Decreasing the Incidence of Clostridium Difficile by Improving the Environmental Services Decontamination Process

Abstract

Background Clostridium difficile (C. diff) is a highly infectious organism that contributes to morbidity, mortality, and the cost of healthcare due to the organism spreading and being extremely difficult to kill. Oncology patients are highly susceptible to contracting C. diff due to their immunosuppression. The local hospital’s oncology unit has not been meeting their benchmark for decontamination of patient rooms. The purpose of this doctorate of nursing practice project was to decrease the incidence of C. diff by improving the EVS (environmental service) cleaning system through standardizing daily cleaning, with a focus on high touch surface areas, using Clorox Bleach wipes and a checklist in all rooms within the oncology unit. Intervention The DNP student developed a teaching simulation, using a SMARTER TOOL, to educate the EVS staff on how to clean the high touch surface objects and how to document the cleaning on the checklist. Each room in the unit was cleaned daily using Clorox Bleach wipes, with a focus on high touch surface areas. The checklist remained in the patient’s room for one week or unless discharged. After the rooms were cleaned, the hospital infection control staff and doctoral student tested for ATP on the high touch surface areas and recorded the data. Once the room cleaning was completed, the EVS staff member signed the checklist. The doctoral student collected the checklists at the end of each week. Methods The data analysis was conducted using descriptive statistics (mean, frequency, and percentage) evaluating the ATP results and items from the high touch surface checklist. There was an analysis of the high touch surface areas cleaning compliance and the quality of the cleaning based upon the ATP scores; items needed to score below 25 in order to pass. Microsoft Excel and PSPP were used to compute the data analysis. Results Data results showed a statistically significant reduction in the ATP levels when using the checklist and Clorox Bleach wipes. Both the IV pump and blood pressure machine showed sustained improvements across the entire intervention timeframe. The bedrail, bedside table, and call light each showed substantial reductions in ATP levels; however, these reductions did not reach statistical significance. Collectively, these findings indicate that the intervention significantly improved how the rooms were cleaned.

The data related to staff compliance with the EVS checklist was transformed into a Likert scale to allow for analysis. On average, the staff was fully compliant < 4 days per week. There was a statistically significant difference between the compliance rating and the ATP levels for the variables of interest, only the blood pressure machine was not significant. Conclusion The project was successful in demonstrating that there was a significant decrease in ATP while using a daily checklist and Clorox Bleach wipes. This decrease in ATP suggests that the environment is less viable for organisms, especially such multi-drug resistant organisms such as C. diff. Since this project’s completion, the hospital has used Clorox Bleach wipes in all C. diff patient rooms for daily cleaning and as a standard for all terminal cleaning.