---
title: Have Wheels? Will travel....including invisible hitchhikers!
description: Have Wheels?  Will travel....including invisible hitchhikers!
---

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## Have Wheels? Will travel....including invisible hitchhikers!

<http://static1.squarespace.com/static/595689fc9de4bbc892200518/t/59568aca5fd63b5f292877a9/1498845561938//img.jpg.com/static/595689fc9de4bbc892200518/t/59568aca5fd63b5f292877a9/1498843850942/1000w/>

In recent years, there has been considerable focus around  
 cleaning and disinfection by environmental services staff (EVS) as we become  
 more in tuned with the risks associated by direct or indirect transmission  
 mission due to a contaminated environment.   
 EVS have been audited, have received training and feedback and have I am  
 certain been reprimanded for neglecting to clean and disinfect one, two or more  
 high touch surfaces.   I know for fact,  
 some of these surfaces get missed as a result of the pressure they get for  
 trying to turn over rooms as fast as possible.   
 In the end, I think we would all agree that having a well trained staff,  
 having an auditing and feedback process and a management team that genuinely  
 appreciates the work EVS does as part of a facility's infection prevention  
 program helps to ensure that EVS are doing the best job possible.

At the other end of the scale are the nursing and other  
 clinical staff who utilize patient care equipment - particularly the portable  
 kinds, on wheels, that can easily move from place to place.  While there have been outbreaks associated  
 with contaminated patient care equipment, there has not been as much focus on  
 who cleans said equipment with what frequency or how to audit to ensure that  
 cleaning and disinfection is in fact occurring.   
 The best example I have of this, and one that I have used for years to  
 highlight the importance of developing roles and responsibilities of who cleans  
 what is what I will refer to as the "case of the poop splattered  
 commode".

Imagine a facility, dealing with a C. diff outbreak, who  
 utilized commodes in semi-private rooms as their way of maintaining private  
 bathrooms.  This facility had an audit  
 program in place using UV reflective markers and was in the process of  
 conducting a clinical study.  In one  
 room, for 5 days the underside of the commode seat was marked and the  
 researcher noted there was fecal matter on the rim of the commode bowl.  For 5 days, the commode did not get cleaned.  There were 5 distinct UV marks that had not  
 been removed or even smeared to show some form of wiping had occurred...  Long story short, when EVS and Nursing were  
 brought together to determine what was going on, EVS stated "a commode is  
 on wheels, therefore is a patient care device that should be cleaned by  
 nursing" and nursing stated "a commode is a toilet, which is a  
 surface that EVS should be cleaning".   
 Clearly, no one had thought to sit down and define who cleaned what.

It for this reason that Havill et al's study titled  
 "Cleanliness of portable medical equipment disinfected by nursing  
 staff" is so interesting.  This  
 facility has taken the time to clearly define roles and responsibilities for  
 what items need to be cleaned and disinfected between use by nursing and  
 clinical staff.  The researchers sought  
 to find out if they were to audit for cleaning compliance and provide feedback,  
 if like the improvements they had found in their EVS staff could they improve  
 the cleanliness of patient care equipment.

During unannounced visits, mobile medical equipment used  
 for patient's vital signs were sampled using ATP (Adenosine Triphosphate  
 Bioluminescence) as well as environmental cultures.  Sites tested included: the control button on  
 the blood pressure unit, thermometer, BP Cuff, machine handle and pulse  
 oximeter.  The results found that these  
 pieces of patient care equipment were frequently contaminated with organic  
 material as well as aerobic bacteria.   
 While VRE was not found on any of the sites sampled, MRSA was found on  
 several surfaces.  The study showed there  
 was a wide variation in cleaning compliance despite polices that clearly  
 outlined who was responsible for cleaning and disinfection.  Similar to results found with EVS staff,  
 implementing an auditing program and periodic education of nursing and clinical  
 staff may be beneficial.

Which leads me back to the title of the blog - Have  
 Wheels?  Will Travel.   Do you know the cleaning and disinfection  
 compliance rates for patient care equipment at your facility?  Or better yet....are you confident that  
 everyone knows who is responsible for cleaning and disinfecting what?  You never know where your "dirty  
 commode" may turn up!

*Bugging Off!*

Nicole

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