In the work force, companies are often organized in silos, this may help from a budgeting or reporting perspective and is generally based on areas of expertise. However, silos like islands can breed the "it's mine" mentality and we forget about sharing or working collaboratively together towards what is best not just for our department or person but for the company as a whole. We revert back to our tendencies as children where we didn't want to share. It would appear after reading the paper published by Zoutman et al in AJIC titled "Working relationships of infection prevention and control programs and environmental services and associations with antibiotic-resistant organisms in Canadian acute care hospitals" that collaboration is the key to reducing HAIs.
Zoutman et al conducted a survey of Infection Prevention and Control (IPAC) professionals at Canadian hospitals to assess the working relationship between IPAC and Environmental Services (EVS). The survey assessed cleaning collaborations, staff training, hospital cleanliness and nosocomial MRSA, VRE and C. diff infection. Based on the survey responses, 40% of the respondents did not feel the level of cleanliness in their hospitals was at the level it should or could be. One third of the facilities surveyed felt that their EVS staff were not adequately trained even though IPAC provided training and education. Of particular interest is that the same type of survey conducted where EVS managers responded believed that the level of cooperation and collaboration between IPAC and EVS was extensive and excellent which certainly highlights the fact that there is always two sides to every story!
That said, for most of you, I hope their conclusions are not that foreign. A good working relationship that promotes and cooperation and collaboration between IPAC and EVS was associated with lower HAI rates. Of concern, at least to me, was that one-fifth of the respondents were from hospitals where IPAC and EVS did not collaborate on cleaning protocols. Having spent considerable time in the field working with both IPAC and EVS the reality is this is true. Far too many times I have been in a meeting with EVS who did not want to involve IPAC as IPAC's decisions would cost them money they did not have. Other times IPAC wanted to control the decision process for what disinfectant products were to be used.
We know from numerous published studies that cleaning reduces the environmental burden of pathogens. If we remove these pathogens from surfaces, we can limit transmission to our patients. Cleaning saves lives and the health and well being of our patients should be the first consideration in any decision we make. EVS are experts in cleaning and the use of chemicals. IPAC are experts in understanding how HAIs are transmitted and implementation of protocols that will limit the spread of disease. The truth of the matter is that a facility cannot have an effective Environmental Hygiene or Infection Prevention program without the cooperation and collaboration of IPAC and EVS. It's time to break down the silos between EVS and IPAC because in the end it should always be about what is best for our patients.