New spotless spotlight shines on EVS workers

Housekeepers are part of 'medical team'

Cleaning patient's rooms may not seem like the most important job in the hospital. But environmental service workers save lives in their own way — by preventing the spread of infections. A new spotlight on their role may boost the resources, communication and training focused on this group of workers.

"Clean Spaces, Healthy Patients," a national initiative of the Association for Professionals in Infection Control and Epidemiology (APIC) and the Association for the Healthcare Environment (AHE), stresses the links between infection control professionals and environmental services.

Within hospitals, the departments are becoming aligned. Although employee health isn't a formal part of the APIC/AHE initiative, EH professionals are often part of the dialogue, as well.

"Historically, we have been two of the departments in health care that have been under-resourced," says Marita Nash, MBA, CHESP, director of Environmental Services and Linen at Hunterdon Medical Center in Flemington, NJ, and a member of the Clean Spaces advisory panel. "Together, we solicit the resources to address that need."

Meanwhile, the Service Employees International Union (SEIU), which represents more than 1 million health care workers, has been training hospital-based environmental services workers in green practices — and in some basics about the difference between cleaning and disinfection and the problem of healthcare-acquired infections.

"We're giving them a fundamental understanding of the importance of their role,' says Bill Borwegen, MPH, health and safety director of SEIU in Washington, DC.

Microbes on mouses

The surfaces in a patient room and the nurses' station are prime culprits for fomite spread of infectious diseases, and research has increasingly found microbes on common items: stethoscopes, bed rails, computer keyboards, telephones. Studies have even found bacteria on doctors' neck ties1 and doctors' coats and nurses' uniforms.2

Better training of housekeepers can reduce the contamination. A study at Rush Medical Center in Chicago found that training and monitoring of housekeepers improved the cleaning of surfaces in patients' rooms — and reduced the transmission of vancomycin-resistant enterococci (VRE).3

At Hunterdon Medical Center, the training includes sessions on communication among professionals and non-professionals — an effort to break down the hierarchical barriers. Environmental service workers are part of the "medical team" on a unit, says Nash.

That integration should occur even if a hospital uses a contractor for environmental services, says Nash. Those workers still have a commitment to doing the job correctly, she says. And the hospital still has a manager who oversees environmental services and can work closely with infection control and employee health, she says.

Green means less risk

Environmental services workers also must learn how to protect themselves from the chemicals they use to decontaminate the rooms. For example, Hunterdon has eliminated most trigger spray bottles, which can aerosolize the cleaning solutions. If a spray bottle is used, the workers spray it onto a rag rather than on the surface, Nash says.

SEIU is promoting the use of less toxic, "green" cleaners, which pose less health risk to the workers as well as others in the health care environment. But the environmental service workers need to understand how to properly use the products, such as how long they must stay on a surface before being wiped off, says Borwegen. "It's important that these workers be properly trained," he says.

Yet there are potential barriers. "These are some of the lowest paid workers in a health care facility," Borwegen says. "In many instances, they're contracted workers — they're not even employees of the hospital. They're predominantly an immigrant population. English may not be their first language."

It's important to use educational materials that have a lot of graphics and pictures, he says. Nash sometimes uses interpreter services, and she adjusts her training to accommodate those who have learning disabilities or literacy problems. For example, they may learn from observing and then demonstrate their competence, she says.

Monitoring quality of cleaning

At Hunterdon, there's an information loop from infection control to environmental services. In an environmental services audit, infection control swabs six surfaces in patient rooms to detect adenotriphosphate (ATP), an indicator of organic matter. They test different surfaces on different shifts in about 30 to 40 rooms a month.

"Right now, we are swabbing the overbed table control knob, blood pressure cuff, the arms on the patient chair, telephone, toilet seat in the bathroom, and the light switch in the bathroom," says Nash.

The monitoring demonstrates the effectiveness of the environmental services staff. Infection control professionals often comment on the cleaning. "They'll stop and say, 'Thanks for doing such a great job.' That means more to my staff than anything in the world," says Nash.

And by teaming up, infection control and environmental services support each other. For example, Nash recently hired an employee for the night shift who cleans keyboards, computer mouses, telephones, medical record covers, and other such surfaces.

Of course, the users of those devices are expected to clean them regularly, as well, says Nash. The hospital provides germicidal wipes. "The culture [at our hospital] is that cleaning is everyone's responsibility," she says.

[Editor's note: More information about "Clean Spaces, Healthy Patients," including links to resources, is available at]


  1. Day, M. Doctors are told to ditch "disease spreading" neckties. BMJ 2006; 332:442.
  2. Wiener-Well Y, Galuty M, Rudensky B, et al. Nursing and physician attire as possible source of nosocomial infections. AJIC 2011; 39:555-559.
  3. Hayden MK, Bonten MJ, Blom DW, et al. Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis 2006; 42:1552-1560.