra time if
needed
bull How will everyone
be trained to do
the same thing
bull Where will soiled
ldquorollingrdquo
equipment be
cleaned
bull How will we
know if
equipment is
clean or soiled
bull How will our
cleaning be
rated
bull Will we be fired
SELECT THE PROCESS IMPROVEMENTS
EXPANDED TEAM
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
Biomedical Engineers
Pharmacist (Manager of Infusion Pumps)
Materials Management Personnel
OR Personnel
TYPE OF
CLEANING
RESPONSIBLE
SERVICE
ITEMS TO BE CLEANED PRODUCTS USED TO
CLEAN
COMMENTS
ROUTINE DAILY
CLEANING OF
PATIENT ROOM
Environmental
Services
1dust window ledge
2spot clean furniture (chairs)
3wipe down over-bed table
4wipe down side rails
5wipe down TV control
6wipe down bathroom fixtures (faucets grab bar
shelf etc)
7clean sink and toilet
8wipe down door handles (room and bathroom)
9mop bathroom and patient floor
10remove trash
1 ndash 9 EPAICC hosp quat
or
1 - 8 EPAICC hosp
bleach wipe for Contact
CD and Enteric
Precautions
9 EPAICC hosp quat
8 Step daily
cleaning process
TRANSFER
DISCHARGE
CLEANING OF
PATIENT
ROOM AND
ANY PATIENT
ROOM AT
NURSErsquoS
REQUEST
(WHEN ROOM
IS EMPTY)
Environmental
Services
1clean bed frame side rails mattress (after nursing
has stripped bed of all linen)
2clean bedside table over bed table phone call bell
TV control
3wipe down flow meters
4wipe down regulators
5dustclean lighting fixtures
6clean outside canister (clean) of suction container
7clean and wipe down IV poles and pumps that need
to remain on the unit apply sani-strip para
8wipe down furniture
9dust all ledges
10clean around sharps containers and glove boxes
11wipe down step stools
12wipe down walkers
13wipe down canes
14clean bedside commode (once emptied by
nursing) apply sani-strip
15clean bathroom fixtures sink shower and toilet
apply sani-strip
16mop bathroom and patient floor
17pull trash
18change out privacy curtains if soiled or on request
1 - 16 EPAICC hosp
quat
or
1-15 EPAICC hosp bleach
wipe for Contact CD and
Enteric Precautions
16 EPAICC hosp quat
para see cleaning
instructions provided by
Clinical Engineering
below
apply sani-strip see
notes below
8 Step
Discharge
cleaning process
CLEANING CHART FOR ENVIRONMENTAL AND
NURSING SERVICES
Dumigan DG et al AJIC 200938387
EQUIPMENT TAG
Method Advantages Disadvantages
Visual inspection Simple Not reliable measure
of cleanliness
Fluorescent
marker system
Inexpensive
Minimal equipment
needed
Can improve practices
Must mark surfaces
before cleaning and
check them after
cleaning
Aerobic colony
counts
Relatively simple
Detects presence of
pathogens
More expensive
Results not available
for 48 hrs later
ATP
bioluminescence
assay systems
Provides quantitative
measure of cleanliness
Quick results
Can improve practices
More expensive
Requires special
equipment
ACT TO CONTINUE TO IMPROVE PROCESS
Methods for Assessing Cleaning Practices
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
Fluorescent Marker System
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
FIND A PROCESS TO IMPROVE
Use data to find failures
Be Brave bring data to CEO CFO CNO
andor Medical Director
Need support from the very top of the organization
to make change
000
100
200
300
400
EXAMPLE OF A PROCESS TO IMPROVE
ENVIRONMENTAL CLEANING
Infect Control Hosp Epidemiol 2007 Oct28(10)1142-7 Epub
2007 Aug 3
Widespread environmental contamination associated
with patients with diarrhea and methicillin-resistant
Staphylococcus aureus colonization of the
gastrointestinal tract
Boyce JM1 Havill NL Otter JA Adams NM
Infect Control Hosp Epidemiol 2008 Aug29(8)723-9 doi
101086589906
Impact of hydrogen peroxide vapor room
decontamination on Clostridium difficile environmental
contamination and transmission in a healthcare setting
Boyce JM1 Havill NL Otter JA McDonald LC Adams
NM Cooper T Thompson A Wiggs L Killgore G Tauman
A Noble-Wang J
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
MEDIAN RELATIVE LIGHT UNIT (RLU) READINGS
AFTER DAILY CLEANING PHASES I
0
100
200
300
400
500
600
700
800
Bedrail OverbedTable
TVRemote
Grab bar ToiletSeat
Re
lati
ve
Lig
ht
Un
its
Phase I
Boyce JM et al ICHE 200930678
ORGANIZE A TEAM THAT KNOWS THE PROCESS
Facilitator - IP- Manage logistics keep team on task
Chair - Hospital Epidemiologist Chief Medical or Nursing
Officer CEO CFO-Someone with AUTHORITY to make
change
Directors of departments that will be affected by change
Frontline workers that know the problems and how the
system ldquoreallyrdquo works ldquothe tip of the spearrdquo
Caveat Diversify donrsquot be afraid of complainers you will
learn the most about yourself as a leader from them
A FEW WORDS ABOUT
PLANNING EFFECTIVE MEETINGS
Who will do what Pre-plan so roles are clear
IP as facilitator
Set goals and communicate clearly
Get agreement from team on frequency of meetings
Weekly or bi-weekly to start
Use sub-committees for effective time management
Get commitment from sub-committee chairs
Plan agendas
Assign speakers
Assign time for each topic (and a timekeeper)
HOUSEKEEPING TEAM
CLARIFY CURRENT KNOWLEDGE OF THE PROCESS
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
QUALITY TOOL 2
CHOSE A QUALITY IMPROVEMENT MODELISHIKAWA DIAGRAM CAUSE AND EFFECT DIAGRAM FISHBONE DIAGRAM
CHOSE A QUALITY IMPROVEMENT MODEL
AFFINITY DIAGRAM QUALITY TOOL 3
UNDERSTAND SOURCES OF PROCESS VARIATION
Easy to use
Handout post-it notes
Everybody gets to participate
Done in silence
Take about 15 minutes to write out each concern One concern per post-it note
Sort and group concerns
Get agreement from group they are sorted correctly
Vote on most important concerns to work on first
Who cleans
what
What gets
cleaned
what product
will be used
How much time
will be allowed for
cleaning
How will everyone
be trained in
process
How will we
know if
equipment is
clean or soiled
bull Is it nursing
or EVS
bull What about
pumps and
special
equipment
bull What if pt
doesnrsquot want
us to touch
their bedside
equipment
bull What about
the OR
bull Do we make our
own solutions
bull How often are
mops changes
bull When do we use
bleach
bull Can we use
bleach wipes
bull How many
wipes or rags do
we use
bull Where in room
do we start
cleaning
bull We donrsquot have
enough time to
clean now
bull We donrsquot have
enough staff
bull Do we change
curtains When do
we change them
Will we be given
enough time
bull How will managers
allow extra time if
needed
bull How will everyone
be trained to do
the same thing
bull Where will soiled
ldquorollingrdquo
equipment be
cleaned
bull How will we
know if
equipment is
clean or soiled
bull How will our
cleaning be
rated
bull Will we be fired
SELECT THE PROCESS IMPROVEMENTS
EXPANDED TEAM
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
Biomedical Engineers
Pharmacist (Manager of Infusion Pumps)
Materials Management Personnel
OR Personnel
TYPE OF
CLEANING
RESPONSIBLE
SERVICE
ITEMS TO BE CLEANED PRODUCTS USED TO
CLEAN
COMMENTS
ROUTINE DAILY
CLEANING OF
PATIENT ROOM
Environmental
Services
1dust window ledge
2spot clean furniture (chairs)
3wipe down over-bed table
4wipe down side rails
5wipe down TV control
6wipe down bathroom fixtures (faucets grab bar
shelf etc)
7clean sink and toilet
8wipe down door handles (room and bathroom)
9mop bathroom and patient floor
10remove trash
1 ndash 9 EPAICC hosp quat
or
1 - 8 EPAICC hosp
bleach wipe for Contact
CD and Enteric
Precautions
9 EPAICC hosp quat
8 Step daily
cleaning process
TRANSFER
DISCHARGE
CLEANING OF
PATIENT
ROOM AND
ANY PATIENT
ROOM AT
NURSErsquoS
REQUEST
(WHEN ROOM
IS EMPTY)
Environmental
Services
1clean bed frame side rails mattress (after nursing
has stripped bed of all linen)
2clean bedside table over bed table phone call bell
TV control
3wipe down flow meters
4wipe down regulators
5dustclean lighting fixtures
6clean outside canister (clean) of suction container
7clean and wipe down IV poles and pumps that need
to remain on the unit apply sani-strip para
8wipe down furniture
9dust all ledges
10clean around sharps containers and glove boxes
11wipe down step stools
12wipe down walkers
13wipe down canes
14clean bedside commode (once emptied by
nursing) apply sani-strip
15clean bathroom fixtures sink shower and toilet
apply sani-strip
16mop bathroom and patient floor
17pull trash
18change out privacy curtains if soiled or on request
1 - 16 EPAICC hosp
quat
or
1-15 EPAICC hosp bleach
wipe for Contact CD and
Enteric Precautions
16 EPAICC hosp quat
para see cleaning
instructions provided by
Clinical Engineering
below
apply sani-strip see
notes below
8 Step
Discharge
cleaning process
CLEANING CHART FOR ENVIRONMENTAL AND
NURSING SERVICES
Dumigan DG et al AJIC 200938387
EQUIPMENT TAG
Method Advantages Disadvantages
Visual inspection Simple Not reliable measure
of cleanliness
Fluorescent
marker system
Inexpensive
Minimal equipment
needed
Can improve practices
Must mark surfaces
before cleaning and
check them after
cleaning
Aerobic colony
counts
Relatively simple
Detects presence of
pathogens
More expensive
Results not available
for 48 hrs later
ATP
bioluminescence
assay systems
Provides quantitative
measure of cleanliness
Quick results
Can improve practices
More expensive
Requires special
equipment
ACT TO CONTINUE TO IMPROVE PROCESS
Methods for Assessing Cleaning Practices
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
Fluorescent Marker System
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
EXAMPLE OF A PROCESS TO IMPROVE
ENVIRONMENTAL CLEANING
Infect Control Hosp Epidemiol 2007 Oct28(10)1142-7 Epub
2007 Aug 3
Widespread environmental contamination associated
with patients with diarrhea and methicillin-resistant
Staphylococcus aureus colonization of the
gastrointestinal tract
Boyce JM1 Havill NL Otter JA Adams NM
Infect Control Hosp Epidemiol 2008 Aug29(8)723-9 doi
101086589906
Impact of hydrogen peroxide vapor room
decontamination on Clostridium difficile environmental
contamination and transmission in a healthcare setting
Boyce JM1 Havill NL Otter JA McDonald LC Adams
NM Cooper T Thompson A Wiggs L Killgore G Tauman
A Noble-Wang J
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
MEDIAN RELATIVE LIGHT UNIT (RLU) READINGS
AFTER DAILY CLEANING PHASES I
0
100
200
300
400
500
600
700
800
Bedrail OverbedTable
TVRemote
Grab bar ToiletSeat
Re
lati
ve
Lig
ht
Un
its
Phase I
Boyce JM et al ICHE 200930678
ORGANIZE A TEAM THAT KNOWS THE PROCESS
Facilitator - IP- Manage logistics keep team on task
Chair - Hospital Epidemiologist Chief Medical or Nursing
Officer CEO CFO-Someone with AUTHORITY to make
change
Directors of departments that will be affected by change
Frontline workers that know the problems and how the
system ldquoreallyrdquo works ldquothe tip of the spearrdquo
Caveat Diversify donrsquot be afraid of complainers you will
learn the most about yourself as a leader from them
A FEW WORDS ABOUT
PLANNING EFFECTIVE MEETINGS
Who will do what Pre-plan so roles are clear
IP as facilitator
Set goals and communicate clearly
Get agreement from team on frequency of meetings
Weekly or bi-weekly to start
Use sub-committees for effective time management
Get commitment from sub-committee chairs
Plan agendas
Assign speakers
Assign time for each topic (and a timekeeper)
HOUSEKEEPING TEAM
CLARIFY CURRENT KNOWLEDGE OF THE PROCESS
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
QUALITY TOOL 2
CHOSE A QUALITY IMPROVEMENT MODELISHIKAWA DIAGRAM CAUSE AND EFFECT DIAGRAM FISHBONE DIAGRAM
CHOSE A QUALITY IMPROVEMENT MODEL
AFFINITY DIAGRAM QUALITY TOOL 3
UNDERSTAND SOURCES OF PROCESS VARIATION
Easy to use
Handout post-it notes
Everybody gets to participate
Done in silence
Take about 15 minutes to write out each concern One concern per post-it note
Sort and group concerns
Get agreement from group they are sorted correctly
Vote on most important concerns to work on first
Who cleans
what
What gets
cleaned
what product
will be used
How much time
will be allowed for
cleaning
How will everyone
be trained in
process
How will we
know if
equipment is
clean or soiled
bull Is it nursing
or EVS
bull What about
pumps and
special
equipment
bull What if pt
doesnrsquot want
us to touch
their bedside
equipment
bull What about
the OR
bull Do we make our
own solutions
bull How often are
mops changes
bull When do we use
bleach
bull Can we use
bleach wipes
bull How many
wipes or rags do
we use
bull Where in room
do we start
cleaning
bull We donrsquot have
enough time to
clean now
bull We donrsquot have
enough staff
bull Do we change
curtains When do
we change them
Will we be given
enough time
bull How will managers
allow extra time if
needed
bull How will everyone
be trained to do
the same thing
bull Where will soiled
ldquorollingrdquo
equipment be
cleaned
bull How will we
know if
equipment is
clean or soiled
bull How will our
cleaning be
rated
bull Will we be fired
SELECT THE PROCESS IMPROVEMENTS
EXPANDED TEAM
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
Biomedical Engineers
Pharmacist (Manager of Infusion Pumps)
Materials Management Personnel
OR Personnel
TYPE OF
CLEANING
RESPONSIBLE
SERVICE
ITEMS TO BE CLEANED PRODUCTS USED TO
CLEAN
COMMENTS
ROUTINE DAILY
CLEANING OF
PATIENT ROOM
Environmental
Services
1dust window ledge
2spot clean furniture (chairs)
3wipe down over-bed table
4wipe down side rails
5wipe down TV control
6wipe down bathroom fixtures (faucets grab bar
shelf etc)
7clean sink and toilet
8wipe down door handles (room and bathroom)
9mop bathroom and patient floor
10remove trash
1 ndash 9 EPAICC hosp quat
or
1 - 8 EPAICC hosp
bleach wipe for Contact
CD and Enteric
Precautions
9 EPAICC hosp quat
8 Step daily
cleaning process
TRANSFER
DISCHARGE
CLEANING OF
PATIENT
ROOM AND
ANY PATIENT
ROOM AT
NURSErsquoS
REQUEST
(WHEN ROOM
IS EMPTY)
Environmental
Services
1clean bed frame side rails mattress (after nursing
has stripped bed of all linen)
2clean bedside table over bed table phone call bell
TV control
3wipe down flow meters
4wipe down regulators
5dustclean lighting fixtures
6clean outside canister (clean) of suction container
7clean and wipe down IV poles and pumps that need
to remain on the unit apply sani-strip para
8wipe down furniture
9dust all ledges
10clean around sharps containers and glove boxes
11wipe down step stools
12wipe down walkers
13wipe down canes
14clean bedside commode (once emptied by
nursing) apply sani-strip
15clean bathroom fixtures sink shower and toilet
apply sani-strip
16mop bathroom and patient floor
17pull trash
18change out privacy curtains if soiled or on request
1 - 16 EPAICC hosp
quat
or
1-15 EPAICC hosp bleach
wipe for Contact CD and
Enteric Precautions
16 EPAICC hosp quat
para see cleaning
instructions provided by
Clinical Engineering
below
apply sani-strip see
notes below
8 Step
Discharge
cleaning process
CLEANING CHART FOR ENVIRONMENTAL AND
NURSING SERVICES
Dumigan DG et al AJIC 200938387
EQUIPMENT TAG
Method Advantages Disadvantages
Visual inspection Simple Not reliable measure
of cleanliness
Fluorescent
marker system
Inexpensive
Minimal equipment
needed
Can improve practices
Must mark surfaces
before cleaning and
check them after
cleaning
Aerobic colony
counts
Relatively simple
Detects presence of
pathogens
More expensive
Results not available
for 48 hrs later
ATP
bioluminescence
assay systems
Provides quantitative
measure of cleanliness
Quick results
Can improve practices
More expensive
Requires special
equipment
ACT TO CONTINUE TO IMPROVE PROCESS
Methods for Assessing Cleaning Practices
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
Fluorescent Marker System
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
MEDIAN RELATIVE LIGHT UNIT (RLU) READINGS
AFTER DAILY CLEANING PHASES I
0
100
200
300
400
500
600
700
800
Bedrail OverbedTable
TVRemote
Grab bar ToiletSeat
Re
lati
ve
Lig
ht
Un
its
Phase I
Boyce JM et al ICHE 200930678
ORGANIZE A TEAM THAT KNOWS THE PROCESS
Facilitator - IP- Manage logistics keep team on task
Chair - Hospital Epidemiologist Chief Medical or Nursing
Officer CEO CFO-Someone with AUTHORITY to make
change
Directors of departments that will be affected by change
Frontline workers that know the problems and how the
system ldquoreallyrdquo works ldquothe tip of the spearrdquo
Caveat Diversify donrsquot be afraid of complainers you will
learn the most about yourself as a leader from them
A FEW WORDS ABOUT
PLANNING EFFECTIVE MEETINGS
Who will do what Pre-plan so roles are clear
IP as facilitator
Set goals and communicate clearly
Get agreement from team on frequency of meetings
Weekly or bi-weekly to start
Use sub-committees for effective time management
Get commitment from sub-committee chairs
Plan agendas
Assign speakers
Assign time for each topic (and a timekeeper)
HOUSEKEEPING TEAM
CLARIFY CURRENT KNOWLEDGE OF THE PROCESS
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
QUALITY TOOL 2
CHOSE A QUALITY IMPROVEMENT MODELISHIKAWA DIAGRAM CAUSE AND EFFECT DIAGRAM FISHBONE DIAGRAM
CHOSE A QUALITY IMPROVEMENT MODEL
AFFINITY DIAGRAM QUALITY TOOL 3
UNDERSTAND SOURCES OF PROCESS VARIATION
Easy to use
Handout post-it notes
Everybody gets to participate
Done in silence
Take about 15 minutes to write out each concern One concern per post-it note
Sort and group concerns
Get agreement from group they are sorted correctly
Vote on most important concerns to work on first
Who cleans
what
What gets
cleaned
what product
will be used
How much time
will be allowed for
cleaning
How will everyone
be trained in
process
How will we
know if
equipment is
clean or soiled
bull Is it nursing
or EVS
bull What about
pumps and
special
equipment
bull What if pt
doesnrsquot want
us to touch
their bedside
equipment
bull What about
the OR
bull Do we make our
own solutions
bull How often are
mops changes
bull When do we use
bleach
bull Can we use
bleach wipes
bull How many
wipes or rags do
we use
bull Where in room
do we start
cleaning
bull We donrsquot have
enough time to
clean now
bull We donrsquot have
enough staff
bull Do we change
curtains When do
we change them
Will we be given
enough time
bull How will managers
allow extra time if
needed
bull How will everyone
be trained to do
the same thing
bull Where will soiled
ldquorollingrdquo
equipment be
cleaned
bull How will we
know if
equipment is
clean or soiled
bull How will our
cleaning be
rated
bull Will we be fired
SELECT THE PROCESS IMPROVEMENTS
EXPANDED TEAM
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
Biomedical Engineers
Pharmacist (Manager of Infusion Pumps)
Materials Management Personnel
OR Personnel
TYPE OF
CLEANING
RESPONSIBLE
SERVICE
ITEMS TO BE CLEANED PRODUCTS USED TO
CLEAN
COMMENTS
ROUTINE DAILY
CLEANING OF
PATIENT ROOM
Environmental
Services
1dust window ledge
2spot clean furniture (chairs)
3wipe down over-bed table
4wipe down side rails
5wipe down TV control
6wipe down bathroom fixtures (faucets grab bar
shelf etc)
7clean sink and toilet
8wipe down door handles (room and bathroom)
9mop bathroom and patient floor
10remove trash
1 ndash 9 EPAICC hosp quat
or
1 - 8 EPAICC hosp
bleach wipe for Contact
CD and Enteric
Precautions
9 EPAICC hosp quat
8 Step daily
cleaning process
TRANSFER
DISCHARGE
CLEANING OF
PATIENT
ROOM AND
ANY PATIENT
ROOM AT
NURSErsquoS
REQUEST
(WHEN ROOM
IS EMPTY)
Environmental
Services
1clean bed frame side rails mattress (after nursing
has stripped bed of all linen)
2clean bedside table over bed table phone call bell
TV control
3wipe down flow meters
4wipe down regulators
5dustclean lighting fixtures
6clean outside canister (clean) of suction container
7clean and wipe down IV poles and pumps that need
to remain on the unit apply sani-strip para
8wipe down furniture
9dust all ledges
10clean around sharps containers and glove boxes
11wipe down step stools
12wipe down walkers
13wipe down canes
14clean bedside commode (once emptied by
nursing) apply sani-strip
15clean bathroom fixtures sink shower and toilet
apply sani-strip
16mop bathroom and patient floor
17pull trash
18change out privacy curtains if soiled or on request
1 - 16 EPAICC hosp
quat
or
1-15 EPAICC hosp bleach
wipe for Contact CD and
Enteric Precautions
16 EPAICC hosp quat
para see cleaning
instructions provided by
Clinical Engineering
below
apply sani-strip see
notes below
8 Step
Discharge
cleaning process
CLEANING CHART FOR ENVIRONMENTAL AND
NURSING SERVICES
Dumigan DG et al AJIC 200938387
EQUIPMENT TAG
Method Advantages Disadvantages
Visual inspection Simple Not reliable measure
of cleanliness
Fluorescent
marker system
Inexpensive
Minimal equipment
needed
Can improve practices
Must mark surfaces
before cleaning and
check them after
cleaning
Aerobic colony
counts
Relatively simple
Detects presence of
pathogens
More expensive
Results not available
for 48 hrs later
ATP
bioluminescence
assay systems
Provides quantitative
measure of cleanliness
Quick results
Can improve practices
More expensive
Requires special
equipment
ACT TO CONTINUE TO IMPROVE PROCESS
Methods for Assessing Cleaning Practices
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
Fluorescent Marker System
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
MEDIAN RELATIVE LIGHT UNIT (RLU) READINGS
AFTER DAILY CLEANING PHASES I
0
100
200
300
400
500
600
700
800
Bedrail OverbedTable
TVRemote
Grab bar ToiletSeat
Re
lati
ve
Lig
ht
Un
its
Phase I
Boyce JM et al ICHE 200930678
ORGANIZE A TEAM THAT KNOWS THE PROCESS
Facilitator - IP- Manage logistics keep team on task
Chair - Hospital Epidemiologist Chief Medical or Nursing
Officer CEO CFO-Someone with AUTHORITY to make
change
Directors of departments that will be affected by change
Frontline workers that know the problems and how the
system ldquoreallyrdquo works ldquothe tip of the spearrdquo
Caveat Diversify donrsquot be afraid of complainers you will
learn the most about yourself as a leader from them
A FEW WORDS ABOUT
PLANNING EFFECTIVE MEETINGS
Who will do what Pre-plan so roles are clear
IP as facilitator
Set goals and communicate clearly
Get agreement from team on frequency of meetings
Weekly or bi-weekly to start
Use sub-committees for effective time management
Get commitment from sub-committee chairs
Plan agendas
Assign speakers
Assign time for each topic (and a timekeeper)
HOUSEKEEPING TEAM
CLARIFY CURRENT KNOWLEDGE OF THE PROCESS
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
QUALITY TOOL 2
CHOSE A QUALITY IMPROVEMENT MODELISHIKAWA DIAGRAM CAUSE AND EFFECT DIAGRAM FISHBONE DIAGRAM
CHOSE A QUALITY IMPROVEMENT MODEL
AFFINITY DIAGRAM QUALITY TOOL 3
UNDERSTAND SOURCES OF PROCESS VARIATION
Easy to use
Handout post-it notes
Everybody gets to participate
Done in silence
Take about 15 minutes to write out each concern One concern per post-it note
Sort and group concerns
Get agreement from group they are sorted correctly
Vote on most important concerns to work on first
Who cleans
what
What gets
cleaned
what product
will be used
How much time
will be allowed for
cleaning
How will everyone
be trained in
process
How will we
know if
equipment is
clean or soiled
bull Is it nursing
or EVS
bull What about
pumps and
special
equipment
bull What if pt
doesnrsquot want
us to touch
their bedside
equipment
bull What about
the OR
bull Do we make our
own solutions
bull How often are
mops changes
bull When do we use
bleach
bull Can we use
bleach wipes
bull How many
wipes or rags do
we use
bull Where in room
do we start
cleaning
bull We donrsquot have
enough time to
clean now
bull We donrsquot have
enough staff
bull Do we change
curtains When do
we change them
Will we be given
enough time
bull How will managers
allow extra time if
needed
bull How will everyone
be trained to do
the same thing
bull Where will soiled
ldquorollingrdquo
equipment be
cleaned
bull How will we
know if
equipment is
clean or soiled
bull How will our
cleaning be
rated
bull Will we be fired
SELECT THE PROCESS IMPROVEMENTS
EXPANDED TEAM
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
Biomedical Engineers
Pharmacist (Manager of Infusion Pumps)
Materials Management Personnel
OR Personnel
TYPE OF
CLEANING
RESPONSIBLE
SERVICE
ITEMS TO BE CLEANED PRODUCTS USED TO
CLEAN
COMMENTS
ROUTINE DAILY
CLEANING OF
PATIENT ROOM
Environmental
Services
1dust window ledge
2spot clean furniture (chairs)
3wipe down over-bed table
4wipe down side rails
5wipe down TV control
6wipe down bathroom fixtures (faucets grab bar
shelf etc)
7clean sink and toilet
8wipe down door handles (room and bathroom)
9mop bathroom and patient floor
10remove trash
1 ndash 9 EPAICC hosp quat
or
1 - 8 EPAICC hosp
bleach wipe for Contact
CD and Enteric
Precautions
9 EPAICC hosp quat
8 Step daily
cleaning process
TRANSFER
DISCHARGE
CLEANING OF
PATIENT
ROOM AND
ANY PATIENT
ROOM AT
NURSErsquoS
REQUEST
(WHEN ROOM
IS EMPTY)
Environmental
Services
1clean bed frame side rails mattress (after nursing
has stripped bed of all linen)
2clean bedside table over bed table phone call bell
TV control
3wipe down flow meters
4wipe down regulators
5dustclean lighting fixtures
6clean outside canister (clean) of suction container
7clean and wipe down IV poles and pumps that need
to remain on the unit apply sani-strip para
8wipe down furniture
9dust all ledges
10clean around sharps containers and glove boxes
11wipe down step stools
12wipe down walkers
13wipe down canes
14clean bedside commode (once emptied by
nursing) apply sani-strip
15clean bathroom fixtures sink shower and toilet
apply sani-strip
16mop bathroom and patient floor
17pull trash
18change out privacy curtains if soiled or on request
1 - 16 EPAICC hosp
quat
or
1-15 EPAICC hosp bleach
wipe for Contact CD and
Enteric Precautions
16 EPAICC hosp quat
para see cleaning
instructions provided by
Clinical Engineering
below
apply sani-strip see
notes below
8 Step
Discharge
cleaning process
CLEANING CHART FOR ENVIRONMENTAL AND
NURSING SERVICES
Dumigan DG et al AJIC 200938387
EQUIPMENT TAG
Method Advantages Disadvantages
Visual inspection Simple Not reliable measure
of cleanliness
Fluorescent
marker system
Inexpensive
Minimal equipment
needed
Can improve practices
Must mark surfaces
before cleaning and
check them after
cleaning
Aerobic colony
counts
Relatively simple
Detects presence of
pathogens
More expensive
Results not available
for 48 hrs later
ATP
bioluminescence
assay systems
Provides quantitative
measure of cleanliness
Quick results
Can improve practices
More expensive
Requires special
equipment
ACT TO CONTINUE TO IMPROVE PROCESS
Methods for Assessing Cleaning Practices
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
Fluorescent Marker System
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
ORGANIZE A TEAM THAT KNOWS THE PROCESS
Facilitator - IP- Manage logistics keep team on task
Chair - Hospital Epidemiologist Chief Medical or Nursing
Officer CEO CFO-Someone with AUTHORITY to make
change
Directors of departments that will be affected by change
Frontline workers that know the problems and how the
system ldquoreallyrdquo works ldquothe tip of the spearrdquo
Caveat Diversify donrsquot be afraid of complainers you will
learn the most about yourself as a leader from them
A FEW WORDS ABOUT
PLANNING EFFECTIVE MEETINGS
Who will do what Pre-plan so roles are clear
IP as facilitator
Set goals and communicate clearly
Get agreement from team on frequency of meetings
Weekly or bi-weekly to start
Use sub-committees for effective time management
Get commitment from sub-committee chairs
Plan agendas
Assign speakers
Assign time for each topic (and a timekeeper)
HOUSEKEEPING TEAM
CLARIFY CURRENT KNOWLEDGE OF THE PROCESS
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
QUALITY TOOL 2
CHOSE A QUALITY IMPROVEMENT MODELISHIKAWA DIAGRAM CAUSE AND EFFECT DIAGRAM FISHBONE DIAGRAM
CHOSE A QUALITY IMPROVEMENT MODEL
AFFINITY DIAGRAM QUALITY TOOL 3
UNDERSTAND SOURCES OF PROCESS VARIATION
Easy to use
Handout post-it notes
Everybody gets to participate
Done in silence
Take about 15 minutes to write out each concern One concern per post-it note
Sort and group concerns
Get agreement from group they are sorted correctly
Vote on most important concerns to work on first
Who cleans
what
What gets
cleaned
what product
will be used
How much time
will be allowed for
cleaning
How will everyone
be trained in
process
How will we
know if
equipment is
clean or soiled
bull Is it nursing
or EVS
bull What about
pumps and
special
equipment
bull What if pt
doesnrsquot want
us to touch
their bedside
equipment
bull What about
the OR
bull Do we make our
own solutions
bull How often are
mops changes
bull When do we use
bleach
bull Can we use
bleach wipes
bull How many
wipes or rags do
we use
bull Where in room
do we start
cleaning
bull We donrsquot have
enough time to
clean now
bull We donrsquot have
enough staff
bull Do we change
curtains When do
we change them
Will we be given
enough time
bull How will managers
allow extra time if
needed
bull How will everyone
be trained to do
the same thing
bull Where will soiled
ldquorollingrdquo
equipment be
cleaned
bull How will we
know if
equipment is
clean or soiled
bull How will our
cleaning be
rated
bull Will we be fired
SELECT THE PROCESS IMPROVEMENTS
EXPANDED TEAM
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
Biomedical Engineers
Pharmacist (Manager of Infusion Pumps)
Materials Management Personnel
OR Personnel
TYPE OF
CLEANING
RESPONSIBLE
SERVICE
ITEMS TO BE CLEANED PRODUCTS USED TO
CLEAN
COMMENTS
ROUTINE DAILY
CLEANING OF
PATIENT ROOM
Environmental
Services
1dust window ledge
2spot clean furniture (chairs)
3wipe down over-bed table
4wipe down side rails
5wipe down TV control
6wipe down bathroom fixtures (faucets grab bar
shelf etc)
7clean sink and toilet
8wipe down door handles (room and bathroom)
9mop bathroom and patient floor
10remove trash
1 ndash 9 EPAICC hosp quat
or
1 - 8 EPAICC hosp
bleach wipe for Contact
CD and Enteric
Precautions
9 EPAICC hosp quat
8 Step daily
cleaning process
TRANSFER
DISCHARGE
CLEANING OF
PATIENT
ROOM AND
ANY PATIENT
ROOM AT
NURSErsquoS
REQUEST
(WHEN ROOM
IS EMPTY)
Environmental
Services
1clean bed frame side rails mattress (after nursing
has stripped bed of all linen)
2clean bedside table over bed table phone call bell
TV control
3wipe down flow meters
4wipe down regulators
5dustclean lighting fixtures
6clean outside canister (clean) of suction container
7clean and wipe down IV poles and pumps that need
to remain on the unit apply sani-strip para
8wipe down furniture
9dust all ledges
10clean around sharps containers and glove boxes
11wipe down step stools
12wipe down walkers
13wipe down canes
14clean bedside commode (once emptied by
nursing) apply sani-strip
15clean bathroom fixtures sink shower and toilet
apply sani-strip
16mop bathroom and patient floor
17pull trash
18change out privacy curtains if soiled or on request
1 - 16 EPAICC hosp
quat
or
1-15 EPAICC hosp bleach
wipe for Contact CD and
Enteric Precautions
16 EPAICC hosp quat
para see cleaning
instructions provided by
Clinical Engineering
below
apply sani-strip see
notes below
8 Step
Discharge
cleaning process
CLEANING CHART FOR ENVIRONMENTAL AND
NURSING SERVICES
Dumigan DG et al AJIC 200938387
EQUIPMENT TAG
Method Advantages Disadvantages
Visual inspection Simple Not reliable measure
of cleanliness
Fluorescent
marker system
Inexpensive
Minimal equipment
needed
Can improve practices
Must mark surfaces
before cleaning and
check them after
cleaning
Aerobic colony
counts
Relatively simple
Detects presence of
pathogens
More expensive
Results not available
for 48 hrs later
ATP
bioluminescence
assay systems
Provides quantitative
measure of cleanliness
Quick results
Can improve practices
More expensive
Requires special
equipment
ACT TO CONTINUE TO IMPROVE PROCESS
Methods for Assessing Cleaning Practices
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
Fluorescent Marker System
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
A FEW WORDS ABOUT
PLANNING EFFECTIVE MEETINGS
Who will do what Pre-plan so roles are clear
IP as facilitator
Set goals and communicate clearly
Get agreement from team on frequency of meetings
Weekly or bi-weekly to start
Use sub-committees for effective time management
Get commitment from sub-committee chairs
Plan agendas
Assign speakers
Assign time for each topic (and a timekeeper)
HOUSEKEEPING TEAM
CLARIFY CURRENT KNOWLEDGE OF THE PROCESS
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
QUALITY TOOL 2
CHOSE A QUALITY IMPROVEMENT MODELISHIKAWA DIAGRAM CAUSE AND EFFECT DIAGRAM FISHBONE DIAGRAM
CHOSE A QUALITY IMPROVEMENT MODEL
AFFINITY DIAGRAM QUALITY TOOL 3
UNDERSTAND SOURCES OF PROCESS VARIATION
Easy to use
Handout post-it notes
Everybody gets to participate
Done in silence
Take about 15 minutes to write out each concern One concern per post-it note
Sort and group concerns
Get agreement from group they are sorted correctly
Vote on most important concerns to work on first
Who cleans
what
What gets
cleaned
what product
will be used
How much time
will be allowed for
cleaning
How will everyone
be trained in
process
How will we
know if
equipment is
clean or soiled
bull Is it nursing
or EVS
bull What about
pumps and
special
equipment
bull What if pt
doesnrsquot want
us to touch
their bedside
equipment
bull What about
the OR
bull Do we make our
own solutions
bull How often are
mops changes
bull When do we use
bleach
bull Can we use
bleach wipes
bull How many
wipes or rags do
we use
bull Where in room
do we start
cleaning
bull We donrsquot have
enough time to
clean now
bull We donrsquot have
enough staff
bull Do we change
curtains When do
we change them
Will we be given
enough time
bull How will managers
allow extra time if
needed
bull How will everyone
be trained to do
the same thing
bull Where will soiled
ldquorollingrdquo
equipment be
cleaned
bull How will we
know if
equipment is
clean or soiled
bull How will our
cleaning be
rated
bull Will we be fired
SELECT THE PROCESS IMPROVEMENTS
EXPANDED TEAM
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
Biomedical Engineers
Pharmacist (Manager of Infusion Pumps)
Materials Management Personnel
OR Personnel
TYPE OF
CLEANING
RESPONSIBLE
SERVICE
ITEMS TO BE CLEANED PRODUCTS USED TO
CLEAN
COMMENTS
ROUTINE DAILY
CLEANING OF
PATIENT ROOM
Environmental
Services
1dust window ledge
2spot clean furniture (chairs)
3wipe down over-bed table
4wipe down side rails
5wipe down TV control
6wipe down bathroom fixtures (faucets grab bar
shelf etc)
7clean sink and toilet
8wipe down door handles (room and bathroom)
9mop bathroom and patient floor
10remove trash
1 ndash 9 EPAICC hosp quat
or
1 - 8 EPAICC hosp
bleach wipe for Contact
CD and Enteric
Precautions
9 EPAICC hosp quat
8 Step daily
cleaning process
TRANSFER
DISCHARGE
CLEANING OF
PATIENT
ROOM AND
ANY PATIENT
ROOM AT
NURSErsquoS
REQUEST
(WHEN ROOM
IS EMPTY)
Environmental
Services
1clean bed frame side rails mattress (after nursing
has stripped bed of all linen)
2clean bedside table over bed table phone call bell
TV control
3wipe down flow meters
4wipe down regulators
5dustclean lighting fixtures
6clean outside canister (clean) of suction container
7clean and wipe down IV poles and pumps that need
to remain on the unit apply sani-strip para
8wipe down furniture
9dust all ledges
10clean around sharps containers and glove boxes
11wipe down step stools
12wipe down walkers
13wipe down canes
14clean bedside commode (once emptied by
nursing) apply sani-strip
15clean bathroom fixtures sink shower and toilet
apply sani-strip
16mop bathroom and patient floor
17pull trash
18change out privacy curtains if soiled or on request
1 - 16 EPAICC hosp
quat
or
1-15 EPAICC hosp bleach
wipe for Contact CD and
Enteric Precautions
16 EPAICC hosp quat
para see cleaning
instructions provided by
Clinical Engineering
below
apply sani-strip see
notes below
8 Step
Discharge
cleaning process
CLEANING CHART FOR ENVIRONMENTAL AND
NURSING SERVICES
Dumigan DG et al AJIC 200938387
EQUIPMENT TAG
Method Advantages Disadvantages
Visual inspection Simple Not reliable measure
of cleanliness
Fluorescent
marker system
Inexpensive
Minimal equipment
needed
Can improve practices
Must mark surfaces
before cleaning and
check them after
cleaning
Aerobic colony
counts
Relatively simple
Detects presence of
pathogens
More expensive
Results not available
for 48 hrs later
ATP
bioluminescence
assay systems
Provides quantitative
measure of cleanliness
Quick results
Can improve practices
More expensive
Requires special
equipment
ACT TO CONTINUE TO IMPROVE PROCESS
Methods for Assessing Cleaning Practices
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
Fluorescent Marker System
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
HOUSEKEEPING TEAM
CLARIFY CURRENT KNOWLEDGE OF THE PROCESS
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
QUALITY TOOL 2
CHOSE A QUALITY IMPROVEMENT MODELISHIKAWA DIAGRAM CAUSE AND EFFECT DIAGRAM FISHBONE DIAGRAM
CHOSE A QUALITY IMPROVEMENT MODEL
AFFINITY DIAGRAM QUALITY TOOL 3
UNDERSTAND SOURCES OF PROCESS VARIATION
Easy to use
Handout post-it notes
Everybody gets to participate
Done in silence
Take about 15 minutes to write out each concern One concern per post-it note
Sort and group concerns
Get agreement from group they are sorted correctly
Vote on most important concerns to work on first
Who cleans
what
What gets
cleaned
what product
will be used
How much time
will be allowed for
cleaning
How will everyone
be trained in
process
How will we
know if
equipment is
clean or soiled
bull Is it nursing
or EVS
bull What about
pumps and
special
equipment
bull What if pt
doesnrsquot want
us to touch
their bedside
equipment
bull What about
the OR
bull Do we make our
own solutions
bull How often are
mops changes
bull When do we use
bleach
bull Can we use
bleach wipes
bull How many
wipes or rags do
we use
bull Where in room
do we start
cleaning
bull We donrsquot have
enough time to
clean now
bull We donrsquot have
enough staff
bull Do we change
curtains When do
we change them
Will we be given
enough time
bull How will managers
allow extra time if
needed
bull How will everyone
be trained to do
the same thing
bull Where will soiled
ldquorollingrdquo
equipment be
cleaned
bull How will we
know if
equipment is
clean or soiled
bull How will our
cleaning be
rated
bull Will we be fired
SELECT THE PROCESS IMPROVEMENTS
EXPANDED TEAM
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
Biomedical Engineers
Pharmacist (Manager of Infusion Pumps)
Materials Management Personnel
OR Personnel
TYPE OF
CLEANING
RESPONSIBLE
SERVICE
ITEMS TO BE CLEANED PRODUCTS USED TO
CLEAN
COMMENTS
ROUTINE DAILY
CLEANING OF
PATIENT ROOM
Environmental
Services
1dust window ledge
2spot clean furniture (chairs)
3wipe down over-bed table
4wipe down side rails
5wipe down TV control
6wipe down bathroom fixtures (faucets grab bar
shelf etc)
7clean sink and toilet
8wipe down door handles (room and bathroom)
9mop bathroom and patient floor
10remove trash
1 ndash 9 EPAICC hosp quat
or
1 - 8 EPAICC hosp
bleach wipe for Contact
CD and Enteric
Precautions
9 EPAICC hosp quat
8 Step daily
cleaning process
TRANSFER
DISCHARGE
CLEANING OF
PATIENT
ROOM AND
ANY PATIENT
ROOM AT
NURSErsquoS
REQUEST
(WHEN ROOM
IS EMPTY)
Environmental
Services
1clean bed frame side rails mattress (after nursing
has stripped bed of all linen)
2clean bedside table over bed table phone call bell
TV control
3wipe down flow meters
4wipe down regulators
5dustclean lighting fixtures
6clean outside canister (clean) of suction container
7clean and wipe down IV poles and pumps that need
to remain on the unit apply sani-strip para
8wipe down furniture
9dust all ledges
10clean around sharps containers and glove boxes
11wipe down step stools
12wipe down walkers
13wipe down canes
14clean bedside commode (once emptied by
nursing) apply sani-strip
15clean bathroom fixtures sink shower and toilet
apply sani-strip
16mop bathroom and patient floor
17pull trash
18change out privacy curtains if soiled or on request
1 - 16 EPAICC hosp
quat
or
1-15 EPAICC hosp bleach
wipe for Contact CD and
Enteric Precautions
16 EPAICC hosp quat
para see cleaning
instructions provided by
Clinical Engineering
below
apply sani-strip see
notes below
8 Step
Discharge
cleaning process
CLEANING CHART FOR ENVIRONMENTAL AND
NURSING SERVICES
Dumigan DG et al AJIC 200938387
EQUIPMENT TAG
Method Advantages Disadvantages
Visual inspection Simple Not reliable measure
of cleanliness
Fluorescent
marker system
Inexpensive
Minimal equipment
needed
Can improve practices
Must mark surfaces
before cleaning and
check them after
cleaning
Aerobic colony
counts
Relatively simple
Detects presence of
pathogens
More expensive
Results not available
for 48 hrs later
ATP
bioluminescence
assay systems
Provides quantitative
measure of cleanliness
Quick results
Can improve practices
More expensive
Requires special
equipment
ACT TO CONTINUE TO IMPROVE PROCESS
Methods for Assessing Cleaning Practices
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
Fluorescent Marker System
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
QUALITY TOOL 2
CHOSE A QUALITY IMPROVEMENT MODELISHIKAWA DIAGRAM CAUSE AND EFFECT DIAGRAM FISHBONE DIAGRAM
CHOSE A QUALITY IMPROVEMENT MODEL
AFFINITY DIAGRAM QUALITY TOOL 3
UNDERSTAND SOURCES OF PROCESS VARIATION
Easy to use
Handout post-it notes
Everybody gets to participate
Done in silence
Take about 15 minutes to write out each concern One concern per post-it note
Sort and group concerns
Get agreement from group they are sorted correctly
Vote on most important concerns to work on first
Who cleans
what
What gets
cleaned
what product
will be used
How much time
will be allowed for
cleaning
How will everyone
be trained in
process
How will we
know if
equipment is
clean or soiled
bull Is it nursing
or EVS
bull What about
pumps and
special
equipment
bull What if pt
doesnrsquot want
us to touch
their bedside
equipment
bull What about
the OR
bull Do we make our
own solutions
bull How often are
mops changes
bull When do we use
bleach
bull Can we use
bleach wipes
bull How many
wipes or rags do
we use
bull Where in room
do we start
cleaning
bull We donrsquot have
enough time to
clean now
bull We donrsquot have
enough staff
bull Do we change
curtains When do
we change them
Will we be given
enough time
bull How will managers
allow extra time if
needed
bull How will everyone
be trained to do
the same thing
bull Where will soiled
ldquorollingrdquo
equipment be
cleaned
bull How will we
know if
equipment is
clean or soiled
bull How will our
cleaning be
rated
bull Will we be fired
SELECT THE PROCESS IMPROVEMENTS
EXPANDED TEAM
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
Biomedical Engineers
Pharmacist (Manager of Infusion Pumps)
Materials Management Personnel
OR Personnel
TYPE OF
CLEANING
RESPONSIBLE
SERVICE
ITEMS TO BE CLEANED PRODUCTS USED TO
CLEAN
COMMENTS
ROUTINE DAILY
CLEANING OF
PATIENT ROOM
Environmental
Services
1dust window ledge
2spot clean furniture (chairs)
3wipe down over-bed table
4wipe down side rails
5wipe down TV control
6wipe down bathroom fixtures (faucets grab bar
shelf etc)
7clean sink and toilet
8wipe down door handles (room and bathroom)
9mop bathroom and patient floor
10remove trash
1 ndash 9 EPAICC hosp quat
or
1 - 8 EPAICC hosp
bleach wipe for Contact
CD and Enteric
Precautions
9 EPAICC hosp quat
8 Step daily
cleaning process
TRANSFER
DISCHARGE
CLEANING OF
PATIENT
ROOM AND
ANY PATIENT
ROOM AT
NURSErsquoS
REQUEST
(WHEN ROOM
IS EMPTY)
Environmental
Services
1clean bed frame side rails mattress (after nursing
has stripped bed of all linen)
2clean bedside table over bed table phone call bell
TV control
3wipe down flow meters
4wipe down regulators
5dustclean lighting fixtures
6clean outside canister (clean) of suction container
7clean and wipe down IV poles and pumps that need
to remain on the unit apply sani-strip para
8wipe down furniture
9dust all ledges
10clean around sharps containers and glove boxes
11wipe down step stools
12wipe down walkers
13wipe down canes
14clean bedside commode (once emptied by
nursing) apply sani-strip
15clean bathroom fixtures sink shower and toilet
apply sani-strip
16mop bathroom and patient floor
17pull trash
18change out privacy curtains if soiled or on request
1 - 16 EPAICC hosp
quat
or
1-15 EPAICC hosp bleach
wipe for Contact CD and
Enteric Precautions
16 EPAICC hosp quat
para see cleaning
instructions provided by
Clinical Engineering
below
apply sani-strip see
notes below
8 Step
Discharge
cleaning process
CLEANING CHART FOR ENVIRONMENTAL AND
NURSING SERVICES
Dumigan DG et al AJIC 200938387
EQUIPMENT TAG
Method Advantages Disadvantages
Visual inspection Simple Not reliable measure
of cleanliness
Fluorescent
marker system
Inexpensive
Minimal equipment
needed
Can improve practices
Must mark surfaces
before cleaning and
check them after
cleaning
Aerobic colony
counts
Relatively simple
Detects presence of
pathogens
More expensive
Results not available
for 48 hrs later
ATP
bioluminescence
assay systems
Provides quantitative
measure of cleanliness
Quick results
Can improve practices
More expensive
Requires special
equipment
ACT TO CONTINUE TO IMPROVE PROCESS
Methods for Assessing Cleaning Practices
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
Fluorescent Marker System
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
CHOSE A QUALITY IMPROVEMENT MODEL
AFFINITY DIAGRAM QUALITY TOOL 3
UNDERSTAND SOURCES OF PROCESS VARIATION
Easy to use
Handout post-it notes
Everybody gets to participate
Done in silence
Take about 15 minutes to write out each concern One concern per post-it note
Sort and group concerns
Get agreement from group they are sorted correctly
Vote on most important concerns to work on first
Who cleans
what
What gets
cleaned
what product
will be used
How much time
will be allowed for
cleaning
How will everyone
be trained in
process
How will we
know if
equipment is
clean or soiled
bull Is it nursing
or EVS
bull What about
pumps and
special
equipment
bull What if pt
doesnrsquot want
us to touch
their bedside
equipment
bull What about
the OR
bull Do we make our
own solutions
bull How often are
mops changes
bull When do we use
bleach
bull Can we use
bleach wipes
bull How many
wipes or rags do
we use
bull Where in room
do we start
cleaning
bull We donrsquot have
enough time to
clean now
bull We donrsquot have
enough staff
bull Do we change
curtains When do
we change them
Will we be given
enough time
bull How will managers
allow extra time if
needed
bull How will everyone
be trained to do
the same thing
bull Where will soiled
ldquorollingrdquo
equipment be
cleaned
bull How will we
know if
equipment is
clean or soiled
bull How will our
cleaning be
rated
bull Will we be fired
SELECT THE PROCESS IMPROVEMENTS
EXPANDED TEAM
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
Biomedical Engineers
Pharmacist (Manager of Infusion Pumps)
Materials Management Personnel
OR Personnel
TYPE OF
CLEANING
RESPONSIBLE
SERVICE
ITEMS TO BE CLEANED PRODUCTS USED TO
CLEAN
COMMENTS
ROUTINE DAILY
CLEANING OF
PATIENT ROOM
Environmental
Services
1dust window ledge
2spot clean furniture (chairs)
3wipe down over-bed table
4wipe down side rails
5wipe down TV control
6wipe down bathroom fixtures (faucets grab bar
shelf etc)
7clean sink and toilet
8wipe down door handles (room and bathroom)
9mop bathroom and patient floor
10remove trash
1 ndash 9 EPAICC hosp quat
or
1 - 8 EPAICC hosp
bleach wipe for Contact
CD and Enteric
Precautions
9 EPAICC hosp quat
8 Step daily
cleaning process
TRANSFER
DISCHARGE
CLEANING OF
PATIENT
ROOM AND
ANY PATIENT
ROOM AT
NURSErsquoS
REQUEST
(WHEN ROOM
IS EMPTY)
Environmental
Services
1clean bed frame side rails mattress (after nursing
has stripped bed of all linen)
2clean bedside table over bed table phone call bell
TV control
3wipe down flow meters
4wipe down regulators
5dustclean lighting fixtures
6clean outside canister (clean) of suction container
7clean and wipe down IV poles and pumps that need
to remain on the unit apply sani-strip para
8wipe down furniture
9dust all ledges
10clean around sharps containers and glove boxes
11wipe down step stools
12wipe down walkers
13wipe down canes
14clean bedside commode (once emptied by
nursing) apply sani-strip
15clean bathroom fixtures sink shower and toilet
apply sani-strip
16mop bathroom and patient floor
17pull trash
18change out privacy curtains if soiled or on request
1 - 16 EPAICC hosp
quat
or
1-15 EPAICC hosp bleach
wipe for Contact CD and
Enteric Precautions
16 EPAICC hosp quat
para see cleaning
instructions provided by
Clinical Engineering
below
apply sani-strip see
notes below
8 Step
Discharge
cleaning process
CLEANING CHART FOR ENVIRONMENTAL AND
NURSING SERVICES
Dumigan DG et al AJIC 200938387
EQUIPMENT TAG
Method Advantages Disadvantages
Visual inspection Simple Not reliable measure
of cleanliness
Fluorescent
marker system
Inexpensive
Minimal equipment
needed
Can improve practices
Must mark surfaces
before cleaning and
check them after
cleaning
Aerobic colony
counts
Relatively simple
Detects presence of
pathogens
More expensive
Results not available
for 48 hrs later
ATP
bioluminescence
assay systems
Provides quantitative
measure of cleanliness
Quick results
Can improve practices
More expensive
Requires special
equipment
ACT TO CONTINUE TO IMPROVE PROCESS
Methods for Assessing Cleaning Practices
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
Fluorescent Marker System
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
AFFINITY DIAGRAM QUALITY TOOL 3
UNDERSTAND SOURCES OF PROCESS VARIATION
Easy to use
Handout post-it notes
Everybody gets to participate
Done in silence
Take about 15 minutes to write out each concern One concern per post-it note
Sort and group concerns
Get agreement from group they are sorted correctly
Vote on most important concerns to work on first
Who cleans
what
What gets
cleaned
what product
will be used
How much time
will be allowed for
cleaning
How will everyone
be trained in
process
How will we
know if
equipment is
clean or soiled
bull Is it nursing
or EVS
bull What about
pumps and
special
equipment
bull What if pt
doesnrsquot want
us to touch
their bedside
equipment
bull What about
the OR
bull Do we make our
own solutions
bull How often are
mops changes
bull When do we use
bleach
bull Can we use
bleach wipes
bull How many
wipes or rags do
we use
bull Where in room
do we start
cleaning
bull We donrsquot have
enough time to
clean now
bull We donrsquot have
enough staff
bull Do we change
curtains When do
we change them
Will we be given
enough time
bull How will managers
allow extra time if
needed
bull How will everyone
be trained to do
the same thing
bull Where will soiled
ldquorollingrdquo
equipment be
cleaned
bull How will we
know if
equipment is
clean or soiled
bull How will our
cleaning be
rated
bull Will we be fired
SELECT THE PROCESS IMPROVEMENTS
EXPANDED TEAM
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
Biomedical Engineers
Pharmacist (Manager of Infusion Pumps)
Materials Management Personnel
OR Personnel
TYPE OF
CLEANING
RESPONSIBLE
SERVICE
ITEMS TO BE CLEANED PRODUCTS USED TO
CLEAN
COMMENTS
ROUTINE DAILY
CLEANING OF
PATIENT ROOM
Environmental
Services
1dust window ledge
2spot clean furniture (chairs)
3wipe down over-bed table
4wipe down side rails
5wipe down TV control
6wipe down bathroom fixtures (faucets grab bar
shelf etc)
7clean sink and toilet
8wipe down door handles (room and bathroom)
9mop bathroom and patient floor
10remove trash
1 ndash 9 EPAICC hosp quat
or
1 - 8 EPAICC hosp
bleach wipe for Contact
CD and Enteric
Precautions
9 EPAICC hosp quat
8 Step daily
cleaning process
TRANSFER
DISCHARGE
CLEANING OF
PATIENT
ROOM AND
ANY PATIENT
ROOM AT
NURSErsquoS
REQUEST
(WHEN ROOM
IS EMPTY)
Environmental
Services
1clean bed frame side rails mattress (after nursing
has stripped bed of all linen)
2clean bedside table over bed table phone call bell
TV control
3wipe down flow meters
4wipe down regulators
5dustclean lighting fixtures
6clean outside canister (clean) of suction container
7clean and wipe down IV poles and pumps that need
to remain on the unit apply sani-strip para
8wipe down furniture
9dust all ledges
10clean around sharps containers and glove boxes
11wipe down step stools
12wipe down walkers
13wipe down canes
14clean bedside commode (once emptied by
nursing) apply sani-strip
15clean bathroom fixtures sink shower and toilet
apply sani-strip
16mop bathroom and patient floor
17pull trash
18change out privacy curtains if soiled or on request
1 - 16 EPAICC hosp
quat
or
1-15 EPAICC hosp bleach
wipe for Contact CD and
Enteric Precautions
16 EPAICC hosp quat
para see cleaning
instructions provided by
Clinical Engineering
below
apply sani-strip see
notes below
8 Step
Discharge
cleaning process
CLEANING CHART FOR ENVIRONMENTAL AND
NURSING SERVICES
Dumigan DG et al AJIC 200938387
EQUIPMENT TAG
Method Advantages Disadvantages
Visual inspection Simple Not reliable measure
of cleanliness
Fluorescent
marker system
Inexpensive
Minimal equipment
needed
Can improve practices
Must mark surfaces
before cleaning and
check them after
cleaning
Aerobic colony
counts
Relatively simple
Detects presence of
pathogens
More expensive
Results not available
for 48 hrs later
ATP
bioluminescence
assay systems
Provides quantitative
measure of cleanliness
Quick results
Can improve practices
More expensive
Requires special
equipment
ACT TO CONTINUE TO IMPROVE PROCESS
Methods for Assessing Cleaning Practices
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
Fluorescent Marker System
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
Who cleans
what
What gets
cleaned
what product
will be used
How much time
will be allowed for
cleaning
How will everyone
be trained in
process
How will we
know if
equipment is
clean or soiled
bull Is it nursing
or EVS
bull What about
pumps and
special
equipment
bull What if pt
doesnrsquot want
us to touch
their bedside
equipment
bull What about
the OR
bull Do we make our
own solutions
bull How often are
mops changes
bull When do we use
bleach
bull Can we use
bleach wipes
bull How many
wipes or rags do
we use
bull Where in room
do we start
cleaning
bull We donrsquot have
enough time to
clean now
bull We donrsquot have
enough staff
bull Do we change
curtains When do
we change them
Will we be given
enough time
bull How will managers
allow extra time if
needed
bull How will everyone
be trained to do
the same thing
bull Where will soiled
ldquorollingrdquo
equipment be
cleaned
bull How will we
know if
equipment is
clean or soiled
bull How will our
cleaning be
rated
bull Will we be fired
SELECT THE PROCESS IMPROVEMENTS
EXPANDED TEAM
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
Biomedical Engineers
Pharmacist (Manager of Infusion Pumps)
Materials Management Personnel
OR Personnel
TYPE OF
CLEANING
RESPONSIBLE
SERVICE
ITEMS TO BE CLEANED PRODUCTS USED TO
CLEAN
COMMENTS
ROUTINE DAILY
CLEANING OF
PATIENT ROOM
Environmental
Services
1dust window ledge
2spot clean furniture (chairs)
3wipe down over-bed table
4wipe down side rails
5wipe down TV control
6wipe down bathroom fixtures (faucets grab bar
shelf etc)
7clean sink and toilet
8wipe down door handles (room and bathroom)
9mop bathroom and patient floor
10remove trash
1 ndash 9 EPAICC hosp quat
or
1 - 8 EPAICC hosp
bleach wipe for Contact
CD and Enteric
Precautions
9 EPAICC hosp quat
8 Step daily
cleaning process
TRANSFER
DISCHARGE
CLEANING OF
PATIENT
ROOM AND
ANY PATIENT
ROOM AT
NURSErsquoS
REQUEST
(WHEN ROOM
IS EMPTY)
Environmental
Services
1clean bed frame side rails mattress (after nursing
has stripped bed of all linen)
2clean bedside table over bed table phone call bell
TV control
3wipe down flow meters
4wipe down regulators
5dustclean lighting fixtures
6clean outside canister (clean) of suction container
7clean and wipe down IV poles and pumps that need
to remain on the unit apply sani-strip para
8wipe down furniture
9dust all ledges
10clean around sharps containers and glove boxes
11wipe down step stools
12wipe down walkers
13wipe down canes
14clean bedside commode (once emptied by
nursing) apply sani-strip
15clean bathroom fixtures sink shower and toilet
apply sani-strip
16mop bathroom and patient floor
17pull trash
18change out privacy curtains if soiled or on request
1 - 16 EPAICC hosp
quat
or
1-15 EPAICC hosp bleach
wipe for Contact CD and
Enteric Precautions
16 EPAICC hosp quat
para see cleaning
instructions provided by
Clinical Engineering
below
apply sani-strip see
notes below
8 Step
Discharge
cleaning process
CLEANING CHART FOR ENVIRONMENTAL AND
NURSING SERVICES
Dumigan DG et al AJIC 200938387
EQUIPMENT TAG
Method Advantages Disadvantages
Visual inspection Simple Not reliable measure
of cleanliness
Fluorescent
marker system
Inexpensive
Minimal equipment
needed
Can improve practices
Must mark surfaces
before cleaning and
check them after
cleaning
Aerobic colony
counts
Relatively simple
Detects presence of
pathogens
More expensive
Results not available
for 48 hrs later
ATP
bioluminescence
assay systems
Provides quantitative
measure of cleanliness
Quick results
Can improve practices
More expensive
Requires special
equipment
ACT TO CONTINUE TO IMPROVE PROCESS
Methods for Assessing Cleaning Practices
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
Fluorescent Marker System
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
EXPANDED TEAM
Infection Preventionist
Hospital Epidemiologist
Directors of Nursing
Nursing Care Coordinators
Nurse Educators
Director of Environmental Services
Environmental Services Supervisors
Housekeepers
Biomedical Engineers
Pharmacist (Manager of Infusion Pumps)
Materials Management Personnel
OR Personnel
TYPE OF
CLEANING
RESPONSIBLE
SERVICE
ITEMS TO BE CLEANED PRODUCTS USED TO
CLEAN
COMMENTS
ROUTINE DAILY
CLEANING OF
PATIENT ROOM
Environmental
Services
1dust window ledge
2spot clean furniture (chairs)
3wipe down over-bed table
4wipe down side rails
5wipe down TV control
6wipe down bathroom fixtures (faucets grab bar
shelf etc)
7clean sink and toilet
8wipe down door handles (room and bathroom)
9mop bathroom and patient floor
10remove trash
1 ndash 9 EPAICC hosp quat
or
1 - 8 EPAICC hosp
bleach wipe for Contact
CD and Enteric
Precautions
9 EPAICC hosp quat
8 Step daily
cleaning process
TRANSFER
DISCHARGE
CLEANING OF
PATIENT
ROOM AND
ANY PATIENT
ROOM AT
NURSErsquoS
REQUEST
(WHEN ROOM
IS EMPTY)
Environmental
Services
1clean bed frame side rails mattress (after nursing
has stripped bed of all linen)
2clean bedside table over bed table phone call bell
TV control
3wipe down flow meters
4wipe down regulators
5dustclean lighting fixtures
6clean outside canister (clean) of suction container
7clean and wipe down IV poles and pumps that need
to remain on the unit apply sani-strip para
8wipe down furniture
9dust all ledges
10clean around sharps containers and glove boxes
11wipe down step stools
12wipe down walkers
13wipe down canes
14clean bedside commode (once emptied by
nursing) apply sani-strip
15clean bathroom fixtures sink shower and toilet
apply sani-strip
16mop bathroom and patient floor
17pull trash
18change out privacy curtains if soiled or on request
1 - 16 EPAICC hosp
quat
or
1-15 EPAICC hosp bleach
wipe for Contact CD and
Enteric Precautions
16 EPAICC hosp quat
para see cleaning
instructions provided by
Clinical Engineering
below
apply sani-strip see
notes below
8 Step
Discharge
cleaning process
CLEANING CHART FOR ENVIRONMENTAL AND
NURSING SERVICES
Dumigan DG et al AJIC 200938387
EQUIPMENT TAG
Method Advantages Disadvantages
Visual inspection Simple Not reliable measure
of cleanliness
Fluorescent
marker system
Inexpensive
Minimal equipment
needed
Can improve practices
Must mark surfaces
before cleaning and
check them after
cleaning
Aerobic colony
counts
Relatively simple
Detects presence of
pathogens
More expensive
Results not available
for 48 hrs later
ATP
bioluminescence
assay systems
Provides quantitative
measure of cleanliness
Quick results
Can improve practices
More expensive
Requires special
equipment
ACT TO CONTINUE TO IMPROVE PROCESS
Methods for Assessing Cleaning Practices
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
Fluorescent Marker System
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
TYPE OF
CLEANING
RESPONSIBLE
SERVICE
ITEMS TO BE CLEANED PRODUCTS USED TO
CLEAN
COMMENTS
ROUTINE DAILY
CLEANING OF
PATIENT ROOM
Environmental
Services
1dust window ledge
2spot clean furniture (chairs)
3wipe down over-bed table
4wipe down side rails
5wipe down TV control
6wipe down bathroom fixtures (faucets grab bar
shelf etc)
7clean sink and toilet
8wipe down door handles (room and bathroom)
9mop bathroom and patient floor
10remove trash
1 ndash 9 EPAICC hosp quat
or
1 - 8 EPAICC hosp
bleach wipe for Contact
CD and Enteric
Precautions
9 EPAICC hosp quat
8 Step daily
cleaning process
TRANSFER
DISCHARGE
CLEANING OF
PATIENT
ROOM AND
ANY PATIENT
ROOM AT
NURSErsquoS
REQUEST
(WHEN ROOM
IS EMPTY)
Environmental
Services
1clean bed frame side rails mattress (after nursing
has stripped bed of all linen)
2clean bedside table over bed table phone call bell
TV control
3wipe down flow meters
4wipe down regulators
5dustclean lighting fixtures
6clean outside canister (clean) of suction container
7clean and wipe down IV poles and pumps that need
to remain on the unit apply sani-strip para
8wipe down furniture
9dust all ledges
10clean around sharps containers and glove boxes
11wipe down step stools
12wipe down walkers
13wipe down canes
14clean bedside commode (once emptied by
nursing) apply sani-strip
15clean bathroom fixtures sink shower and toilet
apply sani-strip
16mop bathroom and patient floor
17pull trash
18change out privacy curtains if soiled or on request
1 - 16 EPAICC hosp
quat
or
1-15 EPAICC hosp bleach
wipe for Contact CD and
Enteric Precautions
16 EPAICC hosp quat
para see cleaning
instructions provided by
Clinical Engineering
below
apply sani-strip see
notes below
8 Step
Discharge
cleaning process
CLEANING CHART FOR ENVIRONMENTAL AND
NURSING SERVICES
Dumigan DG et al AJIC 200938387
EQUIPMENT TAG
Method Advantages Disadvantages
Visual inspection Simple Not reliable measure
of cleanliness
Fluorescent
marker system
Inexpensive
Minimal equipment
needed
Can improve practices
Must mark surfaces
before cleaning and
check them after
cleaning
Aerobic colony
counts
Relatively simple
Detects presence of
pathogens
More expensive
Results not available
for 48 hrs later
ATP
bioluminescence
assay systems
Provides quantitative
measure of cleanliness
Quick results
Can improve practices
More expensive
Requires special
equipment
ACT TO CONTINUE TO IMPROVE PROCESS
Methods for Assessing Cleaning Practices
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
Fluorescent Marker System
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
EQUIPMENT TAG
Method Advantages Disadvantages
Visual inspection Simple Not reliable measure
of cleanliness
Fluorescent
marker system
Inexpensive
Minimal equipment
needed
Can improve practices
Must mark surfaces
before cleaning and
check them after
cleaning
Aerobic colony
counts
Relatively simple
Detects presence of
pathogens
More expensive
Results not available
for 48 hrs later
ATP
bioluminescence
assay systems
Provides quantitative
measure of cleanliness
Quick results
Can improve practices
More expensive
Requires special
equipment
ACT TO CONTINUE TO IMPROVE PROCESS
Methods for Assessing Cleaning Practices
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
Fluorescent Marker System
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
Method Advantages Disadvantages
Visual inspection Simple Not reliable measure
of cleanliness
Fluorescent
marker system
Inexpensive
Minimal equipment
needed
Can improve practices
Must mark surfaces
before cleaning and
check them after
cleaning
Aerobic colony
counts
Relatively simple
Detects presence of
pathogens
More expensive
Results not available
for 48 hrs later
ATP
bioluminescence
assay systems
Provides quantitative
measure of cleanliness
Quick results
Can improve practices
More expensive
Requires special
equipment
ACT TO CONTINUE TO IMPROVE PROCESS
Methods for Assessing Cleaning Practices
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
Fluorescent Marker System
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
ATP Bioluminescence Method
Step 1 Step 2 Step 3
Use special swab Place swab in reaction tube Place tube in luminometer
to sample surface
Fluorescent Marker System
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
Fluorescent Marker System
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
ACT TO CONTINUE TO IMPROVE PROCESS Median Relative Light Unit (RLU) Readings After Daily
Cleaning Phases I and II
Boyce JM et al ICHE 200930678
P lt 001 lt 0001 02 002 87
0
100
200
300
400
500
600
700
800
Rela
tive L
igh
t U
nit
s
Bedrail Overbed
Table
TV
Remote
Grab bar Toilet
Seat
Phase I Phase II
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
0
50
100
150
200
250
300
350
400
450
500
0 5 10 15 20 25
AT
P R
ea
din
gs (
RL
U)
Samples taken Chronologically
Table
Light
Moniter
Phone
Handle
Surfaces lt 200 RLU are considered clean
OR Manager Vol 27 No 7 July 2011
ACT TO CONTINUE TO IMPROVE PROCESS ATP RLU VALUES OF FIVE HIGH TOUCH SURFACES SAMPLED
OVER THREE MONTHS IN AN OPERATING ROOM
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
MULTIPLIER DIMINISHER
Talent Magnet
Attracts talented people and uses them
at their highest point of contribution
Liberator
Creates an intense environment that
requires peoplersquos best thinking and
work
Challenger
Defines an opportunity that causes
people to stretch
Debate Maker
Drives sound decisions through
rigorous debate
Investor
Gives other people the ownership for
results and invests in their success
Empire Builder
Hoards resources and
underutilizes talent
Tyrant
Creates a tense environment
suppresses peoplersquos thinking and
capability
Know-It-All
Gives directives that showcase
how much they know
Decision Maker
Makes centralized abrupt
decisions that confuse the
organization
Micro-Manager
Drives results through personal
involvement
Wiseman L Multipliers How the best leaders make everyone smarter HarperCollins 2010
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
RESOURCES
Centers for Disease Control and Prevention Guideline for Disinfection and Sterilization Available at
httpswwwcdcgovinfectioncontrolguidelinesdisinfectionindexhtml Accessed July 26 2017
Centers for Disease Control and Prevention Guideline for Environmental Infection Controlvailable at
httpswwwcdcgovinfectioncontrolguidelinesenvironmentalindexhtmle Accessed July 26 2017
Minnesota Hospital Association Environmental Services Cleaning Guidebook Available at
httpwwwmnhospitalsorgPortals0DocumentsptsafetyCDICleaning420Environmental20Services20C
leaning20Guidebookpdf Accessed July 26 2017
Shore Health System University of Maryland Medical System Administrative Policy amp Procedure for Cleaning Environment Patient
Equipment and Medical Devices Sample Policy Available athttpcleanspacessiteapicorgfiles201202Equipment-cleaning-policy-
LDpdf Accessed July 26 2017
Centers for Disease Control and Prevention Options for Evaluating Environmental Cleaning Available at httpswwwcdcgovhaitoolkitsevaluating-environmental-
cleaninghtml Accessed July 26 2017
Guh A Carling P Environmental Evaluation Workgroup Division of Healthcare Quality Promotion National Center for Emerging Zoonotic and Infectious Diseases Options
for evaluating environmental cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnviron-Cleaning-Eval-Toolkit12-2-2010pdf Accessed July 26 2017
Virginia Department of Health Frequently Asked Questions about Cleaning and Disinfection Fact Sheet Available at
httpwwwvdhvirginiagovcontentuploadssites3201603Environmental-Cleaning-Fact-Sheetpdf Accessed July 26 2017
Centers for Disease Control and Prevention Environmental Checklist for Monitoring Terminal Cleaning Available at httpswwwcdcgovhaipdfstoolkitsEnvironmental-
Cleaning-Checklist-10-6-2010pdf Accessed July 26 2017
Agency for Healthcare Research and Quality Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Available at
httpswwweffectivehealthcareahrqgovehcproducts5922103healthcare-infections-report-150810pdf Accessed July 26 2017
Association for Professionals in Infection Control and Epidemiology (APIC) APIC Text cleaning disinfection sterilization Available at
httptextapicorgtocbasic-principles-of-infection-prevention-practicecleaning-disinfection-and-sterilization Accessed July 26 2017
Association of periOperative Registered Nurses (AORN) Recommended practices for environmental cleaning In 2014 perioperative standards and recommended practices
Available at httpwwwaornstandardsorgcontent1SEC18body Accessed July 26 2017
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom
THANK YOU
Diane G Dumigan RN BSN CIC FAPIC
Consultant
DGDumigan Consulting LLC
100 York Street Suite 4C New Haven CT
06511
Cell 203-530-2172
Dgdumiganaolcom
George G Dumigan MS
Vice President of Sales and Marketing
New Haven Consulting Group Inc
1077 Bridgeport Avenue Shelton CT 06484
Office203-926-1525
GdumiganNHCGcom