Creating An Infection Control Risk Assessment

BY J. Darrel Hicks

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In healthcare, everything done within the facility should be designed around patient safety. The environmental services (EVS) department exists to insure the health and safety of patients, visitors and staff. Infection prevention and control is the top priority. That is why is so important to take a proactive approach to preventing infections from occurring by assessing the risks that may lead to unsafe conditions within the four walls of the organization.

Disinfectants are essential in controlling and reducing infections, but as the IG report suggests, EVS managers may not want to rely on a disinfectant’s EPA registration alone as their infection prevention strategy. Instead, an infection control risk assessment should be performed by stakeholders responsible for the safety of the patient population.

In addition to EVS and infection prevention/control leaders, the “stakeholders” should include representatives from administration, nursing, patient safety/risk management and materials management, to name a few. These parties must create a structure from which to work.

An infection control risk assessment is more than just running down a list of potential hazards. This assessment should be a living document that changes as products and procedures evolve. It considers potential hazards and prioritizes them to better guide goal-setting and strategy development.

For instance, a strategy for addressing the possibility that a disinfectant might not be efficacious would be to investigate what impacts the disinfectant’s efficiency. This could include:

• Surface condition — Rough and/or porous surfaces will be more difficult to disinfect.

• Surface temperature — Higher temperatures will speed up disinfection rates, but will also increase evaporation.

• Organic load — Blood, sputum, urine, feces, and other bodily fluids can protect and stabilize microorganisms. Organics may also react with the disinfectant, consuming it.

• Dirt, grease, or oils — These all can protect microbes, and grease and oil can repel water-based disinfectants.

• Dried spills — Dried media (i.e. barium) and blood can also decrease a disinfectant’s efficacy.

Taking this information into account, infection prevention managers will need to make all disinfecting of spaces, furniture, furnishings and patient-care equipment a two-step process.

First, use a micro-denier microfiber cloth (16-slice/split microfibers down to 3 to 5 microns) and a general purpose cleaner to physically remove the organic load.

Then, on a pre-cleaned surface, use a pre-moistened disinfectant wipe or microfiber cloth to apply a disinfectant, while assuring the surface remains wet for the EPA stated contact time listed on the label. To comply, the disinfectant may need to be re-applied more than once.

Separating the process into two steps might seem simple, but in facilities where EVS staffs are conditioned to clean and disinfect in one step, managers might get some pushback. Make sure to adjust departmental expectations and cleaning times to allow staff to perform the new process properly.

Once this time allowance and new process has been adopted, the next step is to ensure the proper products are in place — general purpose cleaner, micro-denier microfiber cloths, and hospital-approved disinfectant.

After managers are assured that all the physical elements are in the purchasing and distribution pipeline, every hospital or facility employee (“stakeholder”) who has duties related to disinfecting spaces, furniture, furnishings or patient-care equipment/devices must be educated and trained; including a competency assessment performed for each employee.

There are three very important reasons to involve numerous stakeholders in the assessment. First, this guarantees that the health and safety of patients, visitors and staff is protected. Moreover, the hospital will have done their due diligence in assessing and addressing any problem created by the EPA’s re-registering all 300 disinfectants, which will take a few years to complete.

And finally, the Joint Commission, along with the CMS or state/local regulatory agencies, will be satisfied that departments have met the conditions of participation by enhancing infection prevention practices. In other words, managers have recognized the potential risk to the health and safety of the patients, and have adequately addressed it.

Overall, EVS executives must be proactively addressing the problem of proper disinfection. Ignoring the Office of Inspector General’s recommendations could place the facility in the cross-hairs of a trial attorney’s class action lawsuit for patients who were harmed by hospital negligence. Managers must take the necessary steps to address this issue right away.

J. DARREL HICKS is the author of “Infection Control for Dummies” and is nationally recognized as one of the top experts in infection control. His career working in cleaning management spanned over 36 years.
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