GREENING OFHOSPITALS WORKSHOP   Cleaning of Surfaces in Patient Care                  Areas   Results From New Hospital St...
Two Paradigm Shifts in Patient RoomCleaning   1st Going from the string mop to the flat mop    system for floor cleaning...
Paradigm Shift #1Using Flat (Microfiber) MoppingSystems in Hospitals
Take Home Message 1. Practical, common-sense approach for    patient care areas, but WILL NOT meet    all mopping needs. 2...
Mopping Requirements  Patient care areas   cleaned daily; common   areas cleaned more often  Floor cleaners can   contai...
Why Hospitals Switch to Flat Mopping Systems     Ergonomic issues     Labor savings     Reduced chemical and water usag...
What is Microfiber?                      1/100th of human hair                       1/100th of human hair                ...
What is Microfiber?                     String Mop Strand                        Human Hair           Microfiber          ...
…and what difference does it make for mopping?     Increases the effective surface area      of your mop     More effect...
Flat Mopping Systems: How Do They Work?  1. Place  2. Mop  3. Peel  4. Launder
vs. Conventional Loop Mops 1. Dip and Wring 2. Mop 3. Repeat 3x 4. Change Water 5. Send to Industrial Laundry
Ergonomic Benefits During use, similar gross     motor skills required Unfavorable positions for     both methods, but f...
Ergonomic Analysis  Tasks                        String Mopping                  Flat Mopping  Lift empty                 ...
Ergonomic Analysis  Tasks                        String Mopping                  Flat Mopping  Carry bucket of water,     ...
Ergonomic Analysis  Tasks                        String Mopping                  Flat Mopping                             ...
Ergonomic Analysis  Tasks                        String Mopping                  Flat Mopping  Mopping the floor          ...
Microfiber Considerations  Cannot be used in areas    contaminated with blood    or body fluid  Some products    ineffec...
CA DHS – Licensing and Certification March 2002Memo:   “…acceptable to install household washing   machines to launder mic...
Not All Mopping Systemsare Created Equal…   No governing body or industry     definition of “microfiber”   Density of fi...
Should I Use Disinfectantsfor Cleaning Floors?  Some microfiber products are treated with    triclosan or other antimicro...
How many mops handles/heads needed? Mop Handles = Number of Janitors Mops Heads =    + twice the number of rooms      clea...
Case Study: University of California Davis Medical Center       Reasons for change…           Increase in worker’s      ...
Cost Analysis: Lifetime Mop Costs  Conventional Wet            Microfiber     Loop Mops                  Mops $5 each    ...
Cost Analysis: Chemical Costs  Conventional Wet             Microfiber     Loop Mops                   Mops 10.5 ounces p...
Cost Analysis: Water Use Conventional Wet              Microfiber    Loop Mops                    Mops 21 gallons per day...
Cost Analysis: Labor Costs Conventional Wet               Microfiber    Loop Mops                     Mops 20 rooms clean...
Flat Mopping Systems               Performance Summary    Microfiber last 5 to 10 times longer    Increase production by...
Costs/Benefits That Are Not Quantified  Reduced risk of cross-   contamination related to   mopping  Reduced worker’s   ...
Discussion1. Who’s currently using microfiber   mops?2. How satisfied are you with them in   patient care areas?3. What hu...
Take Home Message 1. Practical, common-sense approach for     patient care areas, but WILL NOT meet all     mopping needs....
ResourcesEPA Factsheethttp://www.epa.gov/region/waste/p2/projects/hospital/mops.pd      fSustainable Hospitals 10 reasons ...
The Need for Action   The number of Healthcare Acquired    Infections is too high   Even with interventions:           ...
   Unnecessary Deaths: The Human and    Financial Cost of Hospital Infections       By Betsy McCaughey, Ph.D.       HAI...
Estimated Hospital Cost of HAIs      2,000,000 Estimated HAIs per year in USA                          X $15,275.69 Averag...
Cleaning is Essential   Cleaning hands is the first step – preventing    recontamination is the second   Two studies sho...
Cleaning of Environmental Surfacesis Essential   Cleaning of environmental surfaces is so    important that if not done p...
Studies of Patient Room Cleaning   Studies undertaken by HospAA of two-step    cleaning process   Studies measured the c...
Paradigm Shift #2                 Two-Step Cleaning   First step: Clean to remove biofilm with non-    detergent cleaner ...
How Detergent-Free Cleaners Work   Cleaning is defined as: the ability to clean or remove soil from    a surface   Accom...
Background for Studies   Used luminometers manufactured by 3M to    measure adenosine triphosphate (ATP)   ATP measured ...
ATP Luminometer
Carling’s 14 High Risk Objects   Objects:       Sink                Visitor Chair Arm Rest       Toilet Seats        ...
Using the ATP Swab
Results of Studies   Three hospitals: Tested a minimum of 25 terminally    cleaned rooms in Phase I       1,011 measurem...
Efforts to Standardize Studies   Attempted to measure a minimum of 25    terminally cleaned rooms in each phase       No...
Results From Four Hospitals   Phase I (cleaner/quaternary ammonium    disinfectant) (N= 408)       Worst Five measured a...
Four Hospital Study ResultsHRO                      RLUs Before*   RLUs After*                          (Phase I)      (Ph...
Four Hospital Cleaning Study                              2,500                              2,000Relative Light Units (RL...
Percent of Samples Found “Clean”   A surface is deemed to be clean at a reading    of 250 RLU or less using the 3M lumino...
Four Hospital Cleaning Study          100.0%          90.0%          80.0%          70.0%          60.0%Percent           ...
Future Patient Rooms
Continuous Improvement   Train EVS staff in use of DFC + bleach   Use ATP monitoring to measure change   Continue use o...
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  • Can cover all kinds of things – later we’ll talk about green building, which is a monster in itself We want to focus top opportunities – janitorial products. Lots
  • This mass of microfibers creates an enormous surface area which accounts for the high absorption rate. Read articles about the technology…
  • This mass of microfibers creates an enormous surface area which accounts for the high absorption rate. Read articles about the technology…
  • 6 MILES of a microfiber strand weighs 1.0 gram Lower weight = More fibers per pad = Better cleaning
  • Not all replaceable flat mop heads are sized larger than the mop hardware to allow the “peel” factor. umf Corporation has first implemented this t make further ergonomic improvements.
  • A gallon of water weighs just over 8 lbs. Send to industrial launder
  • Yellow cells mean flat mop systems present less ergonomic risk. For all instances, flat mopping is the same or better ergonomically.
  • Should not use bleach or high temperature dryers Should not be laundered with other garments/items “ To address your concerns about sticky floors: stickiness on a floor that is using a quat based product usually is attributed to 2 possibilities. First being a HIGHER DILUTION ratio than recommended.  For example, using 6 to 8 ozs per gallon when 2 ozs is listed.  What happens is the level of ammonium chloride is too high and attacks the floor finish which results in a sticky or tacky feeling on the floor.  Second, it is always highly recommended to use a NEUTRAL disinfectant  when mopping floors which is about 1/2 to 1 oz per gallon and does not attack the finish because of the neutral pH.  Although your using a neutral Quat the higher concentration results in a product that can be far from neutral. Assuming that the concentration of disinfectant is stable, the flat mop can only absorb what is in the bucket.  The flat mop can not change or alter the actual concentration of chemical used. Many dispensing systems are calibrated by sales people. Their job is to sell more disinfectant, thus, we often see concentrations at higher levels than recommended.” -- umf Corporation, Traci Cupp, H2E listserve response to question of “sticky floors” associated with flat mop use
  • Should not use bleach or high temperature dryers Should not be laundered with other garments/items
  • Generally assumed that microfiber has a denier of 0.01 to 0.02. A typical one denier polyester fiber has a diameter of 10 microns. Micron (-Sized Fibers) When fiber size is less the 0.3 denier it is best to define the size is terms of its diameter in microns (10-6 meters). Nanofibers Term used for fibers with diameters less than 0.5 microns. Typical nanofibers have a diameters between 50 and 300 nanometers. They can not be seen without visual amplification. Other terms often used are micro-denier, sub-micron and superfine. Human hair has denier of 20 and a strand of silk has a denier of 8
  • “ The combining of anti-microbials and anti-viral technologies with fibers of 1.0 denier and below (includes microfiber) is covered by International Patents. The objective was to develop a line of high performance textiles (HPT) which would reduce the dependancy on highly toxic chemicals such as chlorine, phenolic, and ammonium chloride based chemicals, particularly in health care. The concept is to have a material constructed of microscopic fiber providing an enormous surface area that would effectively remove everything from a surface, absorb and concentrate dirt and contaminats into the HPT thus exposing contaminants (especially biological) to the anti-microbial permanently bonded to the fibers. In addition, the emphasis on dwell time (required by all disinfectants and typically requires a surface to be wet for at least 10 minutes) was moved from the surface being cleaned to the HPT where dwell time is achieved. Dwell time within health care, especially in a patient room, is neither practical or possible and is rarely, if ever, achieved.   In evaluating different antimicrobial technologies that could be used in high performance textiles the governing concept and principal was to ensure that the active ingriedient (including triclosan and others) MUST be bonded permanently to the fiber for the life of the product and would not disperse into the environment. After an extensive product development cycle this objective was realized. Utilizing a new patented chemistry which bonds the active ingredient to synthetic fibers tests were run to ensure that the antimicrobial stayed in the HPT. All testing was done in accordance with the American Association of Textile Chemists and Colorists (AATCC) protocols for laundering and antimicrobial efficacy. In short, the results showed that the antimicrobial agent was equally effective after 200 launderings as when the material was new. This technology incorporated into a flat mop / wiper system helps to improve performance while significantly reducing the use, and waste, of toxic cleaners/disinfectants (EPA published study showing up to a 95% reduction in chemicals used).” -- UMF Corporation, Traci Cupp Alternative references… (from Catherine Galligan, SHP Clearinghouse) -- Polly, Stuart M. MD, review of the Stuart Levy revised book: "The Antibiotic Paradox: How the Misuse of Antibiotics Destroys Their Curative Powers", JAMA, Volume 288(22), 11 December 2002, p 2898-2899. Dr. Polly reviews the updated edition of Levy's book which cautions that the overuse of antibiotics facilitates the development of resistant microorganisms. "Despite the recent substantial increase in the use of antimicrobial ingredients in consumer products, the effects of this practice have not been studied extensively. No data support the efficacy or necessity of antimicrobial agents in such products, and a growing number of studies suggest  increasing acquired bacterial resistance to them. Studies also suggest that acquired resistance to the antimicrobial agents used in consumer  products may predispose bacteria to resistance against therapeutic antibiotics, but further research is needed." -- Litjen Tan, PhD et al, "Use of Antimicrobial Agents in Consumer Products", Archives of Dermatology, Volume 138(8), August 2002, p1082-1086
  • Ultimately 18 months
  • Washing lifetime = vendors estimate conventional wet loop mops last 55 washings, UCDMC replaced them after 200 washings. Vendors guarantee microfiber mops for 500 washings; UCDMC typically uses microfiber mop heads for over 1,000 washings.
  • Conventional loop mops require 3 gallons of water per bucket, which must be changed every 3 rooms for infection control purposes.
  • Because microfiber mops are easier to use, staff are able to clean an extra 2 rooms per eight hour shift. Time savings come from the microfiber mop’s ease-of-use (weighing significantly less than a conventional wet loop mop) and not having to change out the mop bucket every three rooms.
  • Should not use bleach or high temperature dryers Should not be laundered with other garments/items
  • Should not use bleach or high temperature dryers Should not be laundered with other garments/items
  • Should not use bleach or high temperature dryers Should not be laundered with other garments/items
  • Greening of hospitals workshop cleaning studies

    1. 1. GREENING OFHOSPITALS WORKSHOP Cleaning of Surfaces in Patient Care Areas Results From New Hospital Studies
    2. 2. Two Paradigm Shifts in Patient RoomCleaning 1st Going from the string mop to the flat mop system for floor cleaning 2nd Moving from cleaning patient areas with a detergent + disinfectant to a detergent-free cleaner + bleach
    3. 3. Paradigm Shift #1Using Flat (Microfiber) MoppingSystems in Hospitals
    4. 4. Take Home Message 1. Practical, common-sense approach for patient care areas, but WILL NOT meet all mopping needs. 2. Immediate water and chemical savings, but most cost savings are a result of reduced labor. 3. Improved ergonomics and cross- contamination infection control 4. Proactively address potential hurdles to implementation.
    5. 5. Mopping Requirements  Patient care areas cleaned daily; common areas cleaned more often  Floor cleaners can contain dangerous chemicals  Special precautions required to avoid cross- contamination
    6. 6. Why Hospitals Switch to Flat Mopping Systems  Ergonomic issues  Labor savings  Reduced chemical and water usage  Cross-contamination concerns related to conventional mopping
    7. 7. What is Microfiber? 1/100th of human hair 1/100th of human hair Split wedged shape Split wedged shape of Polyester fiber of Polyester fiber
    8. 8. What is Microfiber? String Mop Strand Human Hair Microfiber Hook Feature (1/10th of a human hair) (Cross-section)
    9. 9. …and what difference does it make for mopping?  Increases the effective surface area of your mop  More effective in cleaning up especially small particles  Microscopic fibers thoroughly clean surfaces
    10. 10. Flat Mopping Systems: How Do They Work? 1. Place 2. Mop 3. Peel 4. Launder
    11. 11. vs. Conventional Loop Mops 1. Dip and Wring 2. Mop 3. Repeat 3x 4. Change Water 5. Send to Industrial Laundry
    12. 12. Ergonomic Benefits During use, similar gross motor skills required Unfavorable positions for both methods, but flat mopping systems significantly reduced the frequency and severity of the risk factors“Case Study: Are Microfiber Mops Beneficial for Hospitals?" Sustainable Hospitals Project
    13. 13. Ergonomic Analysis Tasks String Mopping Flat Mopping Lift empty Lift metal bucket (5 lbs) Lift plastic basin (1 lbs) metal/plastic bucket Trunk flexion 60° Trunk flexion neutral from cart Carry empty Forces at trunk, Negligible forces bucket/basin and walk shoulders, elbow, hands (carrying 1 lb) 3 feet (carrying 5 lbs) Forces acting on neck, Fill and lift Less forces acting due back, hands, wrist, bucket/basin to lower weight (8 lbs) shoulders (water 16 lbs) Upper body posture is Flexion of trunk, hips, neutral; less forces Lift bucket of water, knees, shoulders. acting on trunk, wrist, walk to cart Forces at trunk, wrist, shoulder, and lower shoulder, elbow body“Case Study: Are Microfiber Mops Beneficial for Hospitals?" Sustainable Hospitals Project
    14. 14. Ergonomic Analysis Tasks String Mopping Flat Mopping Carry bucket of water, Forces at trunk, wrist, No longer performed walk to cart shoulder, and elbow Lift bucket of water Wrist and elbow flexion. and place on cart Forces acting as No longer performed surface previously. Walk to closet for Neck extension, hips bottle of cleaning flexion, shoulder flexion Same solution on shelf. 120° Reach and grasp. Add cleaning solution Neck extension, hips and replace bottle on flexion, shoulder flexion Same shelf 120°“Case Study: Are Microfiber Mops Beneficial for Hospitals?" Sustainable Hospitals Project
    15. 15. Ergonomic Analysis Tasks String Mopping Flat Mopping Trunk flexion 80°, elbow Pick up wringer and flexion 60°, shoulders hook it onto lip of No longer performed flexion 80°. Forces bucket acting at trunk. Walking with trunk Walking with trunk Push cart to room, flexion 30°, shoulder and flexion neutral. Pushing distance 25’ elbow flexion 80°. cart with standard Forces acting at trunk. equipment. Palmar grasp, shoulder Remove excess water elevation and flexion, Wring cloth, wrist/hand from mop elbow flexion (using mop twisting with grip force wringer)“Case Study: Are Microfiber Mops Beneficial for Hospitals?" Sustainable Hospitals Project
    16. 16. Ergonomic Analysis Tasks String Mopping Flat Mopping Mopping the floor Trunk flexion Trunk flexion Place mop in bucket of Turn mop head water, wring, and downside up and Mopping the floor continue mopping. replace cloth at mop Same risks as previous head steps“Case Study: Are Microfiber Mops Beneficial for Hospitals?" Sustainable Hospitals Project
    17. 17. Microfiber Considerations  Cannot be used in areas contaminated with blood or body fluid  Some products ineffective in greasy, high traffic kitchen areas  Sticky floors? Non-industrial washing machines must be used to wash microfiber mop heads
    18. 18. CA DHS – Licensing and Certification March 2002Memo: “…acceptable to install household washing machines to launder microfiber mops…” provided:  Water Temp between 130 and 140 degrees F  Separately from other textiles  No bleach/fabric softener “…as long as (these conditions) are met, there should be no infection control related issues.”
    19. 19. Not All Mopping Systemsare Created Equal…  No governing body or industry definition of “microfiber”  Density of fibers per square inch can affect pricing and cleaning ability  …vs denier (diameter of fiber)  Some are pretreated with antimicrobials
    20. 20. Should I Use Disinfectantsfor Cleaning Floors?  Some microfiber products are treated with triclosan or other antimicrobials  Concerns about general use of antimicrobials  Potential for causing antimicrobial resistance  Unknown long term consequences of its use
    21. 21. How many mops handles/heads needed? Mop Handles = Number of Janitors Mops Heads = + twice the number of rooms cleaned daily + “shrinkage” + special circumstance – large rooms, extra dirty rooms
    22. 22. Case Study: University of California Davis Medical Center  Reasons for change…  Increase in worker’s compensation claims  Frequent “light duty” ergonomic requirements  Reduce cleaning time for patient rooms  Reduce chemical use and disposal
    23. 23. Cost Analysis: Lifetime Mop Costs Conventional Wet Microfiber Loop Mops Mops $5 each  $4.00 each 55 to 200 washing  500 to 1,000 washinglifetime lifetime 22 rooms cleaned per  1 room cleaned perwashing washing $0.11 to $0.41 per  $0.40 to $0.80 per100 rooms 100 rooms
    24. 24. Cost Analysis: Chemical Costs Conventional Wet Microfiber Loop Mops Mops 10.5 ounces per day  0.5 ounces per day $0.22 per ounce  $0.22 per ounce 20 rooms cleaned per  22 rooms cleaned perday day $11.55 in chemicals  $0.50 in chemicalsper 100 rooms per 100 rooms
    25. 25. Cost Analysis: Water Use Conventional Wet Microfiber Loop Mops Mops 21 gallons per day  1 gallon per day 20 rooms cleaned per  22 rooms cleaned perday day 105 gallons of water  5 gallons of waterused per 100 rooms used per 100 rooms
    26. 26. Cost Analysis: Labor Costs Conventional Wet Microfiber Loop Mops Mops 20 rooms cleaned per 8  22 rooms cleaned per 8hour shift hour shift $12 per hour  $12 per hour $480 per 100 rooms  $436 per 100 rooms
    27. 27. Flat Mopping Systems Performance Summary  Microfiber last 5 to 10 times longer  Increase production by 10%  Use 95% less chemical  (2.5 vs. 53 ounces per 100 rooms cleaned)  Use 95% less water  (5 gals vs. 105 gals per 100 rooms cleaned)  Overall costs about 5-10% less - not including workers comp savings
    28. 28. Costs/Benefits That Are Not Quantified  Reduced risk of cross- contamination related to mopping  Reduced worker’s compensation claims  Reduced water use  Patients say: “quieter, quicker, less disruptive”
    29. 29. Discussion1. Who’s currently using microfiber mops?2. How satisfied are you with them in patient care areas?3. What hurdles did you have to overcome?4. What have you seen as the greatest benefit to using microfiber mops?
    30. 30. Take Home Message 1. Practical, common-sense approach for patient care areas, but WILL NOT meet all mopping needs. 2. Immediate water and chemical savings, but most cost savings are a result of reduced labor. 3. Improved ergonomics and cross- contamination infection control 4. Proactively address potential hurdles to implementation.
    31. 31. ResourcesEPA Factsheethttp://www.epa.gov/region/waste/p2/projects/hospital/mops.pd fSustainable Hospitals 10 reasons to use microfiber mopshttp://www.sustainablehospitals.org/PDF/tenreasonsmop.pdfPractice Greenhealthhttp://www.h2e-online.org/docs/h2emicrofibermops.pdf
    32. 32. The Need for Action The number of Healthcare Acquired Infections is too high Even with interventions:  Hand hygiene education  Gel stations installed throughout patient care areas  Closer oversight of drug administration  HAIs and associated deaths continue  Cost of a patient room runs $9,462 per day
    33. 33.  Unnecessary Deaths: The Human and Financial Cost of Hospital Infections  By Betsy McCaughey, Ph.D.  HAIs are the fourth largest killer in America  HAIs add an estimated $30.5 Billion to the cost of healthcare in the US each year  There is compelling evidence that nearly all HAIs are preventable  This creates a new legal issue
    34. 34. Estimated Hospital Cost of HAIs 2,000,000 Estimated HAIs per year in USA X $15,275.69 Average additional hospital costs per HAI = $30.5 Billion Per year treating HAIs
    35. 35. Cleaning is Essential Cleaning hands is the first step – preventing recontamination is the second Two studies showed that over half of objects that should have been cleaned or disinfected were overlooked As long as surfaces in a hospital are not cleaned, caregivers’ hands will be recontaminated
    36. 36. Cleaning of Environmental Surfacesis Essential Cleaning of environmental surfaces is so important that if not done properly, the placing of a patient into a room previously occupied by a patient with C-diff can be a fatal error
    37. 37. Studies of Patient Room Cleaning Studies undertaken by HospAA of two-step cleaning process Studies measured the current cleaning prior to implementing the two-step cleaning process  Current process used cleaners with quaternary ammonium disinfectant  This process leaves a residue that can lead to a biofilm
    38. 38. Paradigm Shift #2 Two-Step Cleaning First step: Clean to remove biofilm with non- detergent cleaner that contains 218 ppm bleach  Sodium Chloride is used to soften water  Sodium Citrate is used to chelate hard water mineral deposits  Sodium Carbonate is used to saponafy organic soils into soaps that are easily rinsed  Sodium Bicarbonate is used as a builder and sequester Second step: Wipe the 14 HROs with bleach of 1,000 ppm
    39. 39. How Detergent-Free Cleaners Work Cleaning is defined as: the ability to clean or remove soil from a surface Accomplished by one or more of the following  Lowering surface and interfacial tensions  Solubilization of soils  Emulsification of soils  Suspension of removed soils  Saponification of fatty soils  Inactivation of water hardness  Neutralization of acid soils
    40. 40. Background for Studies Used luminometers manufactured by 3M to measure adenosine triphosphate (ATP) ATP measured in relative light units (RLUs) The 14 high risk objects (HROs) outlined by Dr. Philip Carling in his studies were measured
    41. 41. ATP Luminometer
    42. 42. Carling’s 14 High Risk Objects Objects:  Sink  Visitor Chair Arm Rest  Toilet Seats  Patient Telephone  Over Bed Tray  Rest Room Door Knob  Bed Side Table  Restroom Hand Rail  Toilet Handle  Bedpan Cleaner  Bed Side Rail  Patient Room Door Knob  Nurse Call Box  Restroom Light Switch
    43. 43. Using the ATP Swab
    44. 44. Results of Studies Three hospitals: Tested a minimum of 25 terminally cleaned rooms in Phase I  1,011 measurements made of the 14 HROs  Mean Measurement was 441 RLU  Worst HROs:  Nurse Call Box 900 RLU (N=75)  Patient Telephone 742 RLU (N=68)  Visitor Chair Arm Rest 624 RLU (N=75)  Bedside Rail 503 (N=77)  Rest Room Door Knob 489 RLU (N=53)  Sink/Counter 445 RLU (N=79)  Rest Room Hand Rail 411 RLU (N=76)
    45. 45. Efforts to Standardize Studies Attempted to measure a minimum of 25 terminally cleaned rooms in each phase  No disturbance of patients  The room was ready for re-occupancy Trained staff doing ATP measurements  Uniformity in swabbing  Focused on the worst of Dr. Philip Carling’s 14 HROs Sampled with staff and monitored results
    46. 46. Results From Four Hospitals Phase I (cleaner/quaternary ammonium disinfectant) (N= 408)  Worst Five measured at each facility  Mean 1,360 RLU (r=468 RLUs – 2,290 RLUs) Phase II (DFC + bleach) (N= 412)  Mean 143 RLU (r=89 RLUs – 199 RLUs)
    47. 47. Four Hospital Study ResultsHRO RLUs Before* RLUs After* (Phase I) (Phase II)Restroom Door Knob 1,934 89Nurses Call Box 2,290 143Patient Telephone 1,126 104Bed Side Rail 983 164Visitor Chair Arm Rest 1,045 199Restroom Hand Rail 486 143Sink/Counter 468 127* These are Mean scores in RLUs
    48. 48. Four Hospital Cleaning Study 2,500 2,000Relative Light Units (RLUs) 1,500 Prior Cleaning Tw o-step Cleaning 1,000 500 0 NURSE CALL BOX VISITOR CHAIR ARM PATIENT TELEPHONE BED SIDE RAIL RESTROOM HAND RESTROOM DOOR SINK/COUNTER REST RAIL KNOB High Risk Objects (HROs)
    49. 49. Percent of Samples Found “Clean” A surface is deemed to be clean at a reading of 250 RLU or less using the 3M luminometer Results from the four hospital studies:  Phase I: Found 25.0% were below 250 RLU  Phase II: Found 87.4% below 250 RLU
    50. 50. Four Hospital Cleaning Study 100.0% 90.0% 80.0% 70.0% 60.0%Percent Prior Cleaning 50.0% Tw o-Step Cleaning 40.0% 30.0% 20.0% 10.0% 0.0% <250 RLUs 250 - 499 RLUs 500 - 999 RLUs ≥1,000 RLUs Relative Light Units (RLUs)
    51. 51. Future Patient Rooms
    52. 52. Continuous Improvement Train EVS staff in use of DFC + bleach Use ATP monitoring to measure change Continue use of ATP monitoring for training and quality assurance Monitor HAIs Develop a Process Improvement Story

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