Hi Alex699,
I would hate to imagine a scenario where a nurse refused to clean
up a spill on a patient?s bedside table, or toss empty drink cans,
simply because it is not in the job description. Just being helpful
and making the room more pleasant can be done by anyone. On the other
hand, the more nurses do, the fewer support personnel will be hired.
It really is a catch 22 situation, and I certainly empathize. Back in
the 80?s when OSHA mandated that all bio-hazardous waste had to be red
bagged and autoclaved, I resented having to bag our trash daily.
Administration was worried housekeeping would poke themselves with a
dirty sharp! Not only was I required to bag the trash up, but I had to
drag it to the basement to box it, and then tape it up! The entire
time I thought, ?for this I went to college?? I dragged waste through
the hospital while housekeepers were watching. Most medical staff does
not mind working hard, but doing the work of 3 people, or doing so
many extras one gets burned out is injudicious!
Here are some articles on the topic:
?Thus when not busy with their primary job, maids, janitors, transport
workers, kitchen workers, physical therapists, or other hospital staff
would change sterile dressings or insert tracheotomy tubes. Similarly,
if a nurse has a moment to breathe, she might be asked to do transport
work, or social work, or housekeeping. At the same time, hospitals
also laid off workers who actually helped nurses get through the day.
Linda Aiken and her colleagues found that nurses were spending a great
deal of their time giving patients food trays and then picking them up
because food service staff had been laid off. Nurses were pitching in
doing housekeeping duties because housekeepers were laid off or had to
fetch blood products or lab specimens, or shuttle patients around the
hospital because transport workers or lab staff were reduced.7 If a
unit secretary job was eliminated, then nurses had to answer the
phone.?
?Whether they have been downsized or ?rightsized,? nurses tell us that
their workload has increased and that they may be taking care of two
or three times the number of patients they took care of in the
past?perhaps ten to sixteen patients on medical surgical floors, and
three or four patients on ICUs. In California, nurses lobbied
successfully for safe nurseto- patient ratios because they were able
to document this increase in workload. For example, the Institute for
Health and Socio-Economic Policy analyzed 18.2 million California
hospital discharge records and other data collected from state
agencies and the hospital industry. Between 1994 and 1997 there was
?an 8.8 percent increase in the average number of patients for which
an RN must care; a 7.2 percent decrease in the number of RNs employed;
and a 7.7 percent jump in the number of patients per staffed bed
between 1995 and 1998.? Indeed, during this period California, a
pioneer in managed care, ranked second-lowest nationwide (after
Washington State) in the ratio of registered nurses to patients.?
http://www.wnyc.org/books/46321
?In an ASC, where staffing is exponentially smaller, housekeeping
becomes a part of every employee's role. "We all have to pitch in when
needed to keep the center looking clean and professional at all
times," she explains. "That may mean cleaning a bathroom in the middle
of the day or vacuuming the carpet at the entrances when salt is
tracked into the center [in the winter]."
Some employees whose jobs don't normally involve custodial tasks are
asked to regularly look after the reception area. "Cleaning up the
lobby and nutrition area every couple of hours is an expectation I
have of my registration staff," adds McLane. "I usually walk through
the center once or twice a day and I try to see what our patients and
visitors might see. If I see something that needs to be done, I make
sure we do it."
Keeping the ASC clean throughout the day is a matter of respect for
the patients and for the center itself. "I believe that the patient
who registers at 2 p.m. is entitled to the same clean, neat
environment as the patient who registers at 7 a.m. This philosophy
just becomes part of our culture and contributes to the pride we take
in our center. It is reflected in our patient satisfaction surveys,"
McLane asserts.
Some areas of an ASC are easier to keep clean than others --
particularly administration, the lobby, pre-op, PACU and phase II
recovery areas. "Basic housekeeping skills are sufficient to perform
the duties," says McLane. "However, a high level of dedication and
self-motivation are needed. It is necessary for the housekeeping staff
to move furniture at least weekly, to move equipment and organizers on
desks when dusting, to clean blinds and windows regularly, etc. It is
imperative that the housekeepers take pride in their work."
http://www.surgicenteronline.com/articles/351feat3.html
In an ideal world, everyone would be responsible for maintaining the
cleanliness of the hospital! Many good points on this site to discuss
here:
?Nosocomial (hospital associated) infections are very seldom caused by
the environment such as contaminated surfaces, equipment, air and
dust. However, there have been rare incidences of its occurrence.
Housekeeping practices, if performed correctly through educational
presentations, will create an area suitable for patient, visitor and
healthcare worker to enter and be comfortable within the confines of
the environment. The proper maintenance of a health care facility
increases the awareness of other employees of the necessity of good
sanitary practices. Good housekeeping practices increase moral and
public relations. No one wants to work in an area that smells or is
dirty.?
http://www.cinetwork.com/otero/icm_housekeeping.html
Teaming up with housekeeping may pay off! A discussion between
housekeepers and nursing staff may yield some surprising results!
?"Housekeepers are becoming multi-skilled workers and are being used
to do many other jobs, and this has its good side and its bad side,"
Webber says. "On the good side, more relationships are being formed
between people in different departments who might never get the
opportunity to work together and who are much more likely to
understand the other's challenges and point of view. On a grander
scale, setting the multi-skilled issue aside, the key is education and
awareness. The housekeeping department is low profile; if there is to
be a sense of teamwork in the hospital to address infection control
issues, the housekeeping department must be highlighted for the
important role it plays. By necessity this would involve departmental
horn blowing and positive publicity from administrators. Housekeeping
has a critically important role, but is typically the entrance point
into employment in other areas of the hospital, or the exit point to
which one is demoted just before being shuffled out the door."
http://www.infectioncontroltoday.com/articles/2b1feat2.html
?In the U.K., where for-profit hospitals are common, the rate of
hospital-acquired infections has skyrocketed. Cuts in cleaning staff
and poor infection control by for-profit companies have fed this
development. Now the UK government mustpump additional funding into
the health system just to control the spread of superbug infections.
Polls show that dirty hospitals and hospital-acquired infections are
the number one issue for patients in the U.K., well ahead of any other
problems in the health care system.
?No one should come out of a hospital with a disease they didn't have
before going in. With adequate resources and the ability to hire more
cleaners, Ontario hospitals could avoid the fate of the U.K. and
control superbug infections now before they become rampant in our
hospitals," says Hurley.
CUPE's mobile hospital room display ? aimed at raising awareness about
the threat of hospital-acquired infections ? has already toured the
Niagara region, Toronto, Kingston and Windsor. Throughout July, the
mobile exhibit will be in Guelph, Sudbury, North Bay, Ottawa, Oshawa,
Stratford, Cornwall, Brockville, Lindsay, Peterborough, Pembroke,
Burlington and London.?
http://www.ochu.on.ca/ochu/section-03/current.html
?The frequency of cleaning general wards was found to be lower than
that of ICUs and OTs because of the belief that general wards are less
prone to infection. ?Functioning without well-laid guidelines on
cleanliness, staff was found ignorant of the difference between
various modes of cleanliness, even when they had the right equipment.
Most thought sanitising and sterilising a room are the same
procedure,? says Desai.
The study found that most hospitals used a mop repeatedly to clean
various rooms. ?While the liquid solution is changed, one mop is used
for days together, without being cleaned,? says Desai. While only 70
per cent of hospitals use chemicals to clean floor and the rest used
detergents, ceilings are mainly cleaned by dusting.
Removing ?stains? and ?patches? are the key measures for cleanliness.
?Hospitals use bleach for removing stains, whether of blood, urine or
other fluids. Ideally, bleach is not to be used indiscriminately, as
it damages the linen,? adds Desai. The average life of linen in
hospitals was found to be six months.
?Cleaning is a scientific process, where different techniques should
be used for different types of stains. For instance, a blood stain
should be removed by a right blend of detergent, emulsifier and
bleaching agent,? says Desai. Interestingly, more than 30 per cent of
institutes which outsourced cleaning of linen were unaware of the
products used for cleaning.?
http://www.expresshealthcaremgmt.com/20051015/coverstory02.shtml
Then again, read the last line here, and this is in a private home:
?MATERNITY NURSES
Trained Nurses, midwives or health visitors who specialise in the care
of newborn babies. A Maternity Nurse helps the Mother from the time
she leaves hospital until she and her baby are settled into a routine
at home; this normally lasts between four to eight weeks. They work 24
hours a day, 6 days a week. Duties include:
? Responsible for all the physical needs of the baby
? Advise and help the new parents establish a feeding routine (bottle or breast)
? Bathing, changing and settling the baby
? Care of the baby's laundry and nursery
? Keeping the nursery and their own room (if separate) clean and tidy
? Maternity nurses DO NOT do housekeeping!?
http://www.the-agenc.com/glo-dom.php
?
It shall be the policy of the TTUHSC Ambulatory Clinics to notify
housekeeping when the loss of blood or bodily fluids exceeds the
nursing staff capability to
clean and contain. The Nurse Manager will make the decision to contact
housekeeping for additional assistance in cleaning the blood or bodily
fluid spill.
2. The room or area should be closed until such time as housekeeping
has completed the cleaning process. This can be accomplished by
placing a ?closed? sign on the door.
3. Housekeeping should clean the contaminated room or area with an
approved EPA disinfectant as outlined in the housekeeping manual.
However, if the contract
housekeeping manager is concerned about the cleaning procedures for
cleaning a specific spill he will contact the HSC Director of
Environmental Services for assistance
and direction.
http://www.ttuhsc.edu/SOM/PerformanceImprovement/docs/5.12.pdf
?Housekeeping will be responsible for cleaning patient, non-patient
care areas and bathrooms. Housekeeping will also be responsible for
taking down cubicle curtains, sending for cleaning, and for hanging
when cubicle curtains are cleaned.
http://www.ecu.edu/prospectivehealth/forms/04HSKP.pdf
? Assists the midwife in maintaining cleanliness and orderliness of the unit.?
http://www.doh.gov.ph/TMC_home/duties_and_responsibilities.htm
?An important lesson I've learned about patient satisfaction with room
cleanliness is that it's not always about how "clean" a room is.
Several years ago, a client observed that one nursing unit had lower
room cleanliness scores, but by all "objective" measures the rooms
were as clean as any of the others. Rather than reprimand the
housekeeper, the quality team continued to investigate. They observed
that many patients on this unit were older women who had immigrated
from Eastern Europe, and worked as cleaning people for decades. These
women "knew dirt." Armed with this insight, the team decided to
conclude room cleaning with one step, asking the patient, "Is there
anything that I missed?" Most patients say no, but some ask for
something to be touched up, which the housekeeper graciously
accommodates.
The lesson: it's not only what you do, but how you do it. The quality
team also had another important insight. They recognized that
hospitalization takes away patients' identities and strips them of
control over the situation and environment. Housekeepers added a few
simple steps that acknowledged the patients' expertise and gave them
back a little control over their situation. This resulted in improved
patient experiences and better scores. You can extend this notion to
all patients, not just women who worked as domestics. Housekeeping is
one of the "home relevant" services that hospitals provide (another is
food service). Most patients feel like they have some degree of
expertise in these areas. Included below are other observations about
cleanliness that can help improve your quality improvement efforts.
(Note: the term housekeeper is used generically, we know many
hospitals have integrated this function into other positions.)?
?Cleanliness isn't just about the absence of dirt. Cluttered rooms can
give the appearance of being dirty. The same is true of walls with
chipped plaster or rooms with broken curtains or blinds. Another
pitfall: wastebaskets that get emptied early in the morning, but no
one empties throughout the day, particularly after bandages are
changed. Some hospitals have decided to save money by changing
unsoiled linens every other day. The patient perception is that this
is not a sanitary procedure.?
Here's another maintenance tip. The department assigns one person to
be a liaison with each patient care area. This person stops by the
area at least once a week and checks a designated white board for a
list of things that are broken. He/She also meets with the nursing
unit leader or area manager, and periodically attends team meetings.
We know of one hospital that designates a time after dinner for all
trash baskets to be emptied. Everyone in patient care areas
participates, which helps make the room presentable for visitors. It
also serves to remind everyone on the care team of their
responsibilities for keeping the room neat.?
http://www.pressganey.org/products_services/readings_findings/satmon/article.php?article_id=49
Sometimes its all in the perception. Patient comments:
?*Nurses did not act like they wanted to help. More help getting in
and out of bed. Room was never cleaned by a nurse. My wife had to keep
it clean. They never changed sheets on bed.?
?Housekeeping could check rooms more often. Trashcans overflowing.?
?Less stress on RN staff - please don't understaff nursing dept.
nursing is hard work?
http://www.healthparkhospital.com/surveys/detail2.php?id=39&title=07%202004
?When the nurse leader says, Is there anything I can do for you before I
leave?. It tells the patient that the hospital caregivers do not want
to leave if something needs to be done and lets patients know that
their input is important. In short, it will reduce call lights. When
the housekeeper says, Before I leave, I wanted to ask if your room is
clean. Did I miss anything? Housekeeping scores in patient
satisfaction will rise, as will the productivity of housekeeping and
nursing.
If these key words are not used, everyone?s time is wasted and the
perception of quality care is lower: once the housekeeper leaves the
room and area, the nurse will be called back by the patient and told
that housekeeping missed something. The nurse must then call the
housekeeper, explain what happened and have the housekeeper return.
The entire scenario could have been avoided with a simple question or
closing statement.?
http://academyconnect.uchospitals.edu/v1/library/uch_006144.pdf
?One crucial aspect of the redesign involved Lehigh Valley Hospital?s
contracted environmental services provider which handled cleaning in
hospital common areas. The provider?s staff did not clean patient
rooms following discharge. Instead, each unit had support partners
assigned to clean the rooms amongst a long list of tasks. Cleaning
rooms following discharge often was a low priority because they were
performing other functions such as assisting with patient care,?
Romano said.?
http://www.teletracking.com/Solutions/BedManagementSuite/CaseStudies.cfm
Safety and Health Tips
http://www.osha.gov/SLTC/etools/hospital/housekeeping/housekeeping.html
?What is ward housekeeping?
In 2001 a group of staff were brought together to form a Patient
Environment Team at NHS Estates, with a remit to establish Ward
Housekeepers within 50% of hospitals by the end of 2004.
Ward Housekeepers work within the ward team and are responsible to the
Ward Sister/Manager. They provide for the non-clinical needs of the
patients and therefore leave the nursing staff free to do the job they
were trained for ? nursing the patients back to health.?
?As well as making sure the patient has a clean, tidy area and bedding
which is clean, fresh and cared for, there are aspects of the ward
which the Ward Housekeeper can help maintain. Overhead lights which
may need a new bulb; or various items of ward equipment which may need
attention.?
http://patientexperience.nhsestates.gov.uk/ward_housekeeping/wh_content/home/home.asp
?Standards of cleanliness have improved with the introduction of Ward
Housekeepers. They oversee the cleaning staff, assist where necessary,
and can liaise with contractors and staff to make sure all cleaners
are working to the National Standards of Cleanliness, launched August
2003. At St George?s Healthcare NHS Trust, after the introduction of
housekeepers, wards are visibly cleaner, presenting a more pleasant
environment for patients and staff, and most Trusts report
improvements in cleanliness as a result of the introduction of
Housekeepers.
In addition to improving the way healthcare environments feel to
patients and staff, the Housekeeper?s role in cleanliness essential to
tackling healthcare associated infection. By making sure there are
appropriate systems for dealing with used bedding, maintaining stocks
of gloves, alcohol rubs and cleaning products, and making sure that
all potential reservoirs of infection are minimised, Housekeepers are
reducing the risk of patients acquiring infections during their stay.?
http://www.hefma.org.uk/refbook04/04044.htm
What about nursing assistants/aides? If your hospital has them,
wouldn?t ?touch-up? housekeeping be a responsibility of the
assistants? RNs should, ideally, focus their attention on the medical
and health needs of the patient. Location also matters. A busy ER may
require everyone on staff to pitch in to restock and clean up after a
patient to ready the area for another patient. Does your hospital have
round the clock housekeeping staff? If not, nursing staff is expected
to do more of this type work. In the end, we are all there for the
patient, so most of this can be a moral/judgment call.
As far as MRSA bacteria and other nosocomial infections, we all know
that proper handwashing is the best way to decrease risks. All
personnel should be trained in infection control, including (and
sometimes especially) doctors.
Here are the nursing assistant duties in an American hospital:
http://members.tripod.com/~CNA_MUNCHKIN/shari2doc3.htm
NA, orderlies, and attendants
http://online.onetcenter.org/link/summary/31-1012.00
Job descriptions
http://www.jobprofiles.org/heageneralrn.htm
Old Fashioned Nursing
?Furthermore, they often found themselves in situations in which the
distinction between nurses and nursemaids was blurred by family
members, forcing them into the role of nanny or maid. ?Part of a
nurse?s trials and tribulations were being treated like a servant,?
Lynaugh said. ?Authority was a big part of the nurse?s effectiveness.
She had to be able to manage people in their own environment.??
http://www.nurseweek.com/features/99-12/workhist.html
I hope this has helped you out! If anything is unclear, please request
an Answer Clarification before rating this answer.
Sincerely, Crabcakes
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