Researchers found that a novel “education and culture change” program for environmental services workers resulted in behavioral changes and sustained cleaning improvements in five acute-care hospitals in New York City.

The program improved the cleaning of high-touch surfaces in patient rooms and decreased rates of hospital-onset Clostridioides difficile infection (CDI), the researchers reported.

“The patient care environment serves as a reservoir for microorganisms, which may contribute to pathogen transmission and health care-associated infections (HAIs). Studies have shown an increased risk of acquiring multidrug-resistant organisms (MDROs) or Clostridioides difficile during hospitalization if the prior occupant of the hospital room was colonized or infected with these pathogens,” David P. Calfee, MD, MS, infectious disease physician at Weill Cornell Medicine, and colleagues wrote. “Environmental cleaning and disinfection may interrupt this transmission of pathogens, ultimately reducing the risk of HAIs.”

Calfee and colleagues conducted a prospective, quasi-experimental, before-and-after intervention study to test a five-module educational program developed and presented to environmental services workers at two tertiary care academic hospitals, two community hospitals, an academic pediatric hospital and a women’s hospital. The program was titled “Cleaner is Safer — ESW on the Frontline of Infection Prevention.”

“Audience participation and engagement was encouraged by asking participants to answer questions anonymously using an audience response system, role playing, and demonstrations,” Calfee and colleagues explained. “Graphics and videos were used rather than written text, whenever possible, to illustrate ideas and concepts, and local data were provided, when applicable. Medical jargon was avoided. Efforts were made to accommodate the range of [environmental service worker] education levels.”

The topics covered by the program included hand hygiene, isolation precautions, personal protective equipment (PPE), cleaning protocols and strategies to overcome barriers, Calfee and colleagues explained.

An average of 357 environmental service workers participated in each module, the researchers reported. Among them, 93% rated the presentations as “excellent” or “very good,” 95% agreed that they were useful, 91% reported that they were more comfortable donning and doffing PPE, 96% reported being more comfortable performing hand hygiene, and 96% better understood the importance of disinfecting high-touch surfaces after the program, according to Calfee and colleagues.

The researchers found that the cleaning pass rate for high-touch surfaces in occupied patient rooms increased from 26% to 62% in the 3 months after the educational program, including statistically significant improvements in the cleaning of four high-touch areas near the patient: bed rails, call boxes, overbed tables and visitor chairs. Additionally, they reported an 11% decrease in the hospital-onset CDI standard infection ratio associated with the program.

“Overall, the results of this study are encouraging and suggest that an education and culture change intervention designed specifically for frontline [environmental service workers] that addressed locally identified knowledge, attitude, and practice gaps and common barriers to implementation of best practices was well received by participants, resulted in increased knowledge, and was associated with improved daily cleaning of occupied patient rooms,” the authors concluded. – by Caitlyn Stulpin

Disclosures: The authors report no relevant financial disclosures.

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