Checklists and Robots Make It Easier To Clean Patient Rooms

John Palmer

Healthcare systems deal with the perennial problem of properly cleaning and disinfecting patient rooms, both while they are occupied and upon discharge when getting ready for new occupants.

Unfortunately, it’s not a cut-and-dry process, and most hospitals don’t have a set protocol for making sure all surfaces are cleaned the same way. Across the spectrum of healthcare in general, the cleanliness of patient rooms tends to depend on the quality of the environmental services team, and even individual cleaning team members.

Officials at hospitals across the U.S. are looking for new ways to improve patient room cleaning as hard-to-kill infections such as c. difficile take root in the country’s hospitals and medical clinics.

Sentara Healthcare System in Norfolk, Virginia is attempting to change that, at least in their own hospitals, by taking a lesson from the airline industry, which for years has enjoyed one of the safest records of any industry by using checklists in its processes. A group of environmental services managers, infection prevention and control representatives, and nursing leaders have been working together to improve cleaning and disinfection practices, and have come up with a protocol checklist that cleaners can use to help make sure protocols are not deviated from.

“In addition to policies on cubical curtains, (we) updated policies on cleaning occupied isolation rooms and discharged patient rooms,” wrote Joani Brough, R.N., NE-BC, vice president and nurse executive at Sentara Princess Anne Hospital in Virginia Beach, Virginia, in the November 2017 issue of Healthcare Facilities Management magazine.

According to Brough, Sentara developed two new checklists that detail six steps that all cleaning and disinfection personnel should follow when thoroughly cleaning a patient room. The first checklist, which details how an occupied isolation patient room should be cleaned, has 23 separate steps that contain extremely simple and detailed language, including “Clean the patient bed,” “Move clockwise from the door and sanitize all surfaces and equipment in the room,” “Patient’s bathroom” and “Mop room and prepare to exit.” Supplemental guidance includes everything from washing hands to donning personal protective equipment (PPE) to sanitizing the sink. These steps are meant to make sure that cleaning personnel don’t miss any steps. They can simply check the item off the list as they do it.

Likewise, the checklist for cleaning a discharged patient room has 28 steps, including “Restock room,” with supplemental guidance including everything from placing “wet floor” signs to cleaning the mattress.

Invasion of the germ robots

More facilities are taking ultraviolet light to the fight with robots that can “read” the surfaces in a room, and bathe the room in light—essentially giving deadly germs a really bad sunburn and preventing them from multiplying.

“Before 2010, we did everything we could by the recommendations and didn’t budge our C. diff numbers, says Joanne Levin, MD, medical director of infection prevention at Cooley Dickinson Hospital in Northampton, MA. In January 2011, the hospital rented a UV robot from San Antonio-based Xenex, and after the first three months saw claims to have seen an 83% drop in the hospital’s rate of C. diff infection.

At a cost of around $100,000, and boasting a disinfection rate of close to 90%, many hospitals say it’s a cost worth incurring, especially when the tool is added to existing housekeeping efforts. UV technology is not in and of itself a new thing—hospitals have been using it for some time. But it can be prohibitively expensive for smaller facilities, and with an increasing number of healthcare-acquired infections finding their way into ambulatory care facilities and medical clinics, manufacturers are looking for ways to make the units smaller, more affordable, and easier to use so that the technology is accessible to more healthcare facilities.

Turning to precious metals

It’s been known for centuries that minerals such as copper and silver have antimicrobial properties that repel infections. Still, for many reasons, including heftier costs, their regular use in healthcare facilities has been slow to take root. Now, though, some facilities nationwide are testing technologies that weave copper and silver fibers into everyday high-touch items to try to cut down on infections.

Copper, which tends to give fabrics a salmon-colored hue, is being infused into everyday items such as countertops, over-the-bed tables, bed rails, and textiles ranging from bed linens to patient gowns. Metallic silver, meanwhile, is a natural conductor and has been used to produce cooler lab coats, addressing a perennial complaint of healthcare lab workers. Testing has been done on space suits worn by astronauts and apparel worn by elite athletes, and silver has even been used in soldiers’ underwear because it cuts down on odors and is cooler.

The new technology does cost more, however. Wear and tear, as well as time, causes the antimicrobial properties to dissipate, so replacement costs need to be factored in. The overall cost of products that contain copper, for example, can cost 25% more than other products on the market.

In November 2014, Sentara CarePlex Hospital in Hampton, Virginia introduced a clinical trial of copper-infused textiles and hard surfaces into a new wing of its facility. The copper products, which gives the fabrics a salmon-colored hue, are supplied by Richmond-based Cupron, Inc. and EOS Surfaces, a manufacturer based out of Norfolk that manufactures surfaces such as countertops with copper infused in them.

“Sentara is pleased to continue deploying these advanced antimicrobial materials into our inpatient facilities,” said Gene Burke, MD, vice president of clinical effectiveness for Sentara, in published reports. “While the studies at Sentara Norfolk General Hospital and Sentara Leigh Hospital are still ongoing, we’ve seen enough progress that we felt it warranted further analysis.”

The new technology does come at a cost. Wear and tear, as well as time, causes the antimicrobial properties to dissipate, so replacement costs need to be factored in, and the overall cost of products that contain copper can cost 25% more than other products on the market. That may be a tough sell for facilities already strapped for extra cash.

Also being considered in healthcare facilities is metallic silver, she says. As a natural conductor, silver can carry heat away from the body, making it a good choice to produce cooler lab coats. Testing has been done on space suits worn by astronauts and apparel worn by elite athletes and soldiers in Afghanistan.


John Palmer is a contributing writer to PSQH.