de clutter strategy â€“ vancouver island health authority

DE-CLUTTER CAMPAIGN

INFECTION PREVENTION & CONTROL PROGRAM

March, 2010

2 De clutter Strategy – Vancouver Island Health Authority

Getting the team together…

Securing Site Director/Management commitment:

• Action: Ensure agreement for the campaign to be discussed within a regular meeting at which key managers and decision makers are present

March 12 2010

Getting the TEAM together: Infection Prevention & Control Site Director Unit Manager Wellness & Safety CNL/CNE group FM&O Housekeeping/Laundry Logistics Stores This list will be adapted to each site. If a key member cannot be part of this working group please ensure a designate may be present. Other disciplines to be considered: protection services (liaise with Fire Marshall) and food services.

• Action: Ensure support for campaign at site with a presentation of the campaign made to all key staff groups

• Action: Review of De clutter Policy and Procedures by TEAM and recommendations from Saanich Peninsula Hospital initiative report

• Action: Establish and prioritize perceived issues for site, being realistic of goals and timelines

• Action: Review sites established positive de cluttering initiatives with a view to standardize

• Action: Review incident forms re clutter issues and staff injuries to identify any areas of concern

• Action: Establish ‘Work Plan’ and complete work plan document. Consider strategy start date, education, communication re campaign and expectations, and look to establish unit working groups

• Action: Refer to individual ‘Roles and Responsibilities’, add to as necessary, and prepare for strategy to be introduced into your area of work


• Action: Establish follow up meetings for TEAM members to promote good communication throughout strategy

• Action: Familiarize with de clutter audit tool and prepare for initial audits to

be completed in individual areas

• Action: Consider potential positive media involvement, both intrinsic and external

Expectations of TEAM members: To commit to one initiative To move their responsibilities forward To maintain campaign momentum Promote good communication

March 12 2010


Unit level…

Securing unit level commitment:

• Action: Communication of TEAM members to their respective wards/units to inform and secure support of the de cluttering strategy

• Action: Implementation of staff ‘champions’ for each ward/unit in order to facilitate responsibility for local ward based implementation – as change will be ongoing

• Action: Inform staff of the inclusion of audit within this campaign. Explaining that year on year data can assist in monitoring the effectiveness of Infection Prevention and Control programs and assist in strategic planning to meet long term objectives

• Action: Review of working area, identification of de cluttering ‘issues’ and priority of implementation

• Action: Discussion around, and establishment of, the ‘work plan’

• Action: Ensure unit/departmental staff have access to campaign/attend staff education power point presentation of campaign overview

• Action: Implementation of ‘de cluttering contest’ and correlation of suggestions

• Action: Responsible for printing necessary campaign media materials for utilization on individual wards/units

• Action: Implementation of the campaign procedure and de cluttering priorities identified by the TEAM

Expectation of Staff Champions: To move their responsibilities forward To maintain campaign momentum Promote good communication

March 12 2010


March 12 2010

Ongoing initiatives…

• Action: Role out and maintain educational De clutter in-services., ensuring all staff will have access

• Action: Utilize De clutter audit tool on a regular schedule to ensure campaign is having a positive affect within VIHA

• Action: A review by the TEAM of the information gathered, will identify those necessary actions needed to maintain progression of the campaign and support longevity

• Action: TEAM to promote and maintain good communication through all levels

• Action: Utilize internal communication initiatives (i.e. Currents) to feedback success to all VIHA staff

• Action: Take photographs before and after implantation of initiatives to show positive affects

It must be noted that the campaign has a better chance of sustainability if the staff, VIHA wide, have ownership of it.

De-cluttering Policy and Procedure

1.0 Preamble

Cluttered hallways, patient rooms, medication rooms, nursing stations, staff rooms, meeting rooms, and basement corridors all contribute to issues related to the health and safety of staff and patients. Clutter leads to:

Increased injuries

Increased potential for transmission of microorganisms

Interferes with the ability to clean equipment and furniture effectively in a timely and efficient manner

Potential risk in the event of an emergency and/or evacuation (possible fines from the jurisdictional fire department).

All hallways, fire doors, fire pull stations and exits are designated by law (BC Fire Code) to remain clear at all times. Each department is required to arrange effective storage space for the supplies that they need to do their work or furniture they wish to warehouse.

In circumstances where equipment must be stored in a hallway either temporarily or permanently, store the equipment on one side of the hallway.

2.0 Policy

Each program/department will:

1. Create and sustain organized and orderly patient and workspaces where supplies and equipment required for care or practice are clean, in good working order, and accessible in a timely manner, while avoiding the temptation to overstock; and

2. Remove clutter from work areas.

3.0 Definition

Clutter – Items or equipment that interfere with one’s ability to do their work, or have the potential to contribute to issues related to the health and safety of patients and staff.

Procedure for De-cluttering Patient and Workspaces

Area/Space

Strategies for De-cluttering

Rationale Accountability Comments

Cost Impact

Patient Rooms Keep over bed table free of equipment and debris.

Instruct patient and family to store patient’s personal bedside items (eyeglasses and case, reading material, tissues, in a large zip-lock bag. Change the bag weekly or as needed.

Provide individual personal care items for each patient.

Request families to take unnecessary items home

Limit the items kept at the hospital including additional mobility aides not being used.

Determine which medical/surgical supplies MUST be stored in the patient room and remove anything else. Store “required” supplies in a large zip-lock bag. Change the bag weekly or as needed.

Dispose of all used and unused medical/surgical supplies at the time of discharge.

Maintaining patient rooms in an orderly manner allows the patient easy access to his/her personal items, facilitates cleaning of the bedside areas, and provides a clear space for the delivery of meals trays.

Providing individual supplies of personal products prevents the transmission of microorganisms on multi-use products between patients.

Limiting unnecessary supplies in patient rooms reduces clutter and avoids the cost of disposing of the unused items at the time of discharge.

Health Care Workers

Patients/residents Family/visitors

Plastic zip-lock bags are available for storing personal items and medical/surgical supplies.

The sizes of the personal products have been reviewed with the Purchasing Dept.

Minimal cost for zip-lock bags.

Cost savings by reducing the amount of supplies disposed of at time of discharge.

Supplies Regularly monitor inventory Reducing clutter and Health Care In the majority of Initial costs for

Vancouver Island Health Authority ‐ September 2010

Area/Space St ering rategies for De-clutt


Cost Impact

and reduce unnecessary amounts of supplies.

Avoid duplication of supplies in the area whenever possible.

Organize supplies for easy access by function.

Assign each item a spot and label the items by name, ordering number and quota using laminated labels.

Use hooks, pegs, shelving, bins, and/or baskets to store items.

Do not store cardboard boxes on the floor.

Avoid overstocking patients’ rooms with supplies that may not be required.

Store clean or sterile supplies six (6) inches off of the floor.

Supplies dropped on the floor are no longer considered sterile.

organizing supplies allows easier access to required supplies.

Limiting unnecessary supplies in patients’ rooms reduces clutter and avoids the cost of disposing the unused items at the time of discharge.

Cleaning around boxes on the floors creates a wet surface, a source for transmitting microorganisms.

Workers Stores Attendants

cases, three (3) days of supplies are stored on the units in the clean storage area.

hooks, pegs, shelving, bins, and/or baskets offset by cost savings in supplies.

Linen Regularly monitor inventory & reduce unnecessary amounts of linen.

Ensure the room where the linen is stored has a door that is kept closed. If this is not possible, the linen cart covers should remain closed around the linen racks when not being accessed.

Store clean linen at least three (3) feet away from any “dirty area/items” or fire equipment.

Use hooks, pegs, shelving, bins, &/or baskets to store items for easier access.

Limiting unnecessary amounts of linen in patients’ rooms reduces clutter, reduces the frequency of shortages in the department or elsewhere, and avoids the cost of having the unused linen re-laundered at the time of discharge.

Avoid time-consuming chore of storing large amounts of linen on individual lakeside carts along with supplies that are used between patients. The exposed linen is considered contaminated.

Health Care Workers

In the majority of cases, linen is provided daily to the units.

IPC does not support linen being stored in the patient room on carts – closed or open.

Initial costs for hooks, pegs, shelving, bins, and/or baskets to store linen.

Reduction in costs for reducing amount of clean unused linen requiring laundering at time of patient’s discharge.

Reduction in time spent decanting linen from carts to individual

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SArea/Space trategies for De-cluttering


Cost Impact

Clean linen that is removed from the clean supply area/cart should not be returned to the cart. The large linen carts are to be dedicated for linen only and not other supplies.

Do NOT stock bedside tables or patient rooms with additional linen.

Do NOT use individual linen carts for storing linen and taking to the bedside.

Clean linen that has been dropped on the floor is considered soiled.

Install hand hygiene stations close to linen carts and warming cupboards.

Provide a soiled linen hamper for each room; do NOT fill the hamper more than 2/3 full to reduce injuries handling heavy bags. In areas of VIHA where Laundry Totes are used, ensure the Totes are accessible.

Soiled linen is NOT to be placed on the bedside table, the floor or in the sink.

carts; one step process for gathering linen from cart to patient’s room.

Equipment When purchasing new equipment, determine where the equipment will be stored and the process for cleaning it including identifying who is responsible for cleaning the item.

Regularly review equipment and identify the frequency of usage; for example, daily, twice weekly, weekly,

Ensuring equipment is available in a timely manner, clean and in good working order is essential for providing patient care.

Store CLEAN items in CLEAN spaces.

Health Care Workers

Housekeeping Services

Logistics

VIHA’s Facility Maintenance & Operations provide a regular maintenance service for equipment

VIHA’s Logistics Services has policies and procedures for removing, storing, and disposing of equipment.

Initial costs for hooks, pegs, shelving, bins, and/or baskets to store equipment.

Page 4 of 4


Area/Space

St e-cluttering rategies for D

Rationale Accountability

Comments Cost Impact

monthly, etc. Identify equipment requiring

cleaning with a “soiled” label and store in a space identified and labeled specifically for soiled equipment.

Store clean equipment in a clean space. Attach a clean label identifying the date it was cleaned.

Use hooks, pegs, shelving, bins, &/ or baskets for easier access to equipment.

Store clean equipment required less frequently or in a designated storage area for the site.

Request Logistics to dispose of equipment that is no longer required; label equipment as “Recycle”.

Request Logistics to dispose of equipment that is beyond repair; label equipment as “Toss”.

Equipment for Repair

All equipment requiring maintenance or repair must be cleaned and/or disinfected, and tagged with a “clean” label before being removed from the unit and sent to maintenance. Request Housekeeping Services to clean the item and tag it.

Complete a “Request for Service” form and attach a copy to the item.

Maintenance will pick up the clean equipment from the

To reduce transmission of microorganisms on the patient care equipment, it is essential that the equipment is cleaned before and after it is repaired or maintained.

Health Care Workers


Facilities Maintenance & Operations

Page 5 of 5


Area/Space




designated clean equipment room. Following repair, request Housekeeping Services to clean the item, label it, and place it the designated clean space.

Furniture Replace cloth furniture with vinyl furniture in high risk areas specifically used by patients; i.e. Patient rooms, waiting rooms and any areas where a healthcare worker goes after providing direct patient care; e.g. nursing station, staff lounge, report area, conference rooms, offices within patient care areas.

Replace torn vinyl furniture or broken furniture.

Label patient’s wheelchair or walker with the patient’s name. Store the items in the patient’s room whenever possible.

Request patient or patient’s family to store additional patient-owned mobility aides not required off-site.

All furniture should be constructed in a way that permits cleaning of all surfaces. The size, shape and design of the furniture must allow easy access for cleaning staff.

Managers or designates

Health Care Workers

Initial cost of replacing vinyl furniture, torn vinyl furniture or broken furniture.

Hallways All hallways, fire doors, fire pull stations and exits are designated by law to remain clear at all times. Each department is required to arrange effective storage space for the supplies that they need to do their work or furniture they wish to warehouse.

In circumstances where equipment must be stored in

Cluttered hallways are a safety hazard especially in emergency situations when patient and staff are required to evacuate an area. In circumstances where equipment must be stored in a hallway temporarily or permanently, store the equipment on ONE side of the hallway wherever

Health Care Workers

Housekeeping Staff

Fire Regulations require hallways to be clear.

Page 6 of 6


Area/Space

St ering rategies for De-clutt



a hallway temporarily or permanently, store the equipment on ONE side of the hallway.

Designate and label “clean” and “soiled” areas. Ensure they are a minimum of three (3) feet apart.

possible.

Clean Utility Room/Space

Identify the room or space as “CLEAN”.

Ensure the space is a minimum of three (3) feet from a soiled area.

Identify clean items with a “clean” label with the date it was cleaned.

Install hand hygiene stations beside all warming cupboards and linen carts.

Remove the “clean” label when using the clean item.

Store only CLEAN items in CLEAN areas to reduce potential for contamination.

Health Care Workers

Logistics Services

Minimal cost for installation of hand hygiene dispenser holders.

Soiled Utility Room/Space

Store clean urinals, basins, and bedpans in closed cupboards or closed storage containers.

If none of this is possible, open shelves must be located away from “splash or spray risks” around sinks and hoppers.

In addition, store the following items in the soiled utility room: • Cleaning supplies for the

use of non-housekeeping staff;

• Soiled trays and equipment;

• Soiled linen; • Personal Protective

equipment to wear while

Store specimen containers and personal protective equipment behind closed doors to prevent contamination from “splashes” and/or “sprays”.

Health Care Workers

Initial cost of shelving for supplies.

Page 7 of 7


Area/Space




cleaning items (e.g. Face shield, water resistant surgical masks, water resistant aprons, and gloves);

• General and Biohazardous waste containers; and

• Specimen fridge. Do NOT store the following

items in a soiled utility room: • Excess supply of gloves; • Kleenex boxes; • Skin antiseptics; • Personal hygiene

supplies (e. g. soaps, mouth care products, lotions); and

• Sterile items such as wound dressings.

Do NOT store commodes that have been cleaned after patient use in the Soiled Utility Room. Store them in a separate clean area.

Storage Area Clean storage room regularly. Only store clean items

tagged with date of cleaning. Use hooks, pegs, bins,

baskets and/or shelving to store items for easy access.


Health Care Workers


Initial cost of hooks, pegs, bins, baskets, and/or shelving.

Central Depot(s): On-Site

On-site Identify a storage area(s) on

site for equipment used infrequently but when required must be accessible on an urgent or emergent.

Remove all items, clean the room and replace only the items required (items must be cleaned and disinfected).


Health Care Workers


Logistic Services

Page 8 of 8


Page 9 of 9

Area/Space



Cost Impact

Dispose of the other items or share with other facilities.

Paper When developing a poster/sign, consider laminating it if it: • Will be posted for 30

days or more (and dated), or stored and re-used; i.e. precaution signs

• Is posted in a patient or staff bathroom or dirty utility room regardless of the duration of use.

If not laminated, remove and replace it if it becomes dirty, tattered, or torn.

Sheet protectors are not recommended as they cannot be easily cleaned and require tape to seal the top.

Store patient’s clinical records in plastic binders and/or plastic clipboards.

Replace corkboards with white boards or paint corkboards with a sealing product.

Dispose of outdated books and binders

Dispose of manuals where the most current information is available on-line

Do NOT place cardboard boxes on the floor.

Creating surfaces such as white boards or post-it boards that can be cleaned effectively is important in reducing the transfer of microorganisms.

Most signage presents a very low risk for transmission of organisms.

Cleaning around boxes on the floors creates a wet surface, a source for transmitting microorganisms.

Health Care Workers

Managers and Designates

Clinical Nurse Educators

Facilities Maintenance and Operations

Magazines and books are not fomites for microorganisms. However, they may interfere with cleaning the surfaces beneath them.

Cost of lamination of paper.

Cost of white boards or sealing product for corkboards.

De‐Cluttering Patient and Work Spaces

Key Roles and Responsibilities of Stakeholders

Position Responsibilities Comments

Site Director Identify stakeholders and schedule initial meeting

Introduce de-cluttering initiative with PowerPoint presentation and toolkit

Review the policy and procedure with the stakeholders and operationalize it for the facility

Complete initial tour of facility assessing clutter, functionality of space and equipment, and identifying storage areas

Take photos pre- and post-de-cluttering

Communicate initiative to staff Identify areas to be de-cluttered in

work plan Priorize work plan Assign people to the work Schedule regular follow-up

meetings to update progress Evaluate completion of de-

cluttering work Celebrate accomplishments with

stakeholders and staff Identify steps to sustain de-

cluttering work; e.g. Spring and Fall Campaigns

Multiple facility wide or unit specific or room specific tours may be required

Managers/Clinical Coordinators

Participate in identifying and labeling clutter

Label equipment as “Keep”, “Recycle” or “Toss”

Schedule Logistics to remove unwanted items

Coordinate reorganization and labeling of space and supplies

Schedule regular blocks of time whenever possible to maintain momentum of initiative

Clinical Nurse Develop education plan specific to site based on De-Cluttering Policy

Involve the staff as much as possible in the

Vancouver Island Health Authority – September 2010

2

Vancouver Island Health Authority – September 2010

Position Responsibilities Comments

Educator

and Procedure Educate staff about de-cluttering

and how it relates to the principles of Infection Prevention & Control using the PowerPoint presentation

Gather ideas from staff; e.g. a De-Cluttering Contest

Develop a “Top Ten” list of the practice changes specific to the facility and post for staff

Educate patient, family and visitors with information sheet incorporating de-cluttering principles for patient rooms

initiative

Health Care Workers and Support Staff

Store equipment temporarily or permanently on one side of the hallway

Identify clutter for removal Contribute to the discussion re

solutions for storing equipment Limit amount of medical and

surgical supplies and line taken into the patient’s room.

Environmental Support Services Housekeeping Services

Work with the IP&C aides to clean spaces and equipment

Label clean spaces and equipment as clean

IP&C Aide Clean storage rooms Clean equipment before storing in

clean rooms Organize medical and surgical

supplies (working with the unit Equipment Aide or patient Service Aide)

Label supplies Infection Prevention & Control Practitioner

Act as a resource for the stakeholder group, health care workers and support staff

Facilities, Maintenance & Operations (FMO)

Respond to requests for improvements; e.g. installation of shelving.

Logistics Remove equipment, furniture and items for storage or disposal

D E - C L U T T E R I N G

PAT I E N T A N D W O R K S PA C E S

“Top Twelve List”

1. Keep over bed tables clear.

2. Do not store medical/surgical supplies at the bedside.

3. Assign individual personal products for each patient. Do not use multiple-use products

between patients. Patient may be given these products to take home at their time of discharge.

4. Gather linen and medical/surgical supplies at the beginning and during your shift for your

assignment. Do NOT overstock rooms with linen and supplies. Take what you need.

No linen or supplies will be stored on individual lakeside carts.

5. Store soiled linen hampers in patient rooms (or the soiled utility rooms), not in the hallways. Cloth bags are sufficient unless the soiled linen is “saturated” or “dripping”. Fill the bags only 2/3 full to prevent injuries.

6. Keep hallways clear. When it is necessary to store items in the hallways temporarily or

permanently, store them on ONE side of the hallway only to facilitate evacuating the building if necessary.

7. Garbage cans will be placed in patient rooms, not in the hallways.

8. Medical and surgical supplies are centralized to the Clean Supply Room.

9. Store clean items at least 3 feet from any dirty areas/items or fire equipment.

10. Store soiled equipment waiting to be cleaned in the Soiled Utility Room. When cleaned,

they will be labeled with a “clean label” and stored in the appropriate clean storage area.

11. Equipment requiring repair must be cleaned prior to removal from the unit/department.

12. If posting information on the units remember: non laminated posters must be taken down within 30 days.

Enhanced Service

FURNITURE MOVEMENT Crothall Services is pleased to announce the implementation of a standardized furniture movement service at all contracted sites. For many facilities this is an Environmental Service enhancement as per the terms of our contract with VIHA. The service is intended to facilitate the routine relocation of office furniture and other small furnishings or pieces of equipment not requiring the expertise of other VIHA departments. This enhanced service will commence May 9, 2005. To Access Service: 72 hours advance notice will guarantee service delivery during the next

scheduled service session. Contact Crothall Call Center : RJH/VGH: 250-220-8487 SPH/QA/JdeFuca:250-220-8487 CDH: speed dial 3533 NRH: speed dial 1042 Email Crothall Call Center: [email protected] Call center personnel will complete necessary documentation Required Information: Contact person - including department & telephone # Date service is required - routine service will be scheduled between the hours of 10:00 & 14:00 each Tuesday & Thursday Item description - describe what is to be relocated (volume etc) Pick-up point - where is the pick-up to be made (site/room # ) Point of delivery - where is the delivery is to be made (site/room # ) Receiving contact person - including department & telephone # Call center personnel will arrange transport through Material Management Transport Services if the move is between sites. (cost remains the responsibility of VIHA) Service requirements outside the guidelines above should be communicated as early as possible. Confirmation of available ESS service will be communicated after assessment by the Crothall Services supervisory team on a case-by-case basis. To prevent damage in transit or injury to personnel, please ensure that drawers are cleared and that contents are safely secured. Contact your local Crothall Services Supervisor or Manager with comments, suggestions &/or concerns. NOTE: You should continue to use existing systems to support your service needs in the following areas:

the disassembly of furniture and equipment, delivery of new or disposal of old furnishings and equipment, I.S. computer related equipment, transfer of furniture and equipment to and from Plant Services for repair storage of furnishings or equipment transport of files & records minor items such as patient belongings, new mattresses, lab specimens, mail, medications, IV Med Pumps, CPS

supplies etc. Revised May 5, 2005 / Dec 2008

mailto:[email protected]

Work Plan for De-cluttering Patient and Work Spaces

Priority Order

Area or Room


Assigned to

Comments

Funding Requirements

Name of Facility

Keep

Date: ________

Name of Facility

Keep

Date: ________

Name of Facility

Keep

Date: ________

Name of Facility

Keep

Date: ________

Name of Facility

Keep

Date: ________

Name of Facility

Keep

Date: ________

Name of Facility

Recycle

Date: ________

Name of Facility

Recycle

Date: ________

Name of Facility

Recycle

Date: ________

Name of Facility

Recycle

Date: ________

Name of Facility

Recycle

Date: ________

Name of Facility

Recycle

Date: ________

de clutter strategy â€“ vancouver island health authority

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