As a follow up to my article, “Single-Source Infection Control,” in last year’s October issue, I want to begin an open discussion introducing the goal of setting up an infection control (IC) planned maintenance workorder system for the building industry.

Why discuss this concept? Well, some of the reasons are stated in my October article, but what got me thinking about this topic was a TV commercial telling people they can have a next-day reaction from chemotherapy treatment. It went on to suggest to the TV audience that the patient has a 17% chance of needing to return to the hospital, where they may be extremely vulnerable to a new infection. These infections from hospitals are now called health care associated infection (HAI). This was the first time I had seen a commercial warning people of the risk of going to a hospital — something hospitals aren’t going to tell their patients. HAIs are the sixth leading cause of death in America.

The commercial’s solution was to have the doctor prescribe the advertiser’s product to the patient in order to reduce the need for returning to the hospital and thus avoiding exposure to a potential HAI. That said, my October 2017 solution was to have the HVAC maintenance management group take on the establishment of an IC workorder system for all hospital groups and support services, and to draw employees into this IC group from these other departments to form a single group of planned maintenance workers focused on zero-defects dedicated to eliminating HAI.

So what are the areas to be inputted into the CMMS workorder system database? First, one should differentiate whether the workorder is to clean, sanitize, disinfect, and/or a combination of two or all three responsibilities. Next, the categories, as I see them, are:

  1. HVAC equipment and design criteria

  2. Room types and surfaces including counters, light fixtures, etc.

  3. Other equipment (medical equipment, etc.)

  4. Furnishings (chairs, interior decorations, etc.)

Once the workorder category is inputted, then each workorder will need to be populated with tasks and time allowance to complete each task, beginning with the CMMS operator inserting the “special instructions.” These instructions will include guidelines such as:

  1. Room/space classification (e.g., patient room, lobby)

  2. High touch area categories

  3. Pre-workorder preparation (e.g., perform hand hygiene, clean gloves)

  4. Personal protection equipment (PPE) (e.g., face mask, safety glasses)

  5. Note “contact precautions” (e.g., airborne precaution, touch precaution)

  6. Identify the material for wiping (e.g., type of wipe, cloth)

  7. Identify solutions for cleaning (e.g., type of disinfectant)

  8. Inventory special tools (e.g., key, allen wrench, vacuum cleaner) 

  9. Manufacturer’s recommendations for cleaning

  10. Room suggested cleaning path (e.g., clean moving clockwise around the room)

These are just 10 considerations for documenting special instructions. There are certainly far more guidelines when creating the workorders based on the type of room, equipment, furnishing, and/or HVAC design criteria. Once the specific workorder is formatted and the tasks itemized, then a budget estimate of time can be placed next to the task, along with frequency of cleaning (e.g., daily, weekly, monthly, quarterly, semi-annually, or annually).

From a quality control point of view, completed workorders can be randomly selected and the IC HVAC group manager, along with the IC technician who had filled out the finished workorders, can do a tour and inspection. The IC technician will bring along the selected workorders for review and confirm that the IC maintenance had been done according to the workorder special instructions, tasking, and within the estimated timeframe.

Another part of the quality control process should be to monitor and measure the planned maintenance initiative and report to the facility’s personnel in charge (e.g., president, other departments, occupants, and visitors) as a means to highlight the success of this IC group. The reporting will depend on who is receiving the report, but craft it as a marketing piece to share the IC success and the IC zero-defect goal for the facility. For many, a simple graph posted in the front lobby is worth a 1,000 words to spotlight and call attention to the results.