Think Pink: Is your equipment clean?
Think Pink: Is your equipment clean?
Informal exchange leads to bright idea
It began with an exchange between an infection preventionist and a clinical manager over a piece of equipment, a walker used to allow unassisted movement by patients.
IP:Is that piece of equipment clean?
Manager: Of course it is.
IP: How do you know?
Manager: Well . . . just because we clean it between each patient use.
The exchange left a seed of doubt in the manager's mind. It grew into an idea that has gone hospitalwide and taken on a distinctive color and slogan: Think Pink.
"We realized when she challenged us that we needed to come up with a way to communicate that our equipment is clean to other professionals and also to our patients," says Colleen Fitzsimmons, MSPT, clinical manager of inpatient therapy services at St. Joseph Health Services in North Providence, RI.
The IP that asked the telling question is Marlene Fishman, MPH, CIC, director of the infection control program at St. Joseph. "Colleen and her staff came up with this idea for a bright object — hot pink so everyone would see it very easily — and suggested those coiled key ring-style bracelets," she says. "They can be rolled around any item and stretched to a great degree. They began a trial and it worked very well; so, we started to focus on this, bring it hospitalwide, and get everyone enthusiastic about it."
IPs are well aware that the importance of environmental fomite sources of transmission is being taken a lot more seriously with the emergence of an epidemic strain of Clostridium difficile. Then there is the threatened arrival — from a cruise, no doubt — of norovirus on any given hospital day. Beyond those two nasty bugs, everything from bacteria such as methicillin-resistant Staphylococcus aureus and viruses such as hepatitis B have been shown to linger on environmental surfaces and equipment long enough to pose potential transmission risk to a subsequent patient.
Thus Fishman's original question and the program that came to be the answer. The ID tags were trialed successfully on a rehabilitation unit and subacute nursing floor, with nursing, housekeeping, and physical and occupational therapists trained on the key facets of the program. "Before you use a piece of equipment, you remove the tag," she says. "Then once you are done using the equipment, you wipe the equipment down and reapply the tag."
Though all equipment is cleaned between each patient use, the "ready-for-use" tag is placed only on equipment that remains on the floor rather than being stored in the clean equipment area. The idea is to assume any equipment is dirty if it is not labeled and it is not stored in a designated area. "We have a lot of equipment, such as ambulatory devices, walkers, canes, exercise mats, lifts, automatic blood pressure machines," Fitzsimmons says. "Anything that it not stored in a designated clean area would be labeled with one of these tags."
Phones and computer keyboards are not included because they are constantly in use and are more appropriately targeted by periodic cleaning than tagging. "There also are some exceptions we have made for some departments that are very efficient in separating and maintaining their clean equipment," she says. "It would slow them down to have to put the tags on." For example, some of the ambulatory surgical areas have a system established to designate clean stretchers.
Trust but verify
Such was not the case throughout the hospital, as facilitywide training sessions conducted at baseline clearly indicated the need to educate staff on cleaning equipment. Participants at an education program failed 72% of the time in their attempts to remove simulated "germs" that glowed under blacklight. "It was very sticky substance — hard to get off," says Fishman. "I wanted to make sure that they worked hard at it and understood that some time and focus is needed. That was part of our demonstration."
The next phase will be to actually check equipment that has been tagged as clean and report back findings to staff. There also is an ongoing monitoring component to determine that staff understand the identification system and are complying with the use of the tags. Overall, the staff has embraced the program as the "Think Pink" rollout included bookmarks, notepads, pens, and other pink promotional items to raise awareness. "This is a program that is very catchy, and one that my clinical staff bought into rather readily," Fitzsimmons says. "It is always a challenge to convey the importance of what Marlene does to clinical staff."
True enough, they may know to wash their hands — even if they don't always do it — but the threat of the inanimate object is another teaching challenge. "Everyone has been focusing on hand hygiene, but we know that is just one piece of the puzzle," Fishman says. "We made sure that they have a bleach product available to them in the clinical areas. We also brought in a new product, one of those tubs of pop-up wipes. We taught them that they can use a single wipe to clean a visibly clean surface, but if it has blood or body fluids on it or obvious contamination then they should use the bleach product."
A unique approach to identifying cleaned equipment by using a key ring coil with an easily recognizable hot pink identification tag is both simple and effective, she notes. There is no need to date the identification tag, nor does one have to deal with residue from tape or labels.
"You may walk in our corridors and see an EKG machine plugged into a wall charging," Fishman says. "If it has a 'ready-for-use' tag on it, then the next person who comes along to use that equipment will know that it is clean."
It began with an exchange between an infection preventionist and a clinical manager over a piece of equipment, a walker used to allow unassisted movement by patients.Subscribe Now for Access
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