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A pictorial manual keeps nursing and housekeeping on the same page.
Take a few members of your nursing staff into the OR and start pointing out different pieces of equipment, asking each time, "Who's responsible for cleaning that?" Write down their answers, and repeat the exercise with members of your housekeeping staff. Do their answers match up? If they don't, then some of your equipment, furnishings or surfaces may be overlooked in the cleaning process, potentially putting your patients at risk for exposure to infectious agents.
Say it with pictures
Sharing cleaning duties among housekeeping and nursing staff is a good strategy, but it can lead to misunderstandings and potential lapses if you don't spell out the responsibilities of each group. When assigning cleaning duties to different staff members, avoid using general categories. For example, putting nurses in charge of cleaning "equipment" and housekeeping in charge of "furnishings" can cause confusion, as some items don't lend themselves to easy categorization.
In various departments of our hospital, including the OR, we've created a relatively simple way to clearly define cleaning duties: training manuals that contain pictures of each piece of equipment in that unit, information about who's responsible for cleaning the items, and the frequency and method with which they should be cleaned. Before we created the instructional books for our ORs, it wasn't always clear who was supposed to clean items like the anesthesia cart and machine. Housekeepers, in particular, were afraid to touch some equipment and therefore would only clean parts of the machines, leaving them potentially contaminated.
How to do it yourself
To create your own pictorial cleaning manual, start by taking a comprehensive inventory of all the items in your ORs, including equipment, furniture and environmental surfaces. When we recently put together training books for our intensive care unit (see "C. Diff Inquiry Highlights Cleaning Lapses"), the housekeeping training and quality assurance manager (HTQAM) and a representative from the ICU walked through the department and took pictures of all the items and equipment as they appeared in the rooms. They then sat down and drafted the manual using a 3-ring binder. Each page displays a photo of an item along with an outline of who — nursing or housekeeping — is responsible for cleaning it, as well as instructions on how to clean the item and how often to do so.
When creating your own manuals, have both the nursing and housekeeping staffs review the first draft, give their feedback and agree to their responsibilities before you make it official policy. Make at least 2 copies of the final version — one for the nursing staff and one for the housekeeping staff. Use the book to train new hires and existing staff as part of their ongoing training. Also keep the instructions readily accessible so staff can consult them as needed. When a new piece of equipment is added, the nursing staff should alert housekeeping so the 2 groups can agree on the cleaning processes, including who'll be responsible for cleaning the new item, which is then added to the book. At our hospital, the HTQAM also reviews and updates the books annually.
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C. Diff Inquiry Highlights Cleaning Lapses |
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Until we began investigating an increase in Clostridium difficile infections in the intensive care unit of our hospital, we assumed our nurses and housekeepers were well aware of their ICU cleaning duties: Nurses were responsible for medical equipment, while housekeeping would cover all the furnishings. Turns out it's not as simple as that. After some staff raised concerns that certain items weren't being cleaned, our hospital's Housekeeping Training and Quality Assurance Manager (HTQAM), as part of a multi-disciplinary task force formed to investigate the C. diff infections, reviewed with the ICU nursing staff all of the items that "lived in" each room to assess who was cleaning them, when and how often. The investigation revealed that neither the nursing staff nor the housekeeping staff were cleaning key items, not because of negligence, but because the 2 groups weren't on the same page about their respective duties. For example, the nursing staff would clean the wires of bedside monitors, but not the monitors themselves, because they thought monitors were considered "furnishings" since they didn't leave the rooms. Housekeeping staff, however, assumed the nurses were cleaning the monitors because they considered them to be "equipment." Other items that weren't being cleaned included thermometers, pumps and rocking chairs. The discovery led the housekeeping and ICU nursing staffs, with guidance from the HTQAM, to follow the OR's lead and create their own pictorial training manuals to define the cleaning duties in that unit. — Laurie Tostenson, TQAM, and Judy Ptak, RN, MSN |
Picture perfect
Maintaining a clean environment is a vital part of our effort to reduce healthcare-associated infections. Each set of books (2 per unit) costs around $30, including printing, pictures, binders and paper, and takes 10 hours' worth of labor to produce. For this small amount of money and time, we've reaped great rewards in reducing HAIs and improving the consistency of cleaning processes throughout our hospital. We've created books for more than 14 units, and more are planned. They've been very well received, with the involvement of the nursing staff and housekeeping viewed as important keys to the success of the project.
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