Preventing and mitigating the spread of COVID-19 in long-term care centers is a top priority considering CMS’ enhanced enforcement effective June 1, 2020 for infection control deficiencies. CMS has cited F880 at immediate jeopardy level relating to examples such as:
- Failure to adequately clean and disinfect common areas to reduce the transmission of infection
- Not leaving disinfectant spray on the recommended “wet” time before wiping it back off doors and handrails
- Failure to disinfect shared equipment between rooms.
Consequently, adherence to environmental infection control practices is essential to reduce the risk of COVID-19 entering long term care facilities and is the best defense against its spread.
Providers should develop and implement policies and prevention based on guidance from national standards such as CMS and CDC. These policies should include, but are not limited to the following topics:
| POLICY CHECK |
| √ Hand hygiene |
| √ Routine and terminal cleaning and disinfection |
| √ Routine and terminal cleaning and disinfection of resident rooms using appropriate precautions |
| √ Cleaning order |
| √ Product decisions and use |
| √ Required PPE |
| √ Product contact/wet time |
| √ Handling of equipment shared among residents |
| √ High-touch surface cleaning and disinfection in common areas |
| √ Provide appropriate personnel job-specific cleaning and disinfection training and competency |
| √ Cleaning and disinfection procedure quality assurance audits |
Hand hygiene, of course, is a first-line defense that can prevent the spread of germs. While we often focus monitoring activities on nursing staff hand hygiene, do not overlook the importance of oversight for other staff members including environmental services team staff. CDC offers Hand Hygiene Guidance and Education Courses that are beneficial resources. Additionally, The Medicare Learning Network (MLN) has developed web-based training for hand hygiene and other pertinent infection control topics that can be located here.
Other Environmental Services Tips
The Environmental Services Manager should assign responsibilities and monitor completion adherence. A standardized cleaning process/checklist can aid in assuring tasks are completed. Observations should assure that cleaning order is followed such as: (1) starting top to bottom, (2) cleanest to dirtiest and (3) high to low to prevent recontamination. Restrooms should always be cleaned last. Also, a strong systemic process helps avoid missed areas. Staff should focus especially on areas in close proximity to the resident and high-touch surfaces such as the call light, telephone, door knob/levers, light switches, resident chair, bed rails, toilet handle, toilet seat, handrails and sink handles. High touch areas for staff include nurse’s stations, kiosks, keyboards, tablets, etc. Furthermore, nursing, respiratory therapists, infection preventionists, and environmental services should agree upon a list of equipment that are to be cleaned and disinfected by Nursing and which cleaning tasks are performed by Environmental Services.
Cleaning Products & Supplies
Providers should utilize cleaning and disinfection products with EPA-registered disinfectants for healthcare settings that can be used against COVID-19. These disinfectants meet EPA’s criteria for use against COVID-19. The manufacture/product’s instructions for use should be followed including skin/eye protection, ventilation, and the contact or “wet” time. If an area or item is visibly dirty, clean with soap and water or another detergent then use a disinfectant. Also, follow recommendations for the type of surface including soft services and electronics. Time, ease of use, safety and cost are important when selecting products. If a product requires a long contact time, repeated applications might be needed which increases cost and decreases staff efficiency. Remember to maintain the MSDS sheet for all products in use.
Ensure workers have and use any personal protective equipment (PPE) they need to perform their jobs safely. Clear signage should be posted on the door or wall outside of the resident room indicating the type of precautions. Continually monitor PPE stock, the facility specific burn rate, and assess supply chains. Develop a process for decontamination and reuse of PPE, such as face shields and goggles, as appropriate. Follow CDC recommendations for optimization of PPE supplies.
The environmental services team plays a critical role in ensuring that disinfection is performed properly. However, every staff member who works in the facility should understand the facility’s fundamental environmental cleaning procedures and strive to work together to practice infection prevention. Furthermore, include residents and family members as role players that support the health care team. Administration should foster an environment of partnership. Schedule ongoing meetings or develop other systems of open communication between the departments that includes information on environmental safeguards. Also, staff members should feel comfortable reporting safety concerns to reduce infection-related harm to residents.
References
https://qsep.cms.gov/data/274/COVID-19FocusedSurveyforNursingHomes.pdf
https://www.cms.gov/files/document/qso-20-31-all.pdf
Blog by Kristen Walden, MSN, RN, RAC-CT, Proactive Medical Review
Learn more about Kristen and the rest of the Proactive team.