Daniel GravattCleanliness is a high priority in skilled nursing facilities (SNFs) for many reasons. Foremost is to protect the health of residents and create a pleasant living environment. Other considerations include image and reputation. Residents and their families often base their opinion of a SNF on its cleanliness. If they see dirt, grime, or clutter, or if they smell odors, they may look elsewhere for care.

Infection Prevention New Focus

Proper cleaning and disinfection in the SNF environment have recently become even more important. New Centers for Medicare & Medicaid Services (CMS) reimbursement rates are now based on five case-mix-adjusted components.

Two components, nursing and non-therapy ancillary needs, are included to account for increasing acuity of SNF patients. This may lead SNFs to enhance their levels of care and infection prevention to accommodate these patients, according to CMS.

The new reimbursement guidelines will lead some SNFs to offer care and services for patients who formerly would have been treated in acute-care facilities. With an increasing number of vulnerable patients will come a greater emphasis on housekeeping, specifically infection control.

“The value proposition at skilled nursing facilities may change as CMS reimbursement rules change,” says Ben Madrid, region director, ServiceMaster Clean Albuquerque, whose clients include four SNFs and three hospitals. “You may see more market awareness of infection control, and the financial environment will have something to do with that.”

What's the Difference?

At many SNFs, the term “housekeeping” includes tasks such as floor and surface cleaning, trash removal, and laundry services. These duties are performed by in-house staff, are outsourced to janitorial companies, or some combination of the two. Now, with an increasing need to eliminate infection and airborne irritants, facility managers may consider transitioning to an “environmental services” cleaning model.

Environmental services (EVS) differs from housekeeping in one significant way: EVS focuses on the science and procedures necessary to eliminate pathogens. EVS technicians are taught cleaning techniques that not only remove dirt, dust, and grime, they also kill viruses, bacteria, and fungi—the microorganisms that can threaten the health of residents and staff.

Hospitals and other acute care facilities have been focused on infection elimination for years; many SNFs have lagged behind.

“Skilled nursing facility managers understand the difference between housekeeping and environmental services, but most of them don’t have the staff or technical training to implement an EVS approach,” says Madrid. “For that reason, some SNF clients have outsourced housekeeping to companies with EVS capabilities, to help elevate their level of housekeeping and reduce infection risk.”

EVS training is very specific regarding the tools and techniques of infection elimination. Technicians use only Environmental Protection Agency-registered health care-grade disinfectants, and they understand appropriate dwell times. They wear approved PPE (personal protective equipment), which for EVS technicians would include hand protection (chemical-resistant gloves), approved eye protection, and in some cases respiratory and hearing protection. They also practice proper hand hygiene; they use lint-free cleaning cloths and have HEPA (high-efficiency particulate air) filtered vacuum cleaners. By U.S. Department of Energy standards, HEPA filters must remove 99.97 percent of the particulate matter of three micrometers or larger.

The technicians also are thoroughly trained to know why they clean as well as how to clean. It’s all about patient care and healing. EVS professionals consider themselves the first line of defense against infection.

What's the Benefit?

The investment in infection control can pay dividends beyond those that are evident at first glance. For instance, the opportunity to attract residents who previously would require acute facility care creates a larger potential pool of residents. As a result, facilities will have more patients with acute illnesses who require elevated infection prevention services than in years past.

EVS-level cleaning lowers infection risk for all residents and staff. Common problems like Clostridium difficile outbreaks will be significantly reduced. Management will also appreciate lower expenses related to infectious outbreaks, like hospitalizations and staff absenteeism due to illness. Higher satisfaction scores from residents and their families are another plus, and that’s great for the facility’s reputation.

One other noteworthy benefit is better staff morale. Clinical staff can focus more on patients, management has fewer of the worries that are typically associated with infections, and the image of the EVS staff is elevated. Everyone is happier.

Where to Start?

Transitioning to an EVS cleaning model is not like flipping a switch. There must be commitment from management, a period of technical training, and a transition from a housekeeping mindset to a “culture of clean,” as EVS professionals like to describe it.

Every department, every function at the facility must be focused on infection control. Communication and accountability are vital as processes and procedures to keep the SNF infection-free are implemented. Some basic foundational steps include:
  • An emphasis on hand hygiene for everyone in the facility;
  • Identification of high-touch zones for daily, or more often, cleaning;
  • A thorough knowledge of EPA-registered health care-grade disinfectants, dwell times, and cleaning techniques;
  • Elimination of airborne irritants like dust and mold spores;
  • Identification and isolation of residents who are contagious; and
  • Linen management—preventing infection spread through linens and clothing.
Taking these steps is a good start, but infection-control training and proper staffing are necessary to achieve real control of infectious agents. If unsure how to achieve EVS-level cleaning, contact a company with environmental control experience. Also check out the Association for the Health Care Environment at www.ahe.org for more information.
Daniel Gravatt, LNHA, T-CSCT, is business operations manager for ServiceMaster Clean, which has more than 900 franchised and licensed locations around the world. He is a licensed nursing home administrator and a trainer of the Certified Surgical Cleaning Technician program. He can be reached at dgravatt@smclean.com.