The EVS/IP Relationship in the New Normal: Interview with an IP Expert
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.