Successful EVS departments conduct thorough training for new hires and refresher training on a regular basis.

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All jobs involve some level of risk, especially when people work closely together. There is always the possibility of injury along with the potential for infection and illness. What makes a health care environment unique is that its mission to heal exists alongside a working environment where people can get hurt or sick.

Many patients are admitted to hospitals because of infectious bacteria and viruses. They are contagious, and their illness can be transmitted to others. Hospitals work very hard to contain and eliminate pathogens, but the risk remains. Meanwhile, hospital employees are involved in tasks such as cleaning, maintenance, repairs, supply, food services, security and administration, among others. These jobs all involve the risk of injury.

The daily routine of a hospital involves both health and safety. The two objectives coexist for all who work in this setting, but especially for environmental services (EVS) professionals, who stand squarely in the middle of the health and safety equation. 

Patients are the priority

All health care employees know that the well-being of patients is their No. 1 goal, and keeping them safe is essential. One of the greatest dangers patients face is health care-associated infections (HAIs).

Immunocompromised patients are extremely vulnerable to pathogens. The Centers for Disease Control and Prevention estimates that, on any given day, about one in 31 hospital patients have at least one HAI. This is in spite of rigorous cleaning and disinfecting protocols at almost every hospital. Preventing HAIs is a daily battle for both clinical and EVS staff.

While patients are preeminent, the health of hospital employees and guests is also important. For EVS technicians, this is where the concerns of health and safety overlap. Hospital employees and visitors are susceptible to infections, too, so EVS staff are trained to disinfect as well as clean. EVS staff also focus on the safety of others; they must be mindful of slippery surfaces and trip hazards, exposure to chemical products and sharps, and many other dangers associated with cleaning and maintenance.

“Hospital safety is primary to our job,” says Tom Mattice, CHESP, T-CHEST, director of EVS for Montefiore Nyack Hospital in Nyack, N.Y. “Infection control is at the top of the list, but we also put a lot of attention on safety within the hospital. We discuss on-the-job safety on a daily basis, and we train frequently in order to do a better job of cleaning and disinfecting. Both are very important.”

Key considerations

For Mattice and other EVS directors, their jobs involve protecting patients, staff and visitors every day. Safety is the common denominator for every aspect of their work. Key considerations of these efforts include the following:

Conducting training. No job is completely devoid of risk, and that’s true for EVS staff. Their jobs involve a variety of tasks — lifting, bending, repetitive motions, exposure to cleaning products and sharp items, standing on ladders and so forth. As Mattice says, training is almost constant, and state and federal agencies have workplace regulations and guidelines to help prevent injuries. For the most part, EVS departments see few on-the-job injuries.

“Considering our level of activity, we have very few injuries,” says Mattice, who oversees a large staff at the 375-bed hospital as well as nearly 20 additional off-site facilities. “We have the occasional muscle strain or issues with repetitive motion, but rarely anything serious.”

Successful EVS departments conduct thorough training sessions for new hires and provide refresher training on a regular basis. Mattice says his staff discusses safety issues almost daily.

Assessing risks. Cross-contamination prevention protocols get a lot of attention, especially in this era of COVID-19. The proper use of personal protective equipment, the correct way to clean and disinfect a room, the safe disposal of sharps and the proper handling of soiled laundry are all extremely important subjects that should be reviewed often. Disinfecting and infection prevention form a core competency for EVS departments. It is the first line of defense in the battle to maintain a safe hospital environment.

Slip and falls are a common injury in almost any commercial or business setting, and that’s certainly true in health care, where moisture and bodily fluids on floors can be dangerous to both staff and hospital guests. Ladders and stools also must be used with caution. These types of injuries can often be serious, so EVS directors should continually emphasize safety protocols to avoid slip and falls and climbing accidents.

The cleaning solutions used by EVS can sometimes irritate skin and are harmful if ingested. EVS departments should have stringent policies regarding cleaning carts and storage rooms to ensure no unauthorized persons have access to these products. 

Cleaning tools and machines should likewise be kept secured to prevent their misuse. EVS staff should always discard unused chemical products carefully and according to Environmental Protection Agency and Occupational Safety and Health Administration guidelines, and safety data sheet instructions. They also should be sure to use the recommended protective gear.

According to numerous studies, muscle strains and repetitive motion disorders are the most common injuries reported by health care workers. These issues can sometimes be attributed to a lack of training but, in many cases, they occur because staffers take shortcuts and disregard proper techniques. 

EVS directors should remind their EVS teams that lifting is often a team sport and to always have a partner help with heavy loads. When bending over, EVS staff should use their knees rather than their backs. They should use ergonomically designed tools and techniques to prevent repetitive motion issues. Reducing these types of injuries will keep workers safe and more productive.

Needlesticks also occur frequently in the health care environment. They are doubly dangerous because they injure and create a potential source of infection. Experienced EVS personnel know that linens can be a likely source of a sharps injury, so they should take great care when gathering laundry or trash.

Preparing for disasters. The threats to health care safety are not confined within the doors of the facility. Natural and human-made disasters happen frequently, and EVS personnel play an important role when unexpected events occur.

“Disasters are impossible to predict but, just based on my own experience, I’d say we see three to four disaster situations occur in our community each year,” says Mattice, whose hospital is about 20 miles north of New York City. “We do risk assessments frequently to be prepared for major weather events, terrorist attacks, transportation accidents, workplace violence and a number of other contingencies.”

Mattice explains that his EVS team has specific responsibilities when a disaster occurs. One of their first tasks is to round up patient transportation devices such as gurneys and wheelchairs. Next, they help set up isolation areas for the families of victims and move furniture to create additional space where needed. They also work with security personnel to secure the facility. EVS technicians also must continue to perform their normal responsibilities of cleaning and disinfection in the midst of what can be a chaotic situation.

Managing external threats. Danger can also come in the form of a lone individual. The acts of violence seen in society can easily invade the normally safe space of a hospital. 

According to the Bureau of Labor Statistics, the health care field saw 16 homicides on premises by gun violence in 2015. Hospitals also have been the scene of hostage situations and kidnappings. Law enforcement agencies consider hospitals to be soft targets because they are always open and difficult to evacuate.

Security staff may be vigilant and well-trained, but they need the cooperation of the hospital staff, especially the EVS team, in the event of an active shooter or similar situation. EVS technicians know their facilities well. They have a unique knowledge of every room and closet in the facility and see these rooms on a daily basis. They know which doors should be locked or open. They also know most employees by sight and can help identify suspicious individuals. In this way, they are often the eyes and ears of the hospital.

Maintaining code awareness. Hospitals all have code systems to alert employees to various emergency situations. There are typically codes for fires (code red), life-threatening medical emergencies (blue), child abductions (purple), mass-casualty events (green) and maybe a dozen others. 

Some hospitals use a clever “paging Dr. so-and-so” system to alert personnel without alarming patients and guests. For example, the overhead message, “Paging Dr. Strong,” is likely a call for security to a specific area. Still other hospitals use plain language so there is no miscommunication. All hospital personnel should know their code system and their responsibility when an overheard code is used.

Employees who have been on the job for a while have likely participated in numerous emergency drills in preparation for fires, earthquakes, storms or potentially dangerous individuals. Because of their training and knowledge of the facility, they will know exactly how to respond in an emergency. They also can serve as guides to help guests or patients get to designated safe locations or exits.

All about safety

Safety is a broad term for EVS personnel. Safety begins with wellness — the cleanliness and disinfection of the facility that is necessary to protect vulnerable patients, as well as hospital staff and visitors. But that is just the beginning.

The role of EVS in safety extends to the protection of hospital staff and guests — to protect them from injury, danger and threats that may come from external forces. It includes vigilance over the facility and responsiveness when needed. It also involves their own personal safety to avoid injuries that can occur in the normal course of work.

“EVS personnel are located throughout the facility at all times of the day and night, so they can be a very valuable asset with regard to the health and safety of a hospital,” Mattice says. “It’s an important part of our job.” 

Steve Zimmerman, CHESP, T-CSCT, is director of brand operation standards for ServiceMaster Clean. He co-chaired the Association for the Health Care Environment’s advisory council, and also was a member of the conference planning committee as well as the environmental services industry advisory team.