The goal is pretty simple: You want to leave a hospital with health that is at least as good as when you went in. It’s easy to assume hospitals continuously sanitize or disinfect almost every square inch of space, to help you realize that goal.
But this isn’t necessarily so.
Centuries after the discovery that good medical hygiene inhibits the spread of disease, studies have found some hospitals to be unimpressive in the cleaning department - for instance, failing to frequently disinfect bedrails and buttons, where repeated touching can transfer germs. This is believed to be a factor in the spread of hospital-acquired staph infections, among other maladies.
Whether you are a healthcare employee or a patient with a planned hospital stay, you don’t have to take dirty standards lying down. You may be fortunate to live near a number of medical facilities, allowing you to select one with good cleaning practices. Or, insurance and location limitations might motivate you to put pressure on a certain hospital to adopt more appropriate systems. Depending on what you find, it may be worth the expense to go out of town or out of your insurance network for a facility that gives you peace of mind.
So how do you find a clean hospital?
- Find out if it has achieved and maintained certification. A good cleaning team doesn’t fly by the seat of its pants, and CIMS certification is an easy-to-spot flag for serious, disciplined cleaning. CIMS stands for the Cleaning Industry Management Standard, and it means a third party observer has already asked tough questions, looked for and found built-in assurances of quality cleaning — like a written work plan, a time budget that helps ensure all rooms get the attention they need, and a system of inspection that verifies a job well done. Putting plans such as these into place greatly reduces the chances that the war against germs will be lost for the want of a small sanitizing procedure – or for the lack of a well-trained employee.
If the hospital has hired an outside business to take care of the facility, then check that company for certification. An organization must reapply for CIMS every two years – this helps prevent slippage into bad habits.
- Beginning in March 2008, hospitals that receive financial reimbursement from Medicare or Medicaid will be using the HCAHPS survey. HCAHPS stands for Hospital Consumer Assessment of Healthcare Providers and Systems. In the summer of 2002, the Centers for Medicare and Medicaid Services (CMS) asked the Agency for Healthcare Research and Quality (AHRQ) to develop an instrument to measure patient perceptions of care. This measurement would be used to publicly report hospital performance (quality of care as perceived by patients). The goal of this public reporting instrument, as stated by CMS, is to provide consumers with information that might be helpful in choosing a hospital. Although the survey has changed significantly since 2002, its purpose remains the same.
The survey questions cover the following areas:
• Communication with Doctors
• Communication with Nurses
• Responsiveness of Hospital Staff
• Pain Control
• Communication about Medicines
• Cleanliness and Quietness of the Physical Environment
• Discharge Information
You will notice that cleanliness is one of the publicly reported questions asked of former patients. The first public reporting of HCAHPS results will occur in March 2008. Hospital results for patients discharged between October 2006 and June 2007 will be displayed on the Hospital Compare Web site.
- Get a copy of the cleaning instructions for the area of the hospital you plan to occupy. These indicate exactly what an employee is trained to do there, and the hospital or cleaning contractor ought to have these clearly outlined, whether you’ll be visiting a surgical suite or the birthing center. Ask them to fax or e-mail them to you. Remember that as a patient you are paying for a service and you have a right to know what quality you are getting. Or as a medical professional, you can choose to look for a different work environment if you are not satisfied. Once you have received the list of cleaning procedures, look for:
- Who is responsible for checking the quality of cleaning?
- Ask for a Housekeeping Room Inspection form that details what the inspector looks for.
- What is the policy for disinfecting “high-touch” surfaces in the room such as the bedrails, telephone, computer keyboard (if there is a computer in the room), faucet handles, toilet, etc.?
- What is nursing’s role in maintaining the rooms' appearance and cleanliness during your stay?
- Do they have a policy for making hand sanitizer available in the patient’s room?
- What is the practice for disinfecting items before reuse (such as bedside commodes, walkers, IV poles, stethoscopes, blood pressure cuffs)?
- Ask for a tour. When you walk through the hospital, breathe deeply. Does it smell clean or are there malodors such as urine or feces? If there are carpeted corridors, are they spot and stain-free? They may not take you through ICU, but particularly the labor and delivery wing may offer established tours to demonstrate the clean and homey atmosphere. While you are there, ask how often cleaning crews come through and what kind of cleaning is standard while a patient is checked into a room. Find out what hand-washing policies the doctors and orderlies observe. And take a look around. It is possible for areas to look clean when they are not, but if dirt or grime is visible on frequently touched surfaces, invisible dirt is likely right behind it, before it and beside it.
- After you check in: You or a family member need to be aware of some very key elements of your care to help ensure you don’t acquire a serious disease such as VRE, MRSA or C-diff (Clostridium difficile):
- Every person who lays hands on you should wash their hands or use an alcohol-based hand sanitizer before touching or examining you. If they walk into the room with gloves on, have them remove them and go through the hand washing/sanitizing and re-gloving. The point is, you don’t know where they have been or what they touched before entering your room.
- Have the caregiver (including the doctor) sanitize their stethoscope before examining you.
- If you are placed in an area where there are posted isolation rooms, watch the traffic in and out of the room. Are people donning the proper personal protective equipment (PPE) such as gowns and masks? Do healthcare workers come out of the room wearing the PPE, then go into a different patient’s room without changing? Is proper hand washing or sanitizing happening?
- IEHA education. Ask the cleaning personnel if they have been through a program by the International Executive Housekeepers Association, titled “Frontline Training Course.” Or, call the Director of Housekeeping or Director of Environmental Services and determine if they have received an educational designation of CEH or REH from IEHA. These are additional signs of professionalism that increase the odds the hospital you've chosen is clean.