As we enter the fourth year of the COVID-19 pandemic, hospitals and the broader public are more aware than ever of the importance of environmental services (EVS) and infection prevention (IP) teams. As we navigate this new normal, now is a great time for EVS and Infection Prevention Teams to regroup and reassess their cleaning programs to give hospitals a stronger foundation for the future.


To get a bet­ter sense of the rela­tion­ship between infec­tion pre­ven­tion and envi­ron­men­tal ser­vices and the impact that the pan­dem­ic has had on it, Smart Facil­i­ty Soft­ware spoke with infec­tion pre­ven­tion­ist Doe Kley, RN, MPH, LTC-CIP, CIC, T‑CHEST. Kley has over 20 years of hos­pi­tal infec­tion pre­ven­tion and con­trol expe­ri­ence, and is cur­rent­ly the prin­ci­pal infec­tion pre­ven­tion­ist on the Clin­i­cal and Sci­en­tif­ic Affairs team for Clorox­Health­care

Here’s what she had to say about how infec­tion pre­ven­tion has changed over the past three years, what gives her hope, and how she’d like to see the rela­tion­ship between IP and EVS teams con­tin­ue to evolve: 

How did you get involved with infection prevention work?

I’m kind of an odd­i­ty in infec­tion con­trol, because I have a back­ground that prob­a­bly many infec­tion pre­ven­tion­ists don’t have. I am a reg­is­tered nurse, but before that, I received my under­grad­u­ate degree in micro­bi­ol­o­gy. I’m also dual board cer­ti­fied in Infec­tion Con­trol and Epi­demi­ol­o­gy, and have a Mas­ter of Pub­lic Health degree. So I have a good blend of back­grounds that fit nice­ly with infec­tion con­trol.

I became an infec­tion pre­ven­tion­ist by acci­dent, as many peo­ple do. I wasn’t taught about this pro­fes­sion in school, in either my micro­bi­ol­o­gy pro­gram, or my nurs­ing pro­gram. Once I start­ed work­ing in the hos­pi­tal, I knew that we had some­one called an IP on staff, but I had a min­i­mal idea of what that role actu­al­ly entailed.

And then one day, the IP sud­den­ly left the posi­tion, and the man­age­ment said tag, you’re it! I had been help­ing out in the qual­i­ty office, so they knew my back­ground and thought it was appro­pri­ate for the role. They plopped me into the role, and I end­ed up lov­ing it and being pret­ty good at it. The rest is his­to­ry.

I can hon­est­ly say that not a day has gone by in this career that I haven’t learned some­thing new. I wake up ener­gized every day, won­der­ing what I’m going to face.

How did your work evolve during the COVID-19 pandemic?

I joined Clorox in late 2018, so when the pan­dem­ic hit I was beside myself, feel­ing like I real­ly need­ed to be back in the hos­pi­tal.

For­tu­nate­ly, I had the oppor­tu­ni­ty to help in my neck of the woods, up here in North­ern Cal­i­for­nia. We had a crit­i­cal need for addi­tion­al nurs­ing sup­port for COVID patients, and the gov­er­nor com­man­deered sev­er­al hotels in the state to be vir­tu­al hos­pi­tals. So, in the first year of the pan­dem­ic, I picked up a nurse super­vi­sor role on the week­ends with our local pub­lic health depart­ment to help pro­vide care for COVID patients, espe­cial­ly home­less peo­ple and folks in com­mu­nal liv­ing sit­u­a­tions. I did that for the whole first year of the pan­dem­ic, and I was able to admin­is­ter some of the first vac­cines.

I also got to do a lot of edu­ca­tion and train­ing for health­care work­ers through my work at Clorox. Part of my role at Clorox is gath­er­ing indus­try insights. And in late 2019 and ear­ly 2020, I kept see­ing reports of “pneu­mo­nia of unknown cause” hap­pen­ing in Chi­na, and my “spidey sens­es” were up. We didn’t know what it was called yet, but when I saw that it had spread to two oth­er coun­tries out­side of Chi­na, I thought, Oh Lord, here comes a pan­dem­ic. 

I was able to alert Clorox very ear­ly, even before we had known cas­es in the US, so that we could take appro­pri­ate action such as edu­cat­ing our cus­tomers about appro­pri­ate dis­in­fect­ing prod­ucts and prac­tices. I was real­ly proud of that work, to be able to use my epi­demi­ol­o­gy skills to help our inter­nal teams fig­ure out how to han­dle the pan­dem­ic.

At Smart Facility Software, we like to say that clinical staff is there to handle infection in the patients, and EVS and Infection Prevention teams are there to handle infection in the building. Can you tell us a little bit more about how EVS and IP teams work together?

The rela­tion­ship between EVS teams and IPs is very impor­tant. The IP has reg­u­la­to­ry over­sight for the facil­i­ty to ensure that a clean and san­i­tary envi­ron­ment is pro­vid­ed to patients, and EVS is obvi­ous­ly instru­men­tal in achiev­ing this goal, because they’re the ones doing the actu­al work. They under­stand the prod­ucts, and we (IPs) know the pathogens and trans­mis­sion, so we can speak to which prod­ucts are bet­ter for spe­cif­ic pathogens or cir­cum­stances.

A good IP should have a close and sup­port­ive rela­tion­ship with EVS, observ­ing their prac­tices and com­ing up with pro­to­cols and work­flows togeth­er.

When I was in the hos­pi­tal, I worked close­ly with EVS folks, and togeth­er we cre­at­ed some pret­ty awe­some tools such as a C dif­fi­cile ter­mi­nal room clean­ing check­list. At times I was able to edu­cate them on a cer­tain pro­to­col, while oth­er times they showed me a new way of get­ting some­thing done. So we were able to come up with an evi­dence-based work­flow togeth­er.

How has that relationship evolved during the pandemic, and how do you hope to see it continue to evolve?

My sense is that the rela­tion­ship between IP and EVS teams has prob­a­bly deep­ened out of neces­si­ty dur­ing the pan­dem­ic. Now that we’re in this new nor­mal, it’s time for IP and EVS teams to assess their clean­ing pro­grams, for sev­er­al rea­sons.

First, there were sup­ply chal­lenges dur­ing the pan­dem­ic, and it got to the point where folks had to use what­ev­er prod­ucts were avail­able. So right now, in any hospital’s sup­ply clos­et, you’re prob­a­bly going to find a pletho­ra of dis­in­fec­tants, when we only need a few. Do we real­ly need 3 dif­fer­ent quat dis­in­fect­ing wipes? We have to sim­pli­fy, oth­er­wise it makes it too com­plex for staff to do what they need to do. Vari­a­tion in prod­uct leads to vari­a­tion in prac­tice.

Dur­ing the pan­dem­ic, there was also lit­tle time for over­sight, and humans tend to cut cor­ners or drift from best prac­tice. Every­one thinks they’ve been doing what they’ve always done but drift hap­pens slow­ly over time, and you don’t always real­ize how far you’ve drift­ed from the orig­i­nal pro­to­cols. So now is a good time to get out there, cre­ate a check­list based on your poli­cies and pro­to­cols, and observe the work to make sure they align. We’ve got to get peo­ple back on the same page and make sure they’re fol­low­ing the appro­pri­ate poli­cies and pro­to­cols

The oth­er thing that has changed is the Great Res­ig­na­tion. We had a lot of turnover in infec­tion con­trol and EVS dur­ing the pan­dem­ic, and so many teams are still short-staffed. When you’re short staffed, you can’t prop­er­ly onboard, so review­ing EVS train­ing is anoth­er area where IPs can be help­ful right now.

There’s an oppor­tu­ni­ty for edu­ca­tion. When so many of the team mem­bers are new, they might not know that there is sup­posed to be a rela­tion­ship between IP and EVS.  So I think we need to com­mu­ni­cate to folks what that rela­tion­ship is: a sym­bi­ot­ic rela­tion­ship of mutu­al sup­port, resources, and advo­ca­cy.

How would you define the “new normal” with respect to how hospitals have adapted to the pandemic? 

One thing that I hope “sticks” in the new nor­mal is the height­ened aware­ness by all staff on the impor­tance of hygiene––both hand hygiene and envi­ron­men­tal clean­ing and dis­in­fec­tion. We know these prac­tices keep our patients, vis­i­tors, and staff safe. 

A more wor­ri­some part of our new nor­mal, at least for the fore­see­able future, are the finan­cial and staffing chal­lenges that our facil­i­ties are con­tend­ing with. Nei­ther of these issues is expect­ed to be resolved quick­ly, so we need to help new staff to become even more effi­cient. Prod­ucts that com­pa­nies like Clorox­Pro and Smart Facil­i­ty Soft­ware pro­vide will help with effi­cien­cies to save staff time while still pro­vid­ing high qual­i­ty clean­ing ser­vices.

The pan­dem­ic put a spot­light on our bro­ken pub­lic health infra­struc­ture which has his­tor­i­cal­ly been under-fund­ed and short-staffed. This needs to be addressed as I fear that emerg­ing pathogens and pan­demics will occur with increas­ing fre­quen­cy and we need to be bet­ter pre­pared for the next big event.

What are the things that give you hope? 

In addi­tion to the height­ened atten­tion to hygiene, it’s the pub­lic and facil­i­ty-lev­el recog­ni­tion that both IPs and EVS are final­ly get­ting for the incred­i­bly impor­tant life-sav­ing work that they do. Addi­tion­al­ly, in rec­og­niz­ing the burnout and what it has cost them, I am see­ing more facil­i­ties try­ing to make efforts to pri­or­i­tize the self-care of their staff.

What is something you wish everyone understood about infection prevention work

Great ques­tion! I wish that every­one under­stood that IPs are so much more than the “hand hygiene police” – we do so much more! The breadth and depth of what IPs have to know is mind-bog­gling. They look for pat­terns of infec­tion with­in the facil­i­ty; observe prac­tices; edu­cate health­care teams; advise hos­pi­tal lead­ers and oth­er pro­fes­sion­als; com­pile infec­tion data; devel­op poli­cies and pro­ce­dures; and coor­di­nate with local and nation­al pub­lic health agen­cies. They must part­ner across the health­care facil­i­ty with all depart­ments and dis­ci­plines from the bed­side to the C‑suite. They also have to be able to quick­ly assess risk and make deci­sions based on sound sci­en­tif­ic evi­dence.

I also wish that every­one under­stood that EVS tech­ni­cians are not house­keep­ers – they are high­ly trained pro­fes­sion­als with an incred­i­bly com­plex job. They save lives. They pre­vent the trans­mis­sion of pathogens. And these pathogens are get­ting hard­er and hard­er to kill, so their job is only get­ting more tech­ni­cal.

The vast major­i­ty of pathogens are spread by con­tact with hands or sur­faces. The CDC says that hand hygiene is the most impor­tant thing we can do, but I say that our hands are only as clean as the envi­ron­ment.

EVS pro­fes­sion­als under­stand this. They under­stand their mis­sion isn’t just to pro­vide an aes­thet­i­cal­ly pleas­ing clean envi­ron­ment, but to save lives by elim­i­nat­ing the envi­ron­ment as a source of pathogen trans­mis­sion  And I don’t know any­one who works hard­er. EVS work­ers I’ve worked with talk about how they clean a patient room as if a mem­ber of their fam­i­ly will be in that room next. So we need to ele­vate this pro­fes­sion and treat them as the pro­fes­sion­als they are.

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