Written by Claude Hines

Patients in the hospital are at risk for the Hospital-Acquired Infection(s) (HAI) regardless of the hospital’s level of patient care. This can be attributed to the overall integrity of the environment or the physical state of the patient. HAI is still one of the most common infections in the health care industry today despite modern means to break the infection chain because the causative agents like the viruses, bacteria and fungal pathogens are also prevalent in the hospital settings. Secondly, the immune system of the patients is also compromised, making it more favorable for these agents to permeate to these susceptible hosts. According to California’s department of Public Health website, the ratio of HAI is 1:20, which means that for approximately 20 patients, one patient has acquired HAI during his hospital stay. And when patients acquire any hospital infection, this means expenses to the hospital as patients can demand a settlement legally or amicably. As a former Chief of Logistics in hospitals and medical centers, I had the responsibility of managing of a number of branches that supported hospital operations to include the acquisition, storage, distribution and disposal of medical equipment and supplies; property management; facility management; clinical engineering and Environmental Services, sometimes referred to as housekeeping and linen management. Many within the hospital staff valued the services of what the logistics division provided when it came to getting equipment and supplies, keeping the machines and instruments operational, and ensuring that the lights and HVAC systems were in working order. One of the most undervalued services that was provided was housekeeping and linen management. Some of the hospital staff at the time did not appreciate the important role that housekeeping and linen management play in controlling patient acquired hospital infections.

It is for this reason that hospital policy makers are seriously crafting polices on HAI to reduce or to totally eliminate the occurrence of the infections to all patients. The personnel behind the hospital environmental services department or the housekeepers play a huge role in the control of infections in the entire hospital. Sadly, these people aren’t given the same consideration compared to the other members of the health care team.

Hospital housekeepers are the “behind-the-scene” players in the hospital. The main duty is to keep the hospital clean to help avoid the spread of infections which includes the proper disposal of patient’s blood and other bodily fluids; cleaning of patient and exam rooms; sanitization of hospital floors especially before and after patients leave their rooms; and all the exam/diagnostic/procedure rooms. Housekeepers must constantly do wall-to-wall cleaning, including all the hospital counters and surfaces whether specific times of the day or after incidences that require substantial cleaning. Hospital housekeeping personnel aren’t just ordinary housekeepers because they play an important role in the control of infections within the facility. Their main objective every time they perform their duties is to help break the cycle of infection by strictly complying with the national and hospital infection-control regulatory standards. These people are highly-trained to handle any toxic substances that require disposal, following strictly the infection-control guidelines set forth by the hospital and regulatory policies, to avoid any breach in the disposal process to insure the hospital avoids stiff penalties for lack of adherence.

The other important contribution of the hospital housekeepers is the equipment cleanliness and supply upkeep. Some may disregard this task as unimportant but when a piece of equipment, like the suction machine is left unclean and even a malfunctioned hand dryer in the nurses’ station is not addressed for days; the hospital keepers are the first line of defense to either clean the equipment or raise the issue of broken hand dryer to the appropriate personnel to get the issue resolved. Everything about hospital cleanliness is in the hands of the hospital housekeepers and when they are taken out of the picture, the rest of the health care team’s goal, which is to create a safe patient-centered environment, is defeated.

While it is true that among the members of the health care team, the hospital housekeepers are inferior in terms of educational attainment, but the overall effect of their duties and responsibilities help play a role just like the other hospital personnel in patient outcomes especially in avoiding hospital acquired infections. The nature of hospital housekeeper work calls for vigorous physical endurance as well as some analysis in certain tasks in their daily workflow. They need to be able to move fast and work efficiently without compromising the infection-control protocol.

In terms of job qualification, the hospital housekeepers need to be at least a high school graduate or equivalent with preferably one to three years cleaning experience. The other preferred skills include: good in interpersonal skills; can work independently; good in oral communication; a team player; adept in the organizational skills; and computer friendly. Based from the above qualifications, just about anyone can be a hospital housekeeper but the question that remains, is the willingness to do the job. It takes passion and dedication and just like the rest of the members of the health care team, hospital housekeepers have to follow strict policies, guidelines and procedures in performing their daily tasks. They have to be willing, able and ready to handle tough situations such as medical hazardous wastes. This may include putting on protective clothing/gear to accomplish the task. Each of their tasks needs to be carried out in accordance with approved regulations and guidelines.

The other important responsibility of the hospital housekeepers is the distribution of hospital linens to the different wards. Hospital housekeepers are keen on the process workflow to maintain the integrity of the clean and dirty linen. During the linen exchange, hospital housekeepers must carefully handle soiled/dirty linen that might contain opportunistic agents which could lead to patients and workers catching hospital acquired infections. Depending on the hospital’s policy on how often the linens are changed, hospital housekeepers must be ready to distribute the necessary linen on a work shift basis to meet the hospital policy and regulatory guidelines.

Strict adherence to the hospital infection control guidelines safeguards the patients’ as well as the hospital personnel from acquiring preventable infections; this is the essence of the housekeepers’ work. Just like the rest of the members of the team, they also need objective feedback to improve the overall objective of the hospital which is to eliminate HAI to patients. In the prospective, quasi-experimental study conducted by Carling PC, Parry MM, Rupp ME, Po JL, Dick B, Von Beheren S, entitled “Improving cleaning of the environment surrounding patients in 36 acute-care hospitals” published in PubMed (Nov.2008), the study revealed that after the objective feedback given to the environmental service’s staff, there was a significant improvement in disinfection, which can be achieved by most hospitals, without a substantial added fiscal commitment, by the use of a structured approach that incorporates a simple, highly objective surface targeting method, repeated performance feedback to environmental service’s personnel, and administrative interventions. However, administrative leadership and institutional flexibility are necessary to achieve success, and sustainability requires an ongoing programmatic commitment from each institution. (Reference: http://www.ncbi.nlm.nih.gov/pubmed/18851687).

The above data confirms and strengthens the importance of the hospital housekeepers’ contribution to the healthy hospital environment, and they are part and integral to every hospital organization’s success. Hospital infection control is best achieved when the members of the health care team work hand in hand towards one goal, empowering each member and valuing their contributions. Through objective feedback and effective implementation on infection-control programs, the break in the infection cycle is highly probable. So next time you see your hospital housekeeper/fellow healthcare team member be sure to give them a warm welcomed hello and smile.