Tom Wright, Director of Environmental Services
Anna McClane, RN, Infection Control Practitioner
Diane Bennett, Housekeeping Supervisor, Albany Memorial Hospital (AMH)
Mary Jones, Housekeeping Supervisor, Samaritan Hospital (SH)
Peg LaBarr, RN, Nursing Director of pilot unit, Samaritan Hospital Deborah Trembley, RN, Director of pilot unit, Albany Memorial Hospital
Nursing and Housekeeping staff on pilot units

• To decrease MRSA hospital-acquired bloodstream infections to zero by October 2008
• Obtain 80 percent compliance with cleaning of rooms using all-or-nothing checklist by October 2008

• Percent of inpatient rooms that meet all criteria on the all-or-nothing room cleaning checklist
• Methicillin-resistant Staphylococcus aureus bloodstream infection (MRSA BSI) rate per 1,000 patient days

• Trained Environmental Services (ES) staff in “high touch” cleaning activities, using pictures of high touch areas for staff education to overcome language and literacy barriers
• Continued emphasis on proper cleaning as a mechanism to reduce infection
• Reviewed appropriate handwashing methods with Environmental Services staff and asked them to observe and report inadequate handwashing of ALL staff — See Something, Say Something
• Environmental Services staff actively participated in multidisciplinary team meetings to review infection control progress and outcomes
• Created and tested room cleaning checklist, which included high touch areas, with ES staff
• Tested checklist for supervisors to use on assessing room cleanliness
• Provided education on all-or-nothing measurement of room cleaning with checklist ["all-or-nothing" is a composite measure in which all components of the checklist must be completed to be counted]
• Pilot testing of checklist began on one unit at each hospital
• Placed personal protective equipment outside of every patient room
• Placed waterless hand cleaning stations outside of every room
• Monitored results in all-or-nothing format and reported results back to staff on a monthly basis

The Environmental Services staff became engaged in the hospital-wide goal to decrease nosocomial MRSA bloodstream infections, with their inclusion on the Hospital-Acquired Infection Community team. The aim to improve room cleaning with the use of an all-or-nothing checklist provided a measurable goal for all staff and was a link that impacted the outcome measure. 

Involving Environmental Services staff in this improvement project had the immediate effect of improving the cleaning techniques used by staff, served as a great motivator for ES staff, and generated a great deal of pride.

• Environmental Services staff were educated on the importance of their work in decreasing nosocomial infections and, in particular, on effective cleaning for high touch areas.
• A 50 percent staff turnover causes a problem with maintaining the staff education level and a focus on decreasing infection rates.
• Immediate intervention by the supervisor during review of room cleaning allowed for real-time education of staff.
• Pilot testing of checklist began on one unit at each hospital and is now the practice is being spread to other units.
• The continued focus of supervisors is required to maintain the improvements.