Focusing on Bugs

One of the most common areas of deficiencies for HME companies going through an accreditation survey is infection control.

Many providers work hard through the pre-survey process to ensure their policies and procedures for cleaning and disinfection of equipment are well-documented. But when it comes time for the survey, the process goes down the tubes. The staff members in the trenches delivering and picking up the equipment each day are the ones observed during a survey. It can quickly become clear to a surveyor what is part of the employee’s daily routine and what is not.

When a surveyor does not observe proper infection control guidelines being met, the provider is almost always guaranteed a return unannounced visit to insure the process is being handled correctly at a later date.

How can you avoid the most common failures?

• First, teach your staff about proper hand washing. Hand washing is the No. 1 way to prevent the spread of infection. Washing one’s hands with soap and warm water causing friction for at least 10 seconds, followed with drying using paper towels, is the technique all staff should use. In between patients, and when soap and water are not available, staff should have access to large bottles of alcohol hand gel that can be refilled when needed. Bottles that have a pump on the top are best for those driving vehicles or for staff working at stations where they will be accessing the pump several times a day. A surveyor riding along with a staff member making deliveries should see an actively used bottle of gel in the cup holder. The driver should also have ready access to gloves and paper towels. If the surveyor has to ask for it, if the staff member has to rustle around under piles of junk to find it, if the bottle is a tiny travel size that would be inadequate for one day of deliveries, your surveyor immediately recognizes that this is not a part of the driver’s daily practice and you will be cited, no matter how much education you’ve done. There are many ways to assess whether hand washing is part of one’s daily routine. Your surveyor may ask the patient seen during the ride-along if the driver washes his/her hands when making deliveries (when applicable). This is not a function performed merely to please a surveyor; it is the primary means of stopping the spread of infection to your staff and patients and needs to be an integral part of everyone’s daily routine.
• Second, make sure you set up your physical space to allow proper infection control practices to be maintained. You should not allow clean, patient-ready equipment to be commingled with dirty or contaminated equipment. Make sure all items in your clean area are just that. See that they are bagged and tagged according to your policy and procedure and that stray items do not make their way into the area. Each area can be labeled with signage or segregated with tape on the floor if you desire, but it should be clear to all staff and visitors which is your clean and which is your dirty equipment area. Items needing repair or maintenance should be cleaned first before they enter your repair or maintenance area. Items arriving clean from the manufacturer can go directly into your clean area since they are patient-ready. If you uncrate items or open boxes where products will sit in your retail area or on warehouse shelves before they are delivered to the patient, make sure they are wiped down before delivery.
• Third, maintain clean and dirty boundaries in your delivery vehicles when applicable. If you are using small vehicles that do not allow the segregation of clean vs. dirty items during transport, you may have to make separate trips to pick up items, then wipe down the vehicle’s interior space before you place a clean item in it. Transportation issues are important whether you use commercial vehicles, converted mini-vans, small vehicles, personal vehicles or any combination.

This is the time of year when we get our flu shots and worry about the infections we do not want to acquire. Preventing the spread of infection is always an issue, and while accreditation may be the first means by which a provider is exposed to the requirements, it can soon become a natural component of business practice that minimizes risk to both staff and patients.

Mary Ellen Conway, RN, BSN, is president of Capital Healthcare Group, LLC, Bethesda, Md., which provides health care management expertise in accreditation preparation and survey follow-up, operations assistance, design of quality improvement programs and outcome measures. She can be contacted by phone at 301/896-0193 or through www.capitalhealthcaregroup.com.