RESEARCHED PROPOSAL TO EDUCATE HOUSEKEEPERS TO HELP

REDUCE THE TRANSMISSION OF BACTERIA IN THE HOSPITAL ENVIRONMENT

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Salem VA edical Center

To: Naymon ack, Supervisor, F S

From: James F. Deyerle, CWT, F S

Date: 9/28/2010

Re: Proposal to educate housekeepers to reduce transmittal of bacteria in hospital environment

We, as housekeepers, have a duty to our patients to excel in our job at cleaning and disinfecting
our hospital in order to reduce the spread and transmission of hospital associated infections. The
training of our housekeepers is paramount in achieving that goal.

If I told you that something you did could save the life of one of our veterans, would you
do it? Then get ready because proper training of our housekeeping staff can save countless lives
as well as improve the quality of patient care substantially. In my research I have found that the
proper training of housekeepers can significantly reduce the spread of viruses and bacteria
resulting in a more sanitary environment. It is also thought that in order to reduce the spread of
viruses and bacteria that a cleaning effort that exceeds the national standards set by the Centers
for Disease Control and Prevention (CDC) might be needed to reduce the transmission of RSA
(methicillin-resistant Staphylococcus aureus) and other antibiotic-resistant organisms in
intensive-care units (ICUs) in hospitals.

y proposal-TO EDUCATE HOUSEKEEPERS TO HELP REDUCE THE

TRANS ISSION OF BACTERIA IN THE HOSPITAL ENVIRON ENT- will help in this
crucial area. I hope that you find this material beneficial. You can contact me in ICU1/ICU2 at
ext. 1702 or email me at jdeyerle@verizon.net. Thank you for your time on this important
matter.

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 EXECUTIVE SUMMARY

Introduction

Controlling the spread of viruses and bacteria is paramount in the hospital environment. I
would like to concentrate on proper bed cleaning and disinfecting as one way of helping
to reduce bacteria.

Purpose

To train housekeepers to properly clean a hospital bed

Scope and research on which report is based

This would concern all housekeepers working in patient care areas. Research is
based on several different articles on infection control.

Key ideas

Àc A more standardized method of cleaning beds could reduce bacteria

Àc Reducing bacteria results in a more sanitary hospital environment
Àc Training of new employees would be more effective
Àc Training of housekeepers would result in a better employee

Time and cost overview

The time involved would be an in-service for the housekeeping staff. The cost
would be the labor to have the in-service along with the printing cost of the
material to be presented.

Conclusions reached

An in-service on proper bed cleaning and disinfecting along with an addendum to

the Cleaning manual would substantially reduce the spread of viruses and bacteria
in patient care areas.

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Recommendations

I would recommend providing an in-service to housekeepers on proper bed

cleaning and disinfecting. I would also recommend adding an addendum to the
current Cleaning manual. Both these would help with controlling the spread of
transmission based infection in the hospital environment.

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TABLE OF CONTENTS

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I. BACKGROUND/EXISTING BASE OF KNOWLEDGE
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I would like to target beds in an effort to develop a more standardized method of cleaning and
disinfecting them in order to reduce the transmission of bacteria in the hospital environment.
c I have done some preliminary research and found a wealth of information about cross-
contamination. One of the biggest concerns in hospital is trying to control the spread of viruses
and bacteria from room to room and from patient to patient. Greenawalt (2005) states that the
biggest problems in maintaining a sanitary environment are improper workloading, improper or
inadequate training of housekeepers, and inadequate supervision that insures proper methods of
cleaning and disinfecting. Not only is cross contamination especially devastating to people with
compromised immune systems it is a threat to anyone who crosses the facility¶s threshold.
Rubelo (2009) states that a cleaning effort that exceeds the national guidelines set forth by the
Centers for Disease Control and Prevention (CDC) might be needed to reduce the transmission
of RSA (methicillin-resistant Staphylococcus aureus) and other antibiotic-resistant organisms
in intensive-care units (ICUs) in hospitals. He also states that in a previous study found that
admission to an ICU room in which the previous occupant was a carrier of RSA or
vancomycin-resistant enterococci (VRE) increased the next patient¶s risk for RSA or VRE
acquisition by as much as 40%, presumably through environmental contamination. This article
also states some of the areas that are very resistant to decontamination are high-touch areas such
as light switches, touch pads, linen hampers, window ledges, door knobs, bedrails, and beds
themselves. Infection Control Today (Cleaning and Disinfecting Update, 2006) also states that
the surfaces that are the highest risk for pathogen transmission are bed rails and patient
equipment. Infection Control Today also states that ³Housekeeping personnel need to
understand how important their role is in maintaining a safe environment for infection prevention
and control. This education/communication to housekeeping must be balanced with information
that gives them a level of comfort with cleaning effectively, and knowing that they are not at
increased risk in the process. Fran Walsh (2010) states´ There's also increasing evidence that
current terminal cleaning practices of rooms where methicillin-resistant Staphylococcus aureus
or vancomycin-resistant enterococci patients were cared for are not sufficient to prevent
transmission to the next patient assigned to that room.´ She also states that ³Education and
training on proper techniques for cleaning and disinfection are important for both environmental
services and floor staff to help them understand the necessity of a clean environment.´ Gina
Rollins (2009) states that ³Perhaps the most crucial element of achieving performance standards
for cleanliness of the patient environment is the overall approach taken in training and supporting
environmental services staff, ^People can be trained to mop a floor; but if they don't understand
the reasoning behind it, you won't get the effort needed.¶´c
Working in ICU I/ICU2 I have come across a variety of housekeepers. It has been my
experience that most housekeepers clean differently. I think that most people just look at an area
and if it looks clean they assume it has been cleaned appropriately. This does not take into
account the treatment of bacteria because you can¶t see these bacteria. If we were to standardize
the way all housekeepers clean a bed then we would know for certain that this bacteria on these
beds is disposed of in the proper manner.

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 II. STATEMENT OF NEED

In the hospital environment we are faced with infection and transmittal of germs at an
alarming rate. As housekeepers it is our duty to clean and disinfect areas of the hospital to help
minimize germs and the transmittal of these germs. In our patients rooms housekeepers should
follow certain procedures for regular as well as terminal cleaning of rooms. These procedures
should be well outlined and defined to help insure that housekeepers are cleaning and
disinfecting properly in these areas. I am proposing a standard way of cleaning a hospital bed.
This will insure the proper cleaning and disinfection of just one area of the hospital. A lot of
areas could be addressed but the main idea is to properly educate the housekeeping staff to
recognize the importance of proper cleaning and disinfection. The proper cleaning of our patient
beds is just one step towards that goal. This material can also be used as a guide to train new
employees as well as train existing employees properly.

III. PROJECT DESCRIPTION

ÔÔÔ

 

The beds in the hospital are not being cleaned properly on a consistent basis.
Housekeepers need proper guidelines to follow in order to properly clean and sanitize patient
beds.

ÔÔÔ  Ô 



 Developing a standardized method of cleaning the beds is in order.

ÔÔÔ    



The primary goal is to reduce the spread of viruses and bacteria in the hospital environment. To
do this we will concentrate on bed cleaning. Our secondary objectives are:

 1. To train housekeepers to properly clean a bed

2. To provide a standardized method of training to train new employees in bed cleaning

3. To reemphasize how important cleaning and sanitation is reducing the spread of

viruses and bacteria 

4. Provide an Addendum to be added to the current manual

ÔÔÔ   ! 

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 I have included in Appendix A an illustrated guide on proper bed cleaning which explains
fully the proper way of cleaning and sanitizing a bed. This also could be added to the current
cleaning manual as an Addendum.

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 IV. BUDGET (TIME AND COST ESTIMATES)

The cost involved in presenting this information to housekeeping staff depends on your
method of delivery. An in-service could be scheduled to teach them the proper methods of
cleaning and sanitizing beds. The cost would be the labor involved in having an in-service. I
could also make this information available in email format so it could be accessed by all
housekeepers. You would also have the cost of printing whichever parts of the material that you
deem necessary.

CONCLUSION AND RECOMMENDATIONS

Controlling the spread of viruses and bacteria is paramount for housekeepers in the hospital
environment. We should pay close attention to cleaning and disinfecting all areas of the hospital.
I would like to concentrate on the cleaning of our patient beds. These beds are not being cleaned
consistently. In Appendix A I have detailed a thorough method of cleaning these beds. I would
recommend that all housekeepers follow this format. This will insure a uniform cleaning and
disinfecting of these beds. I would recommend an in-service to convey this material to our
housekeepers. I would also recommend that this material be added to the current cleaning
manual which could be used as a reference material when needed. You could also make it
available in email format. The housekeeper needs to know that certain steps are necessary in
order to maintain a safe environment and that these steps are crucial to reducing the spread of
viruses and bacteria. If you decide to use this material I would be glad to answer any questions or
help with the implementation. I can be reached at ICU/ICU2 at ext. 1702 or you can email me at
jdeyerle@verizon.net .

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APPENDIX A

Proper Bed cleaning

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Illustration 1

This is a Hillrom bed (illustration 1). Stryker has a model that is very similar to this bed.
The following are the steps for proper cleaning and disinfecting. All steps are being done
using proper cleaning and disinfecting solution and wearing appropriate PPE. Use your
solution liberally. Soft scrub can be used to remove stubborn stains. Replace dry or soiled
towel with new wet towel as needed.
1.c Start with bed in flat position (illustration 1) and wipe done entire top and sides of
mattress. ake sure you clean behind flap (illustration 4) located on the sides of the
beds.

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2.c Raise bed all the way up and place bed with the head up in sitting position as far as it
will go (illustration 2).

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Illustration 2
3.c Clean underside of carriage, IV poles, front part of floor bottom of bed, push poles,
and headboard. ake sure you remove headboard (Illustration 3C) and clean under it

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(illustration 3b). ake sure you pull up IV poles and wipe (illustration 3a)

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Illustration 3

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Illustration 4
On some of the beds there is a compartment on the headboard side of bed that has to
be cleaned. Fluids sometimes get in this compartment (illustration 4) so the inside
also has to be cleaned.

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If not cleaned regularly the bottom of IV poles will become rusted and soiled
(illustration 5).

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Illustration 5

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4.c Clean bedrails on headboard side of bed (illustration 2). ake sure you clean the
hinge for the bedrail. This is easily seen when bed in sitting position.

Illustration 6
5.c Clean between mattress and frame being careful not to pull mattress out too far as it is
attached to the bed by bed inflating support (illustrations 4).
6.c Lay bed back in prone position (illustration 1).
7.c Fold bottom half of bed over top half and clean bottom of mattress. ake sure you
lift mattress up and clean under it (illustration 6).
8.c Clean bottom part of bed frame. ake sure foot of bed is extended out fully.

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9.c Clean handrails towards foot of bed. Clean hinge area of bedrails. There is a panel on
one side of the bed. Clean behind it (illustration 7).
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Illustration 7

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10.cClean footboard. Clean under footboard (illustration 8). This area is crucial as skin
cells will collect here from patients¶ feet.

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Illustration 8
These skin cells are live and can contain bacteria. There is a small crevice under the
footboard that needs to be cleaned (illustration 8). The best way is with a toothbrush
and sanitizing solution.

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11.cClean underside of bed and bottom of bed on floor. ake sure you clean the wheels
and pedals as well (illustration 11).

Illustration 11
12.cLeave mattress of bed in folded over position and leave bed raised all the way up.
This will let people know that this bed has been cleaned and ready for patient use.

There are other makes of beds in the hospital. The method of cleaning the bed
should remain the same. There are some subtle differences that should be pointed out.
Stryker has a rotating bed which has a thick blue mattress. I will emphasize the areas that
are different.
1.c Start off in prone position as before with bed in the highest position. Clean top and
sides of bed including under flap.
2.c Put bed in sitting position and clean under carriage (illustration 13), headboard, and
front part of base of bed near floor. At this point (illustration 14) fold mattress over
towards foot of bed. This mattress is heavy and if the bed is in the upright (sitting)

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position this will let you fold it over much easier.

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Illustration 13

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3.c Clean underside of mattress (illustration 14A).

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Illustration 14
4.c Put front carriage (illustration 14) back in prone position. Clean top of carriage. Clean
front bedrails. These will be accessed much easier with mattress folded over.
5.c Lay front mattress back on carriage. Fold footboard side of mattress up toward
headboard. Clean underside of bottom of mattress.
6.c Pull off footboard. Clean thoroughly including function panel on top of footboard. Do
not put water in plug part of footboard on bottom of footboard.

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 Clean top of footboard side of carriage. ove compressor carefully and clean under it
making sure not to disconnect wires (Illustration 15).

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Illustration 15
7.c There is a foot extender that has to be pulled out and cleaned. This can be accessed by
pulling on yellow handles (16A and B) and pulling foot extender out (Illustration 16).
Once you have it out clean the extender thoroughly.
8.c Clean footboard side of base of bed near floor. ake sure you clean the accordion
style protective sleeve (coil) that houses the hydraulic lifts (illustration 17). Fluids
sometimes bounce up from floor when dropped. This will cause this area as well as
underneath the bed to become contaminated.
9.c Wipe down bed access panel and stand (Illustration 15).

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Illustration 17
There are also other beds in the hospital. As housekeepers we should take the time
to get to know these beds so that we can effectively clean them. All parts of these
beds need to be cleaned and sanitized properly in order in to help control the spread
of viruses and bacteria.

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