If you'd like to do a better job of cleaning and disinfecting high-traffic areas and high-touch surfaces, download the CDC's Options for Evaluating Environmental Cleaning toolkit at www.cdc.gov/hai/toolkits/evaluating-environmental-cleaning.html. The agency published it last year. Not only was I part of the group that developed the toolkit, but I'm a proud user, too. And I can tell you that it works. Over an 8-month period, our cleaning compliance scores improved from 70% to 90% and our rate of methicillin-resistant Staphylococcus aureus (MRSA) infections dropped from 2.1 to 0.5 per 1,000 discharges. Here are 6 tips for making the toolkit work.

Get everyone involved. Housekeeping shouldn't be the only department concerned with environmental cleaning. Each department has its own view of how surfaces should be cleaned. Create a team with someone from infection prevention, nursing, environmental services, the physician staff and administration. The team should be a mix of management and staff who actually use elbow grease to disinfect and keep things clean. From administration, the higher the position involved, the better, because it reinforces the facility-wide importance of surface disinfection.

Define your expectations. Write down your expectations and goals. Decide what is important to clean and aim for 100% compliance. Start in a single area or department and use the CDC's checklist as a springboard. The checklist has a list of high-touch surfaces found in hospital rooms and other areas including lightswitches, IV poles and call box buttons. But in the end, what gets cleaned, how it's cleaned and who cleans it should be tailored to your facility. If you have a multilingual workforce, translate your educational material and checklist. Your cleaning guidelines should be thorough and realistic. Don't dole out responsibilities or set goals that could set up staff members to fail.

Give everyone the same training. The best way to make sure that everything is cleaned uniformly is to give everyone the same training. Create an educational program that covers why, how and when areas should be cleaned. Include items cleaned between cases, during terminal cleaning and during thorough cycle cleaning every few weeks or months.

Besides checklists and manuals, we also made posters and a DVD with humorous skits. The video stars frontline staff acting out improper work practices followed by proper infection control and cleaning. The DVD helped get team members excited about the program and improved awareness.

All appropriate staff members should attend the training sessions, whether they're new hires or veterans who've worked in your facility for 20 years. For the old-timers, this re-education may mean changing habits passed down from employee to employee over the years that are no longer appropriate.

Track, evaluate and identify problems. In the beginning (Level I), simply use the checklist to track whether the cleaning has been done. Do this with direct observation, a fluorescent gel and black light, swab cultures, an adenosine triphosphate (ATP) monitoring system or agar slide cultures. A staff member from infection prevention or environmental services should perform the monitoring. The monitor should attend the cleaning training program so she knows the checklist and how to monitor correctly.

Start by monitoring a routine cleaning per day and a terminal cleaning per week. Once you feel that cleaning is moving forward, increase the observations to a routine cleaning and terminal cleaning per day. As cleaning improves, you may notice improvement in your patient satisfaction scores related to providing a clean environment. Use these scores as a way to motivate your team.

When you identify problem areas, investigate to see if it's an individual problem or a system problem. If several employees are consistently missing the same area, it may be a system problem that requires re-evaluation of your cleaning protocols. If a single employee is missing the same spot, sit down with the employee to determine what the problem is and how it can be fixed. Stay positive and avoid blaming and finger-pointing. The goal is to improve, not embarrass people. Give your facility plenty of time to get used to using the checklist. It may take 6 months or more until you get good results.

Reward success. Make sure that everyone knows when you've met your goals. We also reward standout staff members who were "caught being great" with pins, gift cards for coffee and mentions in our hospital newsletter. Ask senior-level administrators, such as the president, chief executive or the chief of surgery, to personally thank the people who do the cleaning for a job well done. Again, besides honoring these employees, such high-level commitment helps reinforce the importance of proper surface disinfection.

Follow success with a new challenge. Up the ante and create an objective system for measuring how well surfaces have been disinfected rather than whether they have been cleaned at all. You can do this with a fluorescent gel and a black light. Then calculate your Thoroughness of Disinfection Cleaning (TDC) Score by dividing the number of objects that were cleaned by the number of objects that need to be cleaned. Share your progress at meetings with your staff so that everyone knows how you're doing and what needs to be done. Remember, success is a result of constant attention. The more you put into your environmental cleaning, the more your patients will benefit, which is why you're cleaning in the first place.