As the weather begins to turn colder and the sounds of coughing, sniffling, and sneezing begin to fill your waiting rooms, many urgent care center operators start to have visions of a rising number of ill patients, along with increased revenue. But providing care to the seasonally afflicted—with noses as red as Rudolph’s and honking like a flock of migrating Canadian geese—may mean more than just breaking out the tissues and the prescription pad for Robitussin with codeine.
Cold and flu season accounts for millions of visits to healthcare providers annually. According to the CDC, on average, adults usually get two to three colds per year, while a child might come down with as many as six to 10 by comparison. When you consider that there are more than 200 different viruses that can cause the common cold, it’s really not surprising that so many of us are going through the day with a tissue in one hand and a cellphone in the other. On a yearly basis, there are between 10 to 35 million reported cases of flu throughout the United States; and those are just the ones who actually seek care.
The real question is how many of these folks left your urgent care sicker than when they walked in?
Wait a minute? Is there some implication that your urgent care center is making patients ill? And we’re not talking about the instrumental version of Katy Perry playing in the background either.
No, we’re talking about nosocomial infections or an infection that’s acquired in a hospital or healthcare facility.
But wait, you say. My urgent care center is clean and besides, we don’t perform surgeries or have patients that are at risk of contracting illnesses or diseases via a dirty instrument or poor technique.
That’s likely true, but remember that nosocomial infections really stand for any sort of infection that was acquired not as a result of the original medical condition.
Consider that germs are everywhere and while they may be more prevalent in hospitals, nursing homes, and surgical centers, urgent care facilities are not immune. Surfaces such as door handles, countertops, toilets, and sink handles are all high-contact areas for germs and other viruses. These areas are infection risks on a good day, now amplify those risks during cold and flu season when the viral load is 100 times greater.
So, what can you do to give patients (and staff) a fighting chance against all those pesky viruses just lurking out there and looking to settle in their upper respiratory or GI tract? Have you ever considered just how clean–or not–your facility might be? What steps can you take to ensure that you’re providing the safest environment for both your patients and your staff?
Start with an honest cleanliness evaluation.
Take a look around your facility. When was the last time it had a good, top-to-bottom cleaning? How do the exam tables look? Are the nooks and crannies dusty or dirty? How about the counters or cabinets in the exam and procedure rooms? Are they clean? Wiped down between patients? How about the items on top? Are they actually moved when the counters are cleaned? Are you brave enough to look under, around, or behind that jar of tongue depressors?
Has anyone ever bothered to check things like ceiling tiles or underneath cabinets for where droplets might splatter? How embarrassing might it be for a patient to notice that errant blood splatter from the last I&D you performed?
Maybe your inspection doesn’t reveal anything quite so awful. Perhaps your facility really just needs a good dusting? Do you realize that even the finest layer of dust can harbor everything from dead skin cells to a wide variety of microscopic organisms? The smaller the particle, the longer it can stay in the air and the further it can travel, often being inhaled and leading to conditions such as sneezing, hay fever, asthma, or bronchitis.
While you’re inspecting the facility, also look at the cleaning products you’re using. Is your janitor closet filled with a random supply of whatever was available at the dollar store? Cheaper, less effective, or even inappropriate cleaners. Have you looked at the labels? Are they recommended for cleaning or disinfecting the types of microorganisms that are commonly dealt with in healthcare settings? Many of the detergents/disinfectants and germicidal products for use in healthcare settings are often so strong that they must be registered with the EPA (Environmental Protection Agency.) In fact, there are only a few chemical products effective for killing C. difficile (Clostridium difficile) spores, so chances are if you purchased something from a retail source, it’s not going to be strong enough to be an all-around product for guaranteeing a totaling clean facility.
Lastly, check the expiration dates on your products. It’s fairly common that many have long out-lived their effectiveness. The same can be true for your cleaning tools. Things like mop heads, cleaning cloths, sponges, and dusters should all be replaced on a regularly scheduled basis. Otherwise, they can become breeding grounds for the same microorganisms you’re trying to diligently destroy.
Create a cleaning and maintenance plan.
Once you have determined where your clinic stands on the cleanliness scale and what actions you might want to take, create a plan to make sure everyone understands what’s to be done. This will ensure that there’s no confusion. Many times, the assumption is that the cleaning people will take care of that. If you create a policy, your staff will know what needs to be done and by whom.
The cleaning policy doesn’t have to be oppressive. Remember, the idea here is to create a healthy, safe, environment for everyone—not to prepare for an OSHA or JACHO audit. It should be common sense, yet still be geared toward safety for patient and staff, while not being overly burdensome to any particular staff member or department. Go with the we’re-all-in-this-together sort of approach, but also bear in mind the clean-up-the-mess-you-made concept as well.
Focus on tasks that should be completed with the following guidelines: Post-patient encounter, daily, weekly, monthly, quarterly, and as-needed. Some suggestions might be:
- Post-encounter cleaning: Wipe down exam table (air-dry per product instructions), counter, patient seating (as applicable), replace table paper, reset room.
- Quarterly cleaning: Wipe down of walls; interior cleaning of cabinetry and shelves; disinfect trash cans; clean rugs, mats, and any carpeting.
- Don’t forget to include ongoing inspections as part of your new procedures: Designating a person(s) to conduct a walkthrough of the facility, looking for any space or piece of equipment that might require extra attention should also be an integral piece of any policy.
Get your staff on board.
Even the best plans will not work well unless you have help. As you put together this new or revised policy, consider involving key members or even all staff. Asking for input on products, issues, and what’s working or not, will help you create and implement the new plan. Seeking out staff members to help research best practices or assist with training and compliance will also ensure collaboration.
Spend some time getting to know what the challenges are in each department. Is there enough time to adequately clean due to shortness of staff or increased volume? Do staff know the proper techniques, and have they been appropriately trained on how to use cleaning products? Is there a sense of “not in my job description,” and how can you overcome that attitude?
One of the challenges most often faced by owner/operators is trying to foster a sense of ownership and pride in the appearance and daily operations of the business. When it comes to staff members’ concern about the work environment, nothing is a better indicator than the cleaning and condition of the facility. Are dishes piled up in the breakroom sink waiting for that one staff member who plays mom to the rest? Does garbage get overstuffed into the trash waiting for the evening cleaning crew because no one wants to empty it in the middle of the day?
Emphasizing the importance of promoting a healthy work environment not only for the patients you serve but also for all members of the team can be a way to bring the entire staff together. Promoting a clean team by rewarding those who achieve or consistently complete cleaning tasks can also be a way to ensure that your urgent care is the picture of healthy and hygienic.
Keep it simple.
If your facility is a disaster, don’t try to fix things overnight. If you’ve never had an inspection process or haven’t completed any sort of spring cleaning since the first day you opened, it’s okay. Tackle this one piece at a time.
Don’t create a lengthy cleaning checklist. Even the most OCD staff member will rebel against becoming the new maid. Start with the easy and obvious. If you haven’t been cleaning after every patient, that’s a perfect place to begin and will have the greatest impact on reducing germs and potential risk to your patients.
Next, consider blocking out a good spring cleaning when time and volumes permit. A top-to-bottom cleaning at the center isn’t feasible in the middle of flu season when your patient volumes are high and staff may be worn down themselves. Waiting until May or June when it’s a bit slower, windows and doors can be opened to let in some fresh air, and staff may be more in need of a project to get over the winter blahs could be just the right time.
Don’t forget the importance of reorganization and hitting all those hiding spots. Supplies and equipment that haven’t been touched in months or even years need to be evaluated, cleaned, checked, and possibly even disposed of if they have outlived their usefulness (or expiration date).
Don’t forget, just because you’re starting slow doesn’t mean you shouldn’t be consistent. Create a schedule and stick to it. Remember those checklists and keep staff accountable, including yourself.
Don’t be afraid to outsource.
Finally, if during your evaluation you determine that your needs are simply too large, recognize and acknowledge that you need help. If your clinics’ patient volume is high from opening to close, or if you have multiple facilities that make it more difficult to maintain from an enterprise perspective, then consider outsourcing your more extensive cleaning needs.
If you choose to do this there are a few things to bear in mind.
- Staff should continue to maintain cleaning responsibilities between each patient visit in order to reduce immediate viral and bacterial contaminants.
- Know what you want from your vendor and don’t be afraid to keep them on their toes, or edit the services as your needs change.
- Outsource vendors need to adhere to OSHA bloodborne pathogen standards and have a knowledge of HIPAA guidelines.
- Coordinate with outsourcing vendors to be sure that the correct products are being used to adequately clean and disinfect surfaces.
- Budget correctly to allow for outsourcing environmental services (frequency, types of service).
- Blend the outsource service into procedure and policy.
- Maintain feedback from staff on quality of outsourced vendor.
Last but not least, don’t forget that certain pieces of equipment may require expert cleaning, even if it’s from time to time. Furniture, phones, even certain diagnostic equipment may need to be sent to professionals that specialize in maintenance, repair, and cleaning of biomedical equipment. Be sure to follow manufacturers’ recommendations when it comes to preventative maintenance and include regular inspections on your facility checks.
Keeping your facility clean and healthy doesn’t have to be difficult. Like most tasks, it merely takes some organization, dedication, and attention. The reward will be not only an urgent care center that looks clean and top-notch but also one that won’t be contributing to the cold and flu statistics.
Your patients—and your staff—are counting on you.