Wednesday, October 25, 2006

A Clean Start

It has been a while since I have written a real where shall I begin? How about with a clean bed, where most patients hope to start their hospital experience. Unfortunately, it appears that a clean bed isn't always what it seems. A recent article in the Archives of Internal Medicine reported that ICU patients in beds that were previously occupied with MRSA infected patients had a 40% higher chance of catching the bug than patients whose beds had not. The collective cry of "eh!" from everyone reading this statistic is definitely ringing in the ears hospital housekeeping managers across the country.

Let's take a look at the typical housekeeping department of an American hospital. For one, it is staffed by some of the lowest paid employees in the hospital, which, of course, is not a reflection of their value to the organization, but more of the market. As it is an overhead department, it is likely staffed to the bare bones as well. Frequently, this owes to the fact that housekeeping departments usually report up to a general services VP, who often reports directly to the CFO. The housekeeper is a relatively isolated member of the patient care staff. They are usually assigned a zone or group of departments to work in alone and are not considered a member of those departments' patient care teams. On top of all of this, there is a significant pressure from nursing to "turn over" beds quickly - that is to clean them after a patient has been discharged to get it ready for the next patient. It is in this context that the housekeeper preforms his or her most important task - keeping a bug from one patient from passing to another.

My hope is that this study will cause hospitals to take a second look at not only their infection control policies, but the larger issue of how housekeeping is integrated into the patient care process. If the hospital is supposed to be a special place where the sick go to get well, then we need to make sure that manage each step of the process to that end. Even the clean up.


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