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Learning Session Abstract

Environmental Services Quality Improvement Drives Healthcare-acquired Infection Reduction

Craig, Sarah L. BSN; Lang, Mindy D.M. BS; Schlottman, Kristina J. BSN

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Pediatric Quality and Safety: March/April 2020 - Volume 5 - Issue - p e280
doi: 10.1097/pq9.0000000000000280
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The Environmental Services Staff (EVS) at a nonprofit, independent health system serving children with special healthcare needs adopted an objective feedback approach to ensure high-touch surface cleaning compliance. Utilizing a fluorescent gel marker applied to high-touch surfaces, environmental cleaning could be evaluated with black light illumination. Providing objective feedback to EVS staff on environmental cleaning compliance increased high-touch surface cleaning reliability from 37% to 90% from 2016 to 2018.


Baseline high-touch surface cleaning reliability was established through high-touch surface audits, conducted by non-EVS department members to minimize potential bias. Disposable fluorescent gel markers were used to place gel spots on high-touch surfaces without EVS staff awareness. The gel spots were placed in patient care rooms before cleaning following a patient discharge, end-of-day cleaning of clinic rooms, and terminal cleaning in operating rooms. The team returned after EVS cleaned the area to illuminate marked areas using a black light. In accordance with manufacturing guidelines, if the mark was completely gone, the cleaning was adequate. If there was any mark visible, the cleaning was not adequate. The baseline compliance was 37% in high-touch surface cleaning reliability in the fourth quarter of 2016.

With compliance well-below quality reliability goals of 90%, EVS leaders launched a program to partner with and train EVS staff on process. High-touch surface cleaning training occurred both in a classroom setting and through hands-on education. The documented process created a standardized approach to establish quality priorities to drive measurable improvements. New employee orientation and annual staff education was modified to include focused training on environmental cleaning. Feedback is was provided to staff on individual compliance. The EVS team continues to utilize fluorescent gel marking with black light illumination to assess environmental cleaning compliance quarterly.


Baseline data determined there was 37% compliance in high-touch surface reliability in the fourth quarter of 2016. After education on high-touch surfaces and fluorescent gel marking and illumination was provided, reliability increased to 90% by the first quarter of 2018. Reliability was sustained greater than 90% through Q2 of 2019. Hospital acquired infections (catheter-associated urinary tract infections, ventilator-associated pneumonias, multiple drug resistant organism infections, and surgical site infection events) decreased during the same time. There was a 65% decrease in healthcare acquired infections from 2016 to 2018. Estimated cost avoidance for the organization from 2016 to 2018 was approximately $500,000 (Solutions for Patient Safety, 2017).


Utilizing an objective approach to evaluate environmental cleaning leads to an increase in environmental cleaning compliance along with the decrease in healthcare-acquired infections. These findings underscore the vital role of EVS staff in patient safety. Eliminating harm at an organization requires all teams to identify the role they play in safety.

Fig. 1.:
A graphical description of improved environmental cleaning compliance in relation to decreasing healthcare acquired events.
Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.