Beyond the Surface: Safety Through Effective Terminal Cleaning

Hello and welcome to Transmission Interrupted.

My name is Jill Morgan.

I'm a nurse here at Emory University Hospital in Atlanta, Georgia, and I am the

host today of Transmission Interrupted.

For those of you not yet familiar with NETEC our mission is to set the gold

standard for special pathogen preparedness and response across health systems in

the US with the goals of driving best practices and closing knowledge gaps

and developing innovative resources.

NETEC works alongside and in cooperation with the CDC and is

funded by ASPR the Administration for Strategic Preparedness and Response.

And I am excited and indebted, to the folks that are here with

us today to talk about infection prevention and terminal cleaning.

And I will say that we have two infection prevention specialists with us today.

And it's rare for you to be able to say that you sort of owe your life to a

group of people, but in this case, it really is true that having taken care

of the Ebola patients that we had at Emory, I don't think that we could have

made it through that or had the plans and the processes in place that led

to our success if it weren't for just exceptional infection prevention folks.

And so, my hat is off to infection preventionists, and I'm really

grateful to introduce you guys to the two folks we have with us today.

So, we have with us today Cassie Prather.

She's an infection prevention specialist at Providence Sacred

Heart Medical Center and Children's Hospital in Spokane, Washington.

And Erika Kurili, who is the Senior Infection Prevention

Specialist at Corwell Health West.

I am so excited you guys are here with me today.

I really appreciate it and welcome to Transmission Interrupted.

Thanks for having us.

Thanks, Jill.

Introduction.

you're so welcome, and we're just gonna dive into

just some language and making sure we're all using the same terms.

So obviously infection prevention in terms of biocontainment covers a lot of things.

You know, making sure we're using EPA approved wipes and probably

had a lot to do with the choices of PPE and things like that.

But today we're really specifically gonna talk about something that

we call sort of terminal cleaning.

And so that is a process that would happen, for instance, perhaps

in an emergency department or a biocontainment unit or in a

laboratory after the risk is done.

So after patient care is finished or a patient has moved out or whatever

happens, we're talking about taking on that space and making it usable again.

Safely.

So I'd love to just talk about the terms we use and making sure we're

all in the same place for this.

Like, terminal clean versus dcon, or the difference between terminal

cleaning and just regular cleaning.

I mean, hopefully I want every patient care space to be able to be back and

safely and ready for another patient.

So I would love to dive into this and talk a little bit about

the things y'all know best.

Spaulding Classifications, reading labels, all that kind of stuff, so who

wants to dive in first to sort of the standard room clean versus terminal clean?

I can take that one.

So when we're looking at doing a terminal clean for any of our patients,

obviously we're wanting to make sure that we get every single touch surface

in that area clean from any bioburden.

So, when we do those daily cleans, we're using some of our low level

disinfection, wipes that we have on staff.

We're also looking at trying to make sure that we do high touch

surface on a normal patient.

When we have a patient with a special pathogen, we wanna up those wipes as

much as we possibly can on a daily clean.

So when we're, when we're standing in those rooms and we are kind of waiting

for the next task to hand off with the next patient, It might be wiping

off any of the bed rails, or wiping the door handles, or wiping any of

the countertops or any of those items.

When we're looking at a terminal clean, we're looking at going into that room

after the patient has discharged and really soaking it with a lot of chemicals.

We're looking at really, truly getting the clean bioburden.

We wanna get all of the bioburden off as much as possible.

And then going back in with another process such as a UV light disinfection,

or a hydrogen peroxide spray.

And kind of looking at making sure that we're getting every single surface rid of

any type of organism that we possibly can.

Yeah, it's a lot.

I'm glad you mentioned sort of keeping the bioburden down while

a space is in use, because I think that's absolutely important and

something, you know I don't think I had really thought of before Ebola.

And then after Ebola, I was like, oh my gosh, every time I went into my clinical

shift at work, I'd be like, those night shift nurses are just a hot mess.

And you come through and wipe off your care space and making sure

that the places, for instance, like you said, a bed rail that I'm gonna

lean against, perpetually through the day to deliver patient care.

That I'm wiping that and keeping it clean so that I'm not pressing up against it.

Obviously, in a biocontainment unit that's in my PPE, but in a regular

patient room it might not be.

So, you mentioned wipes and things like that.

Cassie, can you talk us through EPA lists and how you choose the right thing?

And then maybe a little bit about contact time, which I know we

are not so good about obeying.

Sure.

So when we look at picking a disinfectant for our space, specifically for high

consequence infectious diseases, we wanna make sure that that is on a list

that is approved for that pathogen.

So, that means you're looking at list L or Q and you wanna make sure that the

disinfectant that you have within your space, and that may be that typical

purple top or Oxivir or CaviWipes, there's different color tops, but you wanna make

sure those individual cleaning products are registered on one of those EPA lists.

And this just ensures that you actually kill the pathogen that

you're intending to kill and you don't have to go back and do it again

over and over without a disinfectant that really kills that pathogen.

So, that contact time, typically on the front of those wet wipes

or bottles, you'll see like a one, or two, or five minute.

That's indicating the time that that wipe, after you wipe, needs to sit

before you can actually go back to actually ensure that that organism

is killed on top of that surface.

So, if it's a wet time, you wanna make sure that when you are fully saturating

that area and that is the wet space that also has a contact time as well.

So making sure you're fully saturating the area, waiting the amount of

time, and then proceeding with anything else that you're doing.

So, say you have a procedure, or you're going to do an IV, and you're

wiping a surface down, and then you're immediately putting your instruments down.

That doesn't ensure that that organism is not transferred to that instrument

or whatever you're using because you have not allowed that contact

time to fully disinfect or clean.

So really when we think about a contact time we're talking about,

not exactly the same as a kill time, but really the amount of time that you need to

just pause, make sure something's wet with this disinfectant, whatever you've used,

so that it has that time up against these cooties to get them to the point where

we feel like we've killed everything.

And I guess that's a really important point, Cassie, about the difference

between like cleaning something, like if you have visible contamination

on something you, you have to get that off before you can expect

a disinfectant wipe to actually do its job disinfecting, right?

So the separation of I'm gonna clean this because there's stuff on it, and

then I'm gonna wipe it again and make sure it stays wet long enough to have,

its one or three or five, hopefully not five that's so long when I'm

standing there, disinfectant clean time.

So that's that kill time for that pathogen, right?

Did I say all that right?

Yeah, so you just wanna clean first, which that physical

cleaning removes that dirt and germs, or blood, or body fluid, from objects and

surfaces, and then that disinfecting, that going back in to do it again.

That really kills the remaining germs on the surface so you can lower the risk

of spreading that disease or illness.

And I wanna go back, I think, obviously we're talking about some

very scary pathogens, and I get that.

Absolutely understand people's level of discomfort and fear, perhaps in

some cases, about these pathogens.

But honestly, you guys, I know on the every day deal with some pathogens

that are much more difficult to kill in the hospital environment.

So I'm really grateful that, for instance, Ebola and Marburg, Lassa fever, are

pretty wimpy in the environment on a hard surface when I know where they are.

Compared to C. diff, or C. auris, or those kinds of things that

could be super difficult to kill.

Can I give you just a second to, to talk about that?

About those relative challenges?

Erica, what do you think?

Yeah, absolutely.

So we do see a lot of these organisms that are very difficult to clean.

You touched on two of the most important ones that we talk about on a day-to-day

basis right now, C. diff and C. auris.

So we wanna make sure that when we are using the disinfectant that we

are using, as Cassie alluded to, the correct disinfectant for that organism.

So, we do go back to those EPA lists quite frequently as infection

preventionists to ensure that what we are using has been tested and correctly

regulated to ensure that it is going to kill what we want it to kill.

As you had mentioned, a lot of our special pathogens of known

right now are pretty wimpy.

They're very easy to kill and I think that's a big misconception

that a lot of people think.

Ebola is very scary and rightfully so, but it is also one of the

easiest organisms to kill.

So we actually do not have a specific cleaning wipe here

at Corwell Health that we use.

Well, if we know what this pathogen of concern is we don't use a specific wipe.

We use our normal day-to-day cleaner.

And obviously if we are concerned with some of those bigger organisms that we

know are more difficult to clean, we would appropriately change our method and use

a little bit different of a disinfectant such as a bleach based wipe for like

the  C. diff or the C. auris patients.

Yeah, it's funny.

I think, I see this happen and I, in many ways understand it, that if a wipe

smells nice and doesn't seem to be too harsh, I think it can't be that powerful.

And then when I have something that's really dirty or really icky that's what

I reach for the bleach wipes or something else that just seems like, I don't know,

caustic and dangerous and whatever.

That there's something affiliated with that sort of super awful smell

that must go with being clean.

And of course, those things don't go together, right?

That's why I am glad you emphasized the matching of the pathogen and

the disinfectant are so important.

Because you just don't need to ruin equipment, or furniture, or surfaces using

a disinfectant that isn't appropriate for the pathogen you're talking about.

Absolutely.

And I just wanna add that bleach is very caustic to our equipment.

You had mentioned that it is very caustic.

And it's also hard for our patients to have to breathe that in daily.

So being mindful of what our patients are going to experience as well, if

we're cleaning excessively for any of these special pathogens, and, making

sure that we are using the appropriate disinfectant for the desired pathogen.

So stinky does not mean more effective.

Alright, so Cassie, let me circle back to you and talk about, we mentioned

cleaning first and then disinfecting, but even beyond that, there's some

methodology that's fairly important here.

Can you talk about that most of us in biocontainment are used

to this idea of zones of, you know, a hot, warm and cold zone.

Or green, yellow, red.

But with cleaning and disinfecting, we're actually even drilling

down even further than that.

Yeah.

So I think, when we talk about those rooms we're kind of narrowing

down the risk of spreading that pathogen from person to person.

So if it's a high touch surface, you're cleaning it multiple times

in a day with a disinfectant to reduce the spread of that pathogen.

I think something that's we should consider during

this is how you're cleaning.

So are you, cleaning from dirty to clean, or are you cleaning from clean to dirty?

So it's really important, those are all parts of the education and learning

when it comes into these cleaning and disinfectants to ensure that you're

confident in killing the pathogen or the organism that you want to kill.

So when we do clean those high touch surfaces we do wanna make

sure we're cleaning from the cleanest area to the dirtiest area

ensuring you're not spreading that pathogen elsewhere to the outside.

So when you look at a patient care room, you really wanna start from

those outsides and then really bring it into the inside of where that

patient is or moves around the most.

And same with a bathroom you wanna go to the outside in,

typically from top to bottom.

Yeah, I think that's a good point that, you know, I

can't do anything about the fact that my patient in the bed is still

generating these pathogens, right?

I mean, they're still sick, they're still, I can't do anything about that fact, but

that doesn't mean that if I'm gonna be in the room I have to be exposed to it all

the time because I'm gonna try to keep everything outside those bed rails clean.

So if a patient needs to be cleaned and turned, which they

do a lot, that's different.

I'm doing a targeted task there of cleaning this patient that's different

than my room cleaning, where I do wanna start high and clean and work towards my

dirtiest zone, which is that patient bed.

But that doesn't mean that, for instance, you can't address cleaning

up a patient, but you wouldn't start a patient's bath with their bottom right?

That would be gross.

So you know, you wanna start from clean and move towards

the epicenter of dirt there.

So yes, thanks for that, I think the method is so important.

And I think that gets to some of the things that people have heard

about infection prevention, cleaning and disinfection, and terminal

clean, that maybe aren't so true.

Like we've talked about the importance of, okay, so we're gonna keep it

clean on the regular, reduce the bioburden on the regular basis so

that our staff are at lower risk.

When a patient leaves we're going to do thorough cleaning, right?

Just eliminating any bioburden that's visible.

And then we're gonna do a disinfection being very cognizant

of wet time, contact time.

Starting around the outside and moving in.

Doing glove changes, all the things that we would need to

do, making sure everything's staying wet the length of time.

But, there's some things we hear that might not be so helpful, right?

Like, do I have to throw away everything?

And do I have to like, am I gonna have to figure out how to get rid of a whole bed?

What about other durable medical equipment or, I've heard some people say I could

just close the door and let it sit there for a week and it would be okay.

So can we go through some of these myths and sort of pick them apart a little bit?

Yeah, absolutely.

Some of those myths.

especially about these high consequence pathogens, I think, if we shut the

door and turn up the heat really high then it'll be safe to go back in.

Or, if we clean six times instead of four times it'll definitely be gone from there.

But I think the important pieces that we just talked about, those daily

cleans, getting all those high-touch, high clean services, and then once that

patient has left the space, having that clean be what we just talked about.

From those cleanest spaces to the dirtiest spaces, top to bottom.

Making sure you get all of those germs, residues, impurities,

from those objects and surfaces.

And then really setting up your space to then go into your terminal clean.

So that terminal clean is really going to be, it can look very

different in different facilities.

You can have a hydrogen peroxide vapor.

You can have a different set of cleaning tools that you use with a different EPA

registered disinfectant and cleaning.

And then after that, after you do that terminal clean, so for example

we use a hydrogen peroxide vapor.

And once that vapor is done and it has settled and it is safe to walk

back in that room you should be able to walk in that room without PPE,

because at that point you are clean, you have killed all your organism.

Anything that is left in that room should be effectively cleaned.

Now, after that, I think we get into more myths where they say, you know, maybe

we have to go clean it two more times.

And I, I would just encourage that education around why we're cleaning

two more times, because maybe it is a cosmetic clean, but using plain language

around, okay, we're gonna make this room look pretty I think is really

important, just to reduce fear around maybe the fact that that room isn't

safe to go in anymore, or it hasn't been cleaned three, four, or five times.

So, Erica, I don't know if you have anything to add

Yeah, just wanted to add that there is a big misconception as well

right now that we were diving into as a NETEC infection prevention work group

recently related to having two or three days between discharge and that clean.

And there's a big misconception that we were kind of trying to dive into and look

into the literature and say, why are we doing two or three days after a discharge?

So, really diving into the why behind that.

The real reason is, like Cassie said, we wanna get that cosmetic clean in, but it

is also an emotional break for some of your team members who might be doing the

cleaning, but they've also been caring for the patient for X amount of days.

So we just want to be mindful of why are we doing that clean

after a two day downtime as well.

And how long do you wanna keep your room down?

That could be very facility based, so your facility might come up with

one stance, and another facility will come up with another stance based on

their current setup and what their leadership wants to have moving forward.

You might wanna communicate as well with your state or local

or federal regulations as well.

Mainly your local or your state for your facility, to see if there is

something that you need to follow from their perspective on how long

you need to keep that room down.

Yeah, that's a great point because I do think, there's

nothing magic about two or three days, but there might be some other

practical implications, right?

On both sides.

So, one would be okay, it gives everybody a chance to sort of cycle down and

relax and the cleaning of the room doesn't have to be the biggest priority.

They can take care of themselves and then go back in fresh to do such a big job.

I think the other thing is that some of these folks will be

cleaning, for instance, their emergency department space.

And certainly, there aren't many emergency rooms that just have spaces that can

sit open and not be used, and certainly not be used and not pose another risk.

Because, you know, if there's an empty space, somebody's opening

that door to try to figure out where that piece of equipment went that

they're looking for or whatever.

It's really hard to, it's hard to lock down an emergency department

space and keep people out.

Thinking about strategies, a facility might have two different strategies.

One for their biocontainment unit where that staff has been trained, they're

gonna do the cleaning, and then a different strategy for their emergency

department where the patient's moved out and now we've gotta get that room back

up into service as fast as possible.

And so I think it's important to say that while a lot of places do use UV

light, vaporized hydro peroxide or something similar, none of those are

actually required because of what you guys have already mentioned.

You are using an EPA approved disinfectant.

You are making sure, probably with the use of a trained observer, that somebody's

hit every single spot in that room that we have cleaned everything that's maybe

a second person has come through and done it, but there's nothing that's required

about having that additional piece.

I think a lot of hospitals put them into place, for instance, for things

like C. diff or C. auris, because we know that those can be such difficult

pathogens to get in all the tiny nooks and crannies that would be hard to kill.

And certainly if you've got a bed that's been used in a biocontainment unit,

this is where I think probably the two or three day myth came about, was this

idea that in a biocontainment unit where you have a lot of air exchanges,

you could get complete desiccation, or drying out of these viral particles.

Whether that's completely true or not, nobody's gonna let you just do those

experiments in your backyard, but basically you're saying that as long

as I don't have visible bioburden, blood or body fluids that are holding

onto that pathogen, then is probably true that they're not gonna live

very long on a dry surface like that.

So a lot of nuances here that I think are tough for non-IPs

to wrap our brains around.

We've talked a lot about all these different tasks that need to be done,

but who's actually doing this work?

Erica, you might have alluded to this, right,?

Your staff might need a break, like, who's doing the work of cleaning these

rooms once a patient's moved out?

Or we'll set aside the who does the work while the patients are there,

because typically, I think most of those being done by the patient care team.

Yeah, absolutely.

So obviously as you had mentioned, some teams, it's very facility based.

Some teams do have their clinical team that was caring for the patient going back

in and doing that final terminal clean.

Other people have, contracted out to an environmental services partner

and that team has come in and they're trained to wear the appropriate

PPE for the allotted time that they need to, to clean those rooms.

And then some facilities will also train their own environmental services

team if they have one on site.

So, very facility based, depending on what your leadership is looking at

and how they want to pull resources within your own organization would

be something to look into as well.

Yeah.

Cassie, do you have anything to add to that?

Facility based as well.

Just creating a process that everyone is aware of, who is responsible for that

terminal clean is important as well.

Yeah.

Yeah.

You don't want one person thinking somebody else cleaned something.

You want definitely documented who did what and why, and what they were wearing.

And that's something important even for your occupational health folks, right?

This is still if your room has not been declared clean yet, these people

are probably also gonna end up in your list of people that you're monitoring.

And so it's important to know when they were in there and what they were doing and

what they were wearing when they did it.

Super important.

These are not easy decisions because sometimes getting people

trained into PPE and these processes can be labor intensive.

And so a lot of facilities might have a process that they use for,

I will say normal patient care.

And then their biocontainment might be a little different because we

are all dealing with things like staff turnover, and how do we

keep a cohort of people trained?

And so if that's easier for you to keep your EVS leadership, for instance,

trained or their shift leaders trained versus your nurses or your bedside

clinicians, of whatever type, that might be your choice or vice versa.

So I think you really have to think about what makes sense for your facility, who

you're gonna have that's comfortable and competent in doing all this.

And I will say, my husband would probably agree, that cleaning does not

necessarily come naturally to some of us.

So we have to be reminded and we have to be coached and encouraged on what

you do and in what order, because that's not always my job as a nurse.

I do wipe the bedside that I'm gonna lean against, but I'm not

thinking about room cleaning.

That's a different skillset.

Can we talk a little bit about, equipment.

I think a lot of people got this idea that, they were gonna

have to throw everything away.

So can you guys talk about even just a, I don't know, a vital

sign machine or a, an IV pump?

You know, sort of the really typical pieces of equipment, maybe even the

dreaded mattress, and what you think are good plans or strategies for those.

So we do have, a partner here at Corwell Health that will

allow us to discard a lot of items.

I don't think that a mattress will fit into the bin that they give us though.

So to your point, it's very important for us to be able to clean some of

those larger items rather than having to fit them into a 55 gallon drum.

So you're absolutely correct.

With those EPA disinfectants, as long as they are fitting the pathogen that we are

concerned about, we can absolutely wipe off most of those pieces of equipment

and utilize them again and again.

We do have a lot of studies that go into those EPA lists, so trusting the

disinfectants that we are using for the pathogens, that they have been tested

for, is a huge part of the special pathogen process, and making sure that

we are confident in the studies that have been done for those cleaning chemicals and

disinfectants as well as the PPE as well.

Yes, most of the items you can absolutely clean and disinfect with the appropriate

disinfectant and then you may reuse those, obviously it will be facility based.

So, whatever your team is comfortable with for each of those

items may need to be discussed.

Maybe if you're bringing in a portable ultrasound machine,

what does that look like?

But most items can be reused after they're appropriately disinfected.

Thanks.

Cassie?

Yeah, I think those are all really great points, Erica.

With those different machines as well I think one thing that we do tend

to look at a little bit more closely with high consequence pathogens

is do those equipment have extra things on them or surrounding them?

And I think sometimes you can get materials or extra cords or things.

So really eliminating all the extra things that are on those machines or

around those machines if you don't need them at the time, so paying attention

to that I think would be important.

It's a little bit less to disinfect and clean at the end of that

terminal clean when we have tired staff and a lot of things to clean.

And I also like, just my IP brain over here, making sure that we have chairs

that are not fabric in our room or we don't have any sort of breaches in that

medical equipment, I think is also really important too before we use it, because

that puts it into a different category.

But, if you have a fully functioning working mattress without rips or tears,

You can absolutely disinfect that.

And same with those machines as well

Great point that one of the things we wanna do to make this

job easier is on the front end, right?

Before you put that patient, you know, they're sitting in your triage, they've

had a positive travel and symptom screen, and now you wanna put them into

a, an ER space, look at that space.

Is the mattress intact?

Do I have a fabric chair in there?

Is there something else in there that perhaps I need to get outta there first

so I don't have to clean all that stuff?

And then, great point, Cassie, that you know, we talk about minimizing waste

and part of that cannot just be also minimizing the stuff you have to clean.

So, right, if somebody's gonna go in with an ultrasound and I only need one

probe, there's no need for me to take the whole stand and the other probes

and all the other stuff in with me.

Let's just put in one thing at a time so that I don't end up with

all these pieces in there that then have to be handled in some way.

So, great points there.

And thank you for mentioning trash because I think a big piece of this

terminal clean and decon is that people will be creating waste from using wipes

and figuring out all the disposable things that have to be thrown away.

And then all of this does have to be packaged up either to be processed

at your own facility, or put into your incinerator, or to be moved out,

to be handled by your waste vendor.

And so, as Cassie said, a mattress can be quite a challenge.

So if you have a mattress that's not intact, first of all, ick!

Talk to your infection prevention now, because you don't want

that for any of your patients.

But if you end up with a mattress, i'm gonna say now, on the behalf of

the Healthcare Waste Institute, please reach out to your waste vendor as soon

as you know that, so that you can start talking about how you would get rid

of a mattress in the case of a high consequence infectious disease patient.

Because if that mattress is compromised, we don't wanna further put staff

at risk by having you like try to cut it apart or anything like that.

There are strategies, but this is something that really takes the

input of your waste vendor and making sure that you can come to

something that is agreeable to everybody and safe for everybody.

So please, A, you do not have to throw away an intact mattress.

B, protect your mattress in some way if you can.

You know, just so it doesn't get contaminated, clean on the regular,

but if you end up with some big piece of equipment, like a mattress, really

your waste vendor has to be part of your decision making because they're

gonna help direct how you handle that.

So that's my plug.

Alright.

Well I want to thank you guys, but also give you the opportunity to add in

any little nuggets here that you think would be helpful for facilities of any

kind, being able to take on this kind of patient care and get back to normal

operations as quickly as possible.

I think I would say know what kind of products you're

utilizing and their contact times and what they're effective against is going

to be something that's really important.

I think having a process that's easy to use and easy for everyone

to follow is very important and then educating to that process.

So if there are apprehensions about the cleaning and disinfection

process, you're really taking the time to educate why you're doing what

you're doing or how you're cleaning.

And then if that's not enough, creating a validation process to really reinforce

what processes you have in your facility to get rid of all of those extra myths

and fear around returning to a space that maybe they don't think is as clean

or they're gonna be infected later on.

I think those really good, and I like the idea of making

sure that people are comfortable with the process enough to really feel like

they can go back to their jobs safely.

that's a great point.

Thanks Cassie.

Erica.

Yeah, I just wanna add to that.

Cassie, hit it right on the head.

Training is so important and getting out there and repetition

of the cleaning process.

And what is your process after you have validated, obviously, that you're using

the appropriate disinfectant for each of the suspected highly infectious diseases?

But I think it's so important too that we have that partnership with our

environmental services team members, or your contracted team members if that's

who you're going to use, and having that process built into it and having your

staff aware of the process so that they know when they are dealing with these

patients that they are sequestering the waste and that they're not just putting

it out into the hallways or into the soiled utility rooms that they might

normally be doing for a normal patient.

But Cassie hit it right on the top three things would be making sure that

you have your disinfectant, you have a process in place, and then making

sure that you're training and are comfortable with the process so that

you can almost do it in your sleep.

Maybe not to that extent, but you want to make sure that when you put on PPE,

you wanna make sure that you've done it a few times so that you've done

it before and it's not anything new that you're learning right in time.

We obviously have the ability to do just-in-time training for a lot of

things, but it just brings that sense of confidence and allowing them to

focus on the care of the patient.

If we have that education laid out in front of them a little bit more.

Excellent points and I really wanna thank you guys.

I think this actually fits in so well as a part that probably has been

not quite emphasized enough in the high consequence infectious disease

portion of The Joint Commission's national performance goals, right?

So what they say is yes, you have to be able to identify, isolate, and

form, and that's important obviously on the front end, we want people

to be emphasizing those things and really early identification.

So key for staff safety.

But there's this other big piece, which is infection prevention and

making sure people know, how and what to use, and the processes and the PPE

that they should use for that cleaning and disinfection so that you are,

not creating a dangerous environment within your healthcare facility.

And that you're able to contain these things.

I felt like, as a caregiver during Ebola, that it was part of my job to sort of, you

know, I'm the guardian keeping Ebola in that little room behind me and none of it

is gonna get out into our anteroom, into the rest of the hospital, and certainly

not into the community that I live in.

Those are really heavy obligations and concerns and so we want

people to be comfortable and confident in these processes.

So, t hank you guys so much.

This was really interesting to dive into what we mean when we say terminal

cleaning and what that is, and maybe a little bit about what that isn't.

So thank you guys.

For those of you listening at home, thanks for tuning in to

this episode on terminal cleaning.

We hope you'll join us for future episodes on a wide range of topics from healthcare

worker safety, which this obviously was to personal protective equipment, which

everything is for me, and even more about infectious diseases of all kinds.

So thank you.

If you have any questions for NETEC, or ideas for future shows, please feel

free to contact us at info@netec.org.

That's info at NETEC, NETEC.org,

and you can find us on the web at NETEC.org/podcast.

Where you can also subscribe to future episodes and find

more about today's topic.

So we will see you next time on Transmission Interrupted.