AHE welcomes the premise of the Centers for Disease Control and Prevention's (CDC's) recently released "Options for Evaluating Environmental Cleaning" toolkit. However, AHE is extremely disappointed in the lack of representation from AHE and health care environmental services (ES) professionals on the environmental evaluation workgroup that prepared the toolkit.
There is a real risk that services targeted at elimination of health care-associated infections (HAIs) will continue to be fragmented as various health care disciplines remain reluctant to collaborate and engage with each other.
Prevention of HAIs necessitates the cooperative exchange of ideas and best practices across the broad spectrum of professionals involved in this effort. While laudable, the CDC toolkit seeks to impose programs, processes and checklists on health care facilities with little regard for the organizational structure and programs currently in place.
The CDC and the authors of the toolkit unabashedly declare, "The program will be an infection preventionist/hospital epidemiologist infection prevention and control (IPC)-based program internally coordinated and maintained through environmental services management-level participation. The goal should be seen as a joint (IPC/ES), team effort during planning, implementation and ongoing follow-up phases." Yet, where is the necessary collaboration? Where is the exchange of ideas? Where is the united effort?
During the Crimean War, Florence Nightingale, one of the founders of modern nursing, identified the absolute relationship between a sanitary environment, sickness and death. She did not need a statistically proven relationship between disease and medical complications or death; she acted upon her knowledge and the best knowledge available at the time.
As the medical profession progressed and became more complex — including the addition of specialties in infection control and prevention — it has become more structured and focused due to medical advances as well as governmental and nongovernmental regulations and standards. Nurses no longer have the time to clean the health care environment. That job is now the responsibility of ES departments — professionals in their own right with their own standards, guidelines and best practices firmly grounded in the world of medicine.
And yet, many medical professionals and health care administrators have forgotten the lessons of Florence Nightingale and her emphasis on a clean environment and its relationship to infection prevention and control. Proper implementation of ES practices is a science, albeit different in practice and application than that of medicine or nursing. It still has its roots in infection prevention and control.
Breaking the chain of infection is paramount to achieving the goal and it takes the entire health care team to achieve it. Florence Nightingale understood. Isn't it time we all did? n
This month's column was written by John Scherberger, CHESP, AHE at-large board member.
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