ensure that housekeeping is kept up to date on best practices. It's
easy to have caring, hard-working people doing the best they can, but
falling short because they lack knowledge.
One solution is to emphasize training the trainer. Otherwise, knowl-
edge and procedures tend to be handed down from person to person,
and degradation becomes inevitable. Procedures and protocols slowly
regress from good, to average, to poor. And because everybody's busy,
it's possible no one will even notice. "SOP drift" plagues many indus-
tries, and is especially important in health care.
No substitute
Environmental cleaning is a baseline that both sets the tone and plays
an important role in other parts of the battle. Hand hygiene, for exam-
ple, is likely to immediately be compromised if surfaces aren't proper-
ly disinfected.
Meanwhile, expensive new technology that automates disinfection
is exciting, but no one has come up with a way to reduce the need for
basic services. In fact, UV devices and robots require additional train-
ing for environmental services. It's tempting to think that a robot can
reduce the need for housekeeping staff, but be careful. You still need
people who are using their brains to get every nook and cranny and
who can follow every SOP. You can't just shut the door and hit the
fogger. Opportunistic and resistant microbes don't care what new
technology we have in this fight.
Curtis Donskey, MD, staff physician at Louis Stokes Cleveland
Veterans Affairs Medical Center and an author of the C. diff study
cited above puts it this way: "Healthcare facilities are increasingly
turning to automated room disinfection devices as a strategy to
optimize environmental disinfection. (But) with effective monitor-
ing and feedback, motivated environmental services personnel can
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