EMS Procedures and Guidelines.pdf

SFVAMC Environmental Procedure Guide Department of Veteran Affairs

VAPAHCS

Environmental Management Service

Sanitation Procedure Guide

SFVAMC Environmental Procedure Guide - 2 - Department of Veteran Affairs

SFVAMC

Environmental Management Service

Rescission: Environmental Management Service Procedure document dated, April 4, 2014

Reviewed by: Michael T. Bierly, Environmental Care Specialist

Approved by: Vanita Westbrook, Chief Environmental Management Service

SFVAMC Environmental Procedure Guide - 2 - Department of Veteran Affairs

Table of Contents

Section 1 - Introduction

Page-6 Welcome to Employees Page-7 Functional Statement Page-8 Mission, Vision, Values Page-9 Service Telephone Directory Page-10 Background and Orientation Page-12 Employee Orientation Checklist

Page-14 Manual Review Signature Page

Section 2 – Overview

Page-15 Core Competencies

Page-17 Position-Specific Competency Assessment Checklist

Page-23 Personnel Policies and Employee Conduct Page-27 Environmental Management Service

Operations

Section 3 - Service Policies

Page-29 Infection Control Program Page-37 Sanitation Safety Plan Page-41 Fire and Safety Plan Page-46 Cleaning Agents Page-48 Supplies and Equipment Listing

Section 4 - Standard Operating

Procedures – SOP’s

A. General Cleaning Procedures

Page-50 Standards of Cleanliness Page-52 Ash Receptacles Page-54 Bed Cleaning (Terminal/Discharge) Page-56 Carpet Care Page-59 Dry Erase Board Cleaning

Page-60 Door Cleaning and Polishing Page-62 Double-Bucket

Mopping System Micro Fiber Page-65 Drinking Fountain Cleaning Page-67 Dusting Page-69 Elevator Cleaning Page-71 Equipment Care and Cleaning Page-75 Floor Care Page-85 Housekeeping Aid Closet (HAC) Cleaning Page-87 Heat Convectors, Radiators &Vent

Cleaning Page-89 Ice Machine & Water Dispensing Unit

Cleaning Page-91 Light Fixture Cleaning Page-93 Mini-Blind Cleaning

Patient Rooms

Page-95 Patient Room Cleaning (Occupied

Isolation) Page-97 Patient Room (Isolation)

(Terminal/Discharge) Cleaning Page-100 Patient Room (CLC) Monthly Cleaning Page-103 Patient Room Cleaning (Occupied) Page-105 Patient Room C-Diff (Terminal/Discharge) Page-108 Rolling stock and non-critical RME Cleaning Page-112 Patient Transport Stretcher Cleaning Page-110 Patient Transport Wheelchair Cleaning

Page-114 Public Area Cleaning Page-116 Refrigerator Cleaning Page-117 Restroom Cleaning Page-119 Shower Area Cleaning and Disinfecting Page-121 Sink Cleaning Page-123 Stairwell Cleaning Page-125 Wall Washing Page-127 Window

Screen Cleaning Window Treatment http://vaww.vhaco.va.gov/EPS/2005EMS/Intro.htm#Background

- 4 -

Table of Contents Continued

B. Specialty Cleaning Procedures

Page-129 Corridor, X-Ray, Pharmacy & Laboratory

Cleaning Page-131 Pharmacy IV Room Page-134 Examination Room Cleaning Page-136 Hemo-dialysis Treatment Area Cleaning Page-138 Morgue Cleaning Page-142 Magnetic Resonance Imaging (MRI)

Cleaning Page-144 Operating Room Cleaning Page-146 Soiled Linen Handling Page-148 Supply, Processing and Distribution (SPS)

Cleaning Page-151 Waste Handling

Section 5 – Patient Centered Care (PCC)

8.1.1 Patient Centered Care (PCC) Statement

VAPAHCS Environmental Procedure Guide - 5 - Department of Veterans Affairs

Foreword

The purpose of this Environmental Management Services Sanitation Procedure Guide is to provide standardized guidance in the development of sanitation practices for VHA Healthcare Systems Environmental Management Service program.

Environmental Management Service consists of dedicated employees. Their responsibility is to perform duties to maintain a healthcare environment in a state of physical and biological cleanliness and appearance, while continually enhancing Environmental Services ability to create healthy, healing environments for our nation’s Veterans and their families that inspire, enable and sustain health and well being.

This Environmental Management Services Sanitation Procedure Guide is based upon successful programs currently in use throughout VHA’s Healthcare Systems.

The scope of this document includes the duties and tasks required to maintain an effective environmental program.

This Sanitation Procedure Guide consists of necessary procedures and training applicable for Environmental Management Services programs throughout VHA’s Healthcare System.

Aubrey Weekes, MBA Director, Environmental Programs Service VHACO (10NA7)

VAPAHCS Environmental Procedure Guide - 6 - Department of Veterans Affairs

Section 1 – Introduction

Welcome to Employees I wish to take the opportunity to welcome you as a member of the San Francisco Veterans Administration Medical Center, Environmental Management Service (EMS).

You have been selected to fill a very important position on a team dedicated to providing the best possible healthcare to our patients. You can take pride in being a member of this team. Your role requires you to develop a professional attitude and to acquire the skills and knowledge necessary to support the delivery of quality healthcare.

EMS was established in 1954 to provide support to the healthcare team in the following areas:

Office of the Chief

Environmental Sanitation

Textile Care

Patient Assistance

Waste Management/Recycling

Integrated Pest Management

All of the above activities have an important relationship to the Service’s common goal and mission: to provide a safe, sanitary and healing environment for those who have served and for those who, in turn, serve them. You are required to promote a positive image for our facility and create a feeling of confidence for co-workers, patients and visitors.

This Guide will assist you in becoming a valued member of the healthcare team. Please read it carefully; it covers the basic methods and techniques which will help you acquire the skills and knowledge required for your position. This Guide also provides general information in regards to leave administration, employee responsibility, conduct and tours of duty, as well as other information you will need to know.

Again, welcome to Environmental Management Service.

Rick E. Newman Chief, Environmental Management Service

VAPAHCS Environmental Procedure Guide - 7 - Department of Veterans Affairs

Functional Statement

The Environmental Sanitation Operation ensures that the facility will be maintained in a state of physical and biological cleanliness and appearance, which fully meets the sanitary and aesthetic requirements by:

Providing environmental sanitation services for all wards, clinics, public and administrative areas within all Medical Center locations.

Selecting appropriate sanitation procedures, controls and monitors to ensure that all sanitation requirements are properly and efficiently addressed.

Conducting orientation and in-service training, including demonstrations of standard cleaning methods and procedures.

Assisting in formulation of sanitation standards and establishing effective staffing distribution.

Routinely testing new products and equipment to ensure that such items meet industry standards.

Providing the necessary resources to meet all workload requirements.

Procuring, storing and delivering all necessary supplies used within the sanitation operation.

The effectiveness of the Sanitation Operations directly impacts patient outcomes and the image of a healthcare facility.

VAPAHCS Environmental Procedure Guide - 8 - Department of Veterans Affairs

Mission, Vision, Values

SFVAMC

EPS Mission Statement

The mission of the San Francisco Veterans Administration Medical Center is to honor, comfort and protect Veterans by developing and guiding innovative improvements in health care Environmental Sanitation, Textile Care, Interior Design, and Waste Management programs that exemplify VA’s Core Values and Characteristics.

EPS Vision Statement

The vision of the San Francisco Veterans Administration Medical Center is to continually enhance VHA’s ability to create healthy, healing environments for our nation’s Veterans and their families that inspire, enable and sustain health and well-being.

VHA’s Values

“Secretary Core Values”

“I” Integrity “C” Commitment “A” Advocacy “R” Respect “E” Excellence

VAPAHCS Environmental Procedure Guide - 9 - Department of Veterans Affairs

Telephone Directory

Environmental Management Service Telephone Directory

Position Name Extension

Chief, EMS Rick E. Newman 6312 Assistant Chief, EMS Michael Anderson 3399 Environment of Care Specialist Mario Morales 3574

Administrative Officer Vanessa Lindsey 6916 Transportation Supervisor

Timekeeper Lou Castro 6450

Quality Assurance Trainer

Senior Housekeeping Supervisor Mike Bierly 4271 Housekeeping Aide Supervisor Randy Turner 4272 Housekeeping Aide Supervisor Fernando Lindsey 4271 Housekeeping Aide Supervisor James Burford 4271 Housekeeping Aide Supervisor Ronnie Cogshell 2808

Work Leader

Mark Alford 4271

Work Leader

Supply Clerk

Charles W. Watson III 4594

VAPAHCS Environmental Procedure Guide - 10 - Department of Veterans Affairs

Background and Orientation

Prior to 1954, the Nursing, Registrar, Supply and Engineering Services were performing many of the cleaning functions currently assigned to Environmental Management Service. On June 24, 1954, specific functions related to cleaning, sanitation and interior design were transferred to the new Service and placed under the direct supervision of an Executive Housekeeper. This transfer established the new Service in VA’s healthcare system, and identified it as the Housekeeping Division.

The Housekeeping Division assumed the responsibility of the Laundry operations in July 1961. Since the Housekeeping Division already had control of linen purchasing, distribution and repair, it was felt that it was also logical for the Laundry to be included in this operation. At that time interior Pest Management was a well-established component of the Division, due to its relationship with sanitation.

A Directive in October 1966 advised a change in the title of the organization from Housekeeping Division to Building Management Service, which was again changed a few days later to Building Management Division. This title remained until December 1972, when Central Office in Washington, DC, sent a Directive to all stations indicating that only those departments dealing with veterans’ benefits should remain as a Division. All other departments should be known as Services. Therefore, the organization was again known as Building Management Service.

On June 1, 1993, the name of the Service was changed to Environmental Management Service to properly identify our responsibilities, other than just Housekeeping and Laundry. Many Environmental Management Services at other VA facilities have expanded their role to include related activities, e.g., painting, maintenance, signage and graphics, furniture repair, waste management treatment and incineration, recycling, exterior pest control, grounds and transportation.

The primary responsibilities of Environmental Management Service at all divisions of the San Francisco Veterans Administration Medical Center are:

Environmental Sanitation

Textile Care/Uniforms/Patient’s Assistance

Waste Management/Recycling

Integrated Pest Management

A brief description of what each of these responsibilities entail will aid you in seeing the entire scope of operations of your Service, and will help you to better understand how you fit into the overall functions of EMS.

VAPAHCS Environmental Procedure Guide - 11 - Department of Veterans Affairs

Environmental Sanitation -- Sanitation is an extremely necessary and important function in the total operation of the SFVAMC. In a healthcare environment, concern must go beyond the dirt that is visible to the naked eye and extend to the organisms that cannot be visually detected, i.e., germs. Even if an area appears clean, it must be treated with an Environmental Protection Agency (EPA)-approved germicidal disinfectant to sanitize the area and provide as germ-free an environment as possible to protect the patients, employees and visitors from spreading disease-causing organisms.

Integrated Pest Management -- The relationship of Environmental Management Service (EMS) to the discipline of Integrated Pest Management (IPM) is one of mutual importance. The EMS employee is to report any insects, pests or rodents they see to an EMS Supervisor or to the EMS main office, noting where they saw the insect, pest or rodent; the time of day; and, if possible, where it came from and where it went. All available information regarding such incidents will aid the pest control operators in tracking down and eliminating pests.

Textile Care -- EMS involvement with the linen management activity may include shelving clean linen, picking up soiled linen and distribution of clean linen. Each ward requires a set quota for each item of linen used on a daily basis. The linen carts from the Linen Distribution Section are brought to the hospital, and linen closets are restocked with an established quota for that particular ward.

Uniform Issue -- This program involves the issuing, marking, repairing, tailoring and laundering services to Service employees that are required to wear uniforms.

Patient Assistance Program -- At this facility, responsibility for this function falls under the EMS; at other medical centers, the Health Administration Service may be tasked with this responsibility.

This activity involves the inventory, storage and re-issue of a patient’s personal effects while the patient is hospitalized. This program also provides clothing, shoes and personal hygiene items to indigent patients, as well as haircut vouchers. There are only a few employees who are crossed-trained in this area, due to the sensitivity involved with proper recording and dealing with patients’ personal information and dealing with the public.

Waste Management -- Waste management includes collecting wastes and recyclable materials generated in the healthcare, laboratory, food preparation, shop and administrative areas, and transporting waste to collection, storage, sorting, treatment and/or disposal areas. Inappropriately disposed goods must be reported to the Supervisor. Additionally, waste management involves all employees in the facility in recycling efforts and waste segregation to benefit the eco-system, generate revenue and reduce the expense of waste removal.

VAPAHCS Environmental Procedure Guide - 12 - Department of Veterans Affairs

Employee Orientation Checklist

The following information will be provided/discussed/reviewed with you:

Job Description/Performance Standard/Competency/Performance Appraisal

General Safety Procedures/Regulations

Smoking Policy

Fire Regulations/RACE (Rescue, Alert, Confine, Extinguish) Procedures

Disaster Plan

Infection Control Procedures

Tuberculosis Control Plan

Material Safety Data Sheets (MSDS) and Location; Chemical Inventory Sheets and Location

Hazardous Communication Policy/Rights/Responsibilities

Leave Policies and Procedures

Automated Safety Incident Surveillance and Tracking System (ASISTS) Program/Rights/Responsibilities

Standard Precautions and Transmission-Based Precautions

Handling of Spills

Basic Procedures and How to Use Manual in Performance of Duties

Occupational Safety and Health Administration (OSHA) Blood Borne Pathogens Standards; Employee’s Right to Receive Hepatitis B Vaccine; Occupational Health/Employee Healthcare

Ethics Policy

Medical Center Policy for the Prevention of Sexual Harassment

Protective Personal Equipment (PPE) Procedure

Transport Cart Training and Competency Certification

Parking Regulations and Registration

Time and Leave and Pay Scale Information

Medical Center Brochure

VAPAHCS Environmental Procedure Guide - 13 - Department of Veterans Affairs

Patient Centered Care (PCC)

Customer Service

Medical Center Customer Service Requirements

Mission/Vision/Value Statement/Goals

Restrictions for Use of Cell Phones within the Medical Center

Computer Access Codes and Training

High Performance Development Model (HPDM)

Alternative Dispute Resolution (ADR) Program

Policies and Procedures and Employee Responsibilities (Laundry, Linen and other)

Tour Changes and Rotations, if applicable

Employee Identification (ID) Badge Provision and Display

As set forth in this orientation guideline, I have reviewed, discussed and fully understand the requirements of my position and performance, position description, performance requirements and procedures manual. I understand that I may receive the Hepatitis B vaccine from Occupational Health. If I choose not to receive the vaccine, I must sign a declination form.

Employee Signature Date

Supervisor’s Signature Date

VAPAHCS Environmental Procedure Guide - 14 - Department of Veterans Affairs

Manual Review Signature Page

Service-Specific Orientation/Checklist

Performance Appraisal/Competency (inclusive of rating factors)

Personal Protective Equipment (PPE)

Compliance with JC, OSHA, EPA, VHA Program Guides, Local, State and Federal Regulatory Agencies.

Probationary Period

Smoking Policy

Tour of Duty, Breaks, Lunch, Dinner

Employee Responsibilities

Ethics

Attendance, Scheduling of Leave, Types of Leave

Age-Specific Training

Personal Appearance

Uniforms

Conduct, Manner, Attitude, Customer Service

ID Badge

Automatic Data Processing (ADP)/Information Security Officer (ISO) Confidentiality

ASISTS Program

Keys and Access Regulations

The Department of Veterans Affairs National Sanitation Manual consists of necessary policies, procedures and training applicable for any sanitation section within VHA. Policies and procedures within this Guide were last reviewed on April 4, 2013 and accepted as written and/or edited by Michael T. Bierly and supersede manual dated April 4, 2013 .

VAPAHCS Environmental Procedure Guide - 15 - Department of Veterans Affairs

Section 2 - Overview

Core Competencies Universal core competencies form part of the vital knowledge, skills and abilities that are critical for an employee to perform effectively at all levels of work. Employees obtain these universal core competencies through personal education and experience, through agency orientation and mission-related training programs, and through interaction with peers, teams and supervisors. These universal core competencies are the foundation for all jobs, and should be considered in each employee’s training and development program for the future.

1. Mission Comprehension and Integration – Comprehends and integrates the organizational mission into daily work and responsibilities. Is able to interpret organizational and work group missions, and integrate and pursue them in daily work responsibilities.

2. Agency Structure and Operation – Productively applies knowledge of organizational structure and operational procedures. Is able to use knowledge of organizational structure, practices and procedures to effectively accomplish responsibilities and deliver value.

3. Fundamental Values – Exhibits certain attitudes and behaviors to accomplish an assigned job and to contribute to the overall health of the organization. Includes leadership and teamwork behaviors; ethical behavior toward people and the organization; support of cultural diversity and fairness issues in the workplace; and, a positive attitude toward safe behavior for one’s self and for others’ mental and physical fitness.

4. Communication Skills – Communicates effectively with the public and employees in writing and speech. Is able to clearly articulate thoughts and ideas, both verbally and in writing, as well as accurately interpret the thoughts and ideas of others.

5. Positive Feedback – Positively delivers constructive feedback. Is able to understand and anticipate others’ needs for feedback, and delivers it clearly and positively in either verbal or written form in order to positively affect performance and the value of deliverables.

6. Embraces Change – Understands and accepts change as an opportunity to learn and grow. Sees the positive side of change, and has the ability to let go of old, ineffective habits, beliefs and procedures, while confidently accepting or acquiring new ones.

7. Participation and Collaboration – Actively contributes, both individually and within a group, remaining active and purposeful in contributing individual effort.

VAPAHCS Environmental Procedure Guide - 16 - Department of Veterans Affairs

8. Accountability and Responsibility – Remains accountable and responsible for actions and outcomes. Makes and reliably follows through on commitments, and takes ownership of results, regardless of their relative success or failure.

9. Positive Attitude – Keeps a positive outlook, and consciously spreads it to others. Looks for the good in things; can maintain a positive point of view, regardless of the situation.

10. Continuous Improvement – Continuously improves processes and outcomes. Is able to keep a fresh perspective, and continually sees new ways to improve processes, professional relationships and the resulting products and services.

11. Problem Solving – Effectively analyzes and solves problems. Is able to evaluate and resolve situations that represent obstacles to normal goals and objectives.

12. Individual Planning and Development – Recognizes and acts on personal and career development needs.

VAPAHCS Environmental Procedure Guide - 17 - Department of Veterans Affairs

Position-Specific Competency Assessment Checklist

Position Title: Housekeeping Aid, WG-

Service/Station: EMS/

Period Covered:

Employee Name:

□ Initial Assessment □ Annual Assessment:

This checklist is a record of competency requirements and assessments pertinent to your role in the above position. This checklist is a prospective assessment, to be completed upon completion of orientation and at the beginning of the rating period thereafter. (Refer to the bottom of these Core Competencies for legend identification.)

Part I: Core Competencies

Competency Verification Competency A. General Method Code

1 Ability to describe proper housekeeping procedures for assigned area. OB, D

Understands the EMS organization and business. Builds trust relationship to provide services that meet the customers' needs. OB, D

Communicates effectively with co-workers, customers, staff, patients and officials at all times. Demonstrates interpersonal skills that support an environment in which good communication takes place. OB, D

4 Describes working knowledge and proper use of all housekeeping chemicals. OB, D

Demonstrates the ability to change and/or refill any dispenser (paper, soap, etc.). OB, D

6 Demonstrates the use of all mops (dust and wet). OB, D 7 Knowledge and demonstration of all housekeeping cleaning procedures. OB, D

Can verbalize the proper use of each chemical used to complete assigned tasks. OB, D

9 Demonstrates the proper use of Standard Precautions. OB, D

Can verbalize the proper cleaning techniques for cleaning a patient's room that has had Methicillin-resistant Staphylococcus aureus (MRSA) or Clostridium difficile(C-diff). OB, D

Can verbalize and demonstrate the proper techniques for handling trash, bio-hazardous waste and sharps containers. OB, D

12 Can demonstrate the proper usage of using Wet-Floor signs. OB, D

Can verbalize and demonstrate the proper cleanliness of the housekeeping closet and housekeeping cart. OB, D

VAPAHCS Environmental Procedure Guide - 18 - Department of Veterans Affairs

Can demonstrate how to secure the housekeeping cart and chemicals during the assignment (including while on breaks and lunch). OB, D

Teamwork: Encourages and facilitates cooperation, pride, trust, group identity; fosters commitment and team spirit; works with others to achieve goals. OB, D

Attention to Detail: Is thorough when performing work and conscientious about attending to details. OB, D

17 Can demonstrate proper safety mechanics in lifting, pulling, pushing, etc. OB, D 18 Can demonstrate the following procedures: OB, D 19 Bed-making and cleaning OB, D 20 Patient room-cleaning (terminal, isolation and daily) OB, D 21 Double-bucket mopping system OB, D 22 Restroom cleaning OB, D 23 Floor care OB, D 24 Housekeeping Aid Closet (HAC) cleaning OB, D

B. Age-Specific - Adult (19-64 years)

Accepts chosen lifestyle (i.e., personal appearance, hygiene, and socio-economic status) and consciously avoids being critical and/or judgmental. C, D, V

Recognizes that patients/customers in this age group may be striving for independence and self-worth in conjunction with life circumstances, and avoids the appearance of "talking down" to them. C, D, V

Aware of the need to phrase questions and choose words to match the patient/customer's level of understanding. C, D, V

Recognizes that persons in this age group are motivated by economic security, employment and self-sufficiency. C, D, V

Demonstrates an understanding of the need for and provides appropriate safety measures, when indicated. C, D, V

29 Age-Specific - Older Adult (65-79 years)

Demonstrates understanding that persons in this age group may take longer to assist secondary to decreased vision, diminished hearing, decreased cognitive ability, affected balance or forgetfulness. C, D, V

Recognizes that persons in this age group have concerns about financial security and independence. C, D, V

Demonstrates an understanding of the need for and provides appropriate safety measures, when indicated. C, D, V

33 Age-Specific - Geriatric Adult (80+ Years)

Aware that changing health patterns and physiologic function change may cause limitations in the person's ability to respond or react appropriately or quickly. C, D, V

Demonstrates an understanding of the need for and provides appropriate safety measures, when indicated. C, D, V

VAPAHCS Environmental Procedure Guide - 19 - Department of Veterans Affairs

C. Equipment 36 Demonstrates the ability to keyboard using a computer. OB, D, V

Demonstrates the understanding and application of VISTA computer database. OB, D, V

38 Can demonstrate the proper use and cleaning of the following equipment: OB, D, V 39 Buffer OB, D, V 40 Burnisher (both riding and stand behind) OB, D, V 41 Scrubbers (both riding and walk behind) OB, D, V 42 Carpet extractor OB, D, V 43 Vacuums (both wet and dry) OB, D, V 44 Blowers OB, D, V

Part II: Position-Specific Competencies

Verification Competency Competency Method Code A. General

1 Ability to describe proper housekeeping procedures for assigned area. OB, D

Understands the EMS organization and business. Builds trust relationship to provide services that meet the customers' needs. OB, D

Communicates effectively with co-workers, customers, staff, patients and officials at all times. Demonstrates interpersonal skills that support an environment in which good communication takes place. OB, D

Describes working knowledge and proper use of all housekeeping chemicals. OB, D

Demonstrates the ability to change and/or refill any dispenser (paper, soap, etc.). OB, D

6 Demonstrates the use of all mops (dust and wet). OB, D 7 Knowledge and demonstration of all housekeeping cleaning procedures. OB, D

Can verbalize the proper use of each chemical used to complete assigned tasks. OB, D

9 Demonstrates the proper use of Standard Precautions. OB, D

Can verbalize the proper cleaning techniques for cleaning a patient's room that has had MRSA or C-diff. OB, D

Can verbalize and demonstrate the proper techniques for handling trash, bio-hazardous waste and sharps containers. OB, D

12 Can demonstrate the proper usage of using Wet-Floor signs. OB, D

Can verbalize and demonstrate the proper cleanliness of the housekeeping closet and housekeeping cart. OB, D

Can demonstrate how to secure the housekeeping cart and chemicals during the assignment (including while on breaks and lunch). OB, D

VAPAHCS Environmental Procedure Guide - 20 - Department of Veterans Affairs

Teamwork: Encourages and facilitates cooperation, pride, trust, group identity; fosters commitment and team spirit; works with others to achieve goals. OB, D

Attention to Detail: Is thorough when performing work and conscientious about attending to details. OB, D

17 Can demonstrate proper safety mechanics in lifting, pulling, pushing, etc. OB, D 18 Can demonstrate the following procedures: OB, D 19 Bed-making and cleaning OB, D 20 Patient room-cleaning (terminal, isolation and daily) OB, D 21 Double-bucket mopping system OB, D 22 Restroom cleaning OB, D 23 Floor care OB, D 24 Housekeeping Aid Closet (HAC) cleaning OB, D B. Age-Specific - Adult (19-64 years)

Accepts chosen lifestyle (i.e., personal appearance, hygiene, and socio-economic status) and consciously avoids being critical and/or judgmental. C, D, V

Recognizes that patients/customers in this age group may be striving for independence and self-worth in conjunction with life circumstances, and avoids the appearance of "talking down" to them. C, D, V

Aware of the need to phrase questions and choose words to match the patient/customer's level of understanding. C, D, V

Recognizes that persons in this age group are motivated by economic security, employment and self-sufficiency. C, D, V

Demonstrates an understanding of the need for and provides appropriate safety measures, when indicated. C, D, V

30 Age-Specific - Older Adult (65-79 years)

Demonstrates understanding that persons in this age group may take longer to assist secondary to decreased vision, diminished hearing, decreased cognitive ability, affected balance or forgetfulness. C, D, V

Recognizes that persons in this age group have concerns about financial security and independence. C, D, V

Demonstrates an understanding of the need for and provides appropriate safety measures, when indicated. C, D, V

34 Age-Specific - Geriatric Adult (80+ Years)

Aware that changing health patterns and physiologic function change may cause limitations in the person's ability to respond or react appropriately or quickly. C, D, V

Demonstrates an understanding of the need for and provides appropriate safety measures, when indicated. C, D, V

C. Equipment 1 Demonstrates the ability to keyboard using a computer. OB, D, V

VAPAHCS Environmental Procedure Guide - 21 - Department of Veterans Affairs

Demonstrates the understanding and application of VISTA computer database. OB, D, V

3 Can demonstrate the proper use and cleaning of the following equipment: OB, D, V 4 Buffer OB, D, V 5 Burnisher (both riding and stand behind) OB, D, V 6 Scrubbers (both riding and walk behind) OB, D, V 7 Carpet extractor OB, D, V 8 Vacuums (both wet and dry) OB, D, V 9 Blowers OB, D, V

Competency Assessment Checklist Codes Verification Method:

C – Course/Class M – Mandatory Review OB – Observation D – Demonstration V- Verbalization T – Test/Quiz DR – Document Review O – Other N/A – Not Applicable AV – Audiovisual I – In-service

Competency Code:

C – Competent NAT – Needs Additional Training

VAPAHCS Environmental Procedure Guide - 22 - Department of Veterans Affairs

Part III: Education Plan

Date of Initial Competency Assessment

Educational Intervention(s)*

Competency Date Method Code

*Examples of educational interventions include course work, seminar, independent study, etc.

Part IV: Signatures

I feel competent to perform the activities that have been covered on the preceding pages with the exception of those noted.

(If more training/information is requested, document in Part III, Education Plan.)

Employee’s Signature Date

I feel that the employee is competent to perform those activities that have been covered on the preceding pages with the exception of those noted.

Supervisor’s Signature Date

Reassessment Verification

VAPAHCS Environmental Procedure Guide - 23 - Department of Veterans Affairs

Personnel Policies and Employee Conduct

1. Purpose: To provide guidelines and standards pertaining to Environmental Management Service Sanitation Section job-related issues.

2. Policy:

Personal Appearance - All employees are responsible for being neat and well groomed while on duty. Employees must wear a clean uniform daily. All shoes must be clean and serviceable; for safety reasons, no canvas shoes, sandals, dress shoes, etc., will be permitted. Choices of work shoes will be either work boots or athletic tennis shoes. Good hygiene (clean hair and body) is a daily requirement.

Uniforms - Employees will be issued government-owned uniforms, sufficient to allow them to wear a clean uniform every day. Laundry service will be provided at government expense. You may wear your uniform to and from your residence. Name badges are to be worn and be clearly visible at all times while on VA property. If name badges are lost, employee must make arrangements for replacement at the earliest opportunity. Name badges are to be worn with picture facing outwards to make identification easy. Sunglasses are not to be worn inside, unless required by physician.

Hats and earplugs are not to be worn. Cell phones, IPods or other electronic devices are not to be used while on duty.

Speech - Use a pleasant tone of voice, and avoid loud or boisterous talk or conduct at all times in the hospital and on the campus. Always remember Patient Privacy standards and principals.

Manner - Be alert, courteous, helpful and brief. Employees should report any problems or issues to their immediate supervisor. Avoid showing irritation with patients and staff members, even if you feel you have just cause. Be interested in your job and in learning how to do it better. It is an important job; one you should take pride in. Be considerate of patients and the staff responsible for their care. Knock before entering a room. If asked to leave, do so graciously and return when the nurse or doctor is through. Be willing to assist each other and help employees of other Services, as needed. It is vital in our type of work that we show cooperation and enthusiasm while on duty.

Protocol/Chain of Command - Following the proper chain of command is fundamental to ensuring continuity between upper management, supervisory personnel and EMS employees. It is important that all operational issues be addressed on the appropriate level of supervision first.

Conduct - Your actions and behavior on and off duty reflect upon you, this Service, the hospital and the Department of Veterans Affairs.

Leave (Time Off)- Leave is granted according to national and/or local negotiated agreements and Medical Center policy.

VAPAHCS Environmental Procedure Guide - 24 - Department of Veterans Affairs

Accidents - If an employee is involved in an on-the-job accident, whether or not they are injured, they must report the incident to their supervisor as soon as possible. First aid and medical attention are available for employees injured on the job. Light duty and accommodations for job related injuries are developed as needed.

Breaks, Lunch Periods and Absences from Assigned Area - Except for designated breaks and lunch periods, employees will remain in their job area at all times. When an employee must be absent from the assigned area, approval from their supervisor will be obtained. Smoking breaks are to be taken according to facility policy. Employees are reminded to remain in their assigned work area until the end of their tour of duty.

Reporting On or Off Duty - Each employee is to report for duty on time, fully dressed and ready for work, and is not to leave before the end of their shift. Employees will check in and out with their immediate supervisor or designee at the beginning and end of their tour.

Tardiness - Repeated tardiness will not be excused. Excessive tardiness could be a cause for employee to be charged absent without official leave (AWOL).

Use of Drugs and Alcoholic Beverages - The use of drugs (except those prescribed by a physician) and intoxicating beverages are strictly prohibited on duty and on VA property.

Horseplay - Boisterous conduct, horseplay and loud talking are prohibited.

Obscene Language/Gestures - Vulgar or obscene language/gestures are prohibited, and will not be tolerated.

Conserving Utilities - Employees are expected and encouraged to turn off unnecessary lights and turn off water faucets to help conserve utilities in their areas.

Smoking - Do not give smoking materials or matches to patients at any time. Smoking is permitted only in accordance with the Medical Center Policy (insert MCM# here).

Financial Dealings - Employees will not engage in financial dealings with patients, volunteers, students or staff members while on duty or on VA property.

Care of Tools and Equipment - Each employee is expected to use tools and equipment properly and to keep them in clean and good operating condition. Tools and equipment will be properly stored at all times when not in use. At no time should equipment be left unattended in hallways. All supply rooms, housekeeping aid closets, work carts, storage areas, etc., are to be maintained in a clean and orderly manner. No food, drinks and/or eating utensils are to be stored in these areas (OSHA AWE, SOARS, and Joint Commission requirements).

Reporting Discrepancies/Work Orders - If an employee discovers that repairs to equipment, tools, furnishings or other items are needed, they should report the needed repairs to their supervisor for work order submission.

VAPAHCS Environmental Procedure Guide - 25 - Department of Veterans Affairs

Reporting Fires - Any employee who discovers a fire should immediately implement RACE (Rescue, Alert, Confine and Extinguish) procedures and other local reporting requirements.

Indebtedness - The VA does not normally become involved in the financial affairs of employees; however, if repeated complaints of non-payment of justifiable financial obligations are received from creditors, action will be taken as authorized by applicable regulations.

Attendance - Regular attendance on the job is essential. Excessive missed days could be a cause for employee to be terminated.

Work Assignments - Employees are to receive work assignments from their supervisors and/or work leaders - During emergent situations, employees may be asked to perform housekeeping duties by other hospital personnel.

Patient/Employee Interactions - For the safety of patients, employees are not permitted to give food, drink (including water) or cigarettes to any patient at any time. Be courteous and assist patients or visitors who are in need of help going through doors or into elevators or who need directions. Avoid any and all dealings involving money with patients, relatives or visitors. This includes loaning, borrowing, making purchases, getting checks cashed or accepting money, gifts or tips. Playing cards or gambling with patients is strictly forbidden.

Change of Address or Telephone Numbers - Any change of street address, telephone number or emergency address is to be reported to your supervisor on the day following the change. These records must be kept accurate at all times.

Schedules/Tour Changes - Schedule/tour changes will be addressed according to local labor/management agreements and Medical Center policies.

Probationary Period and Performance Ratings o The first year of employment is a probationary period.

o Your supervisor will keep you informed on a continuous basis throughout this first year as to how you are performing your work and job assignments. He/she will point out your strengths, weaknesses and particular areas in which you need to make improvement, and provide assistance toward improvements.

o Each year all employees receive a mid-term rating and annual rating of their work performance. All employees are encouraged to submit a self-evaluation at the end of each annual rating period. Employees will be given advance notice for the submittal dates of these evaluations.

Communication - There are several methods that can be used to communicate information to employees. These methods include, but are not limited to, mail boxes, bulletin boards, electronic mail (e-mail), staff meetings, verbal conversations, etc.

VAPAHCS Environmental Procedure Guide - 26 - Department of Veterans Affairs

Aesthetics - All Medical Center employees should focus on providing a pleasing environment, regardless of the position they hold. When any employee notices litter, trash, etc., on floors, counters, stairwells, etc., he/she should dispose of such items in the closest waste receptacle. We must all work together (team work) to ensure that this is the cleanest Medical Center in our VA System. All employees, not just EMS employees, are expected to dispose of waste when visible; this includes interior and exterior areas.

3. Responsibility - It is the responsibility of all EMS employees to adhere to the above policies and standards.

VAPAHCS Environmental Procedure Guide - 27 - Department of Veterans Affairs

Environmental Management Service Operations

The following schedule of cleaning will be followed in patient care areas. Environmental Protection Agency (EPA) -approved hospital-grade germicide/disinfectant will be used, unless otherwise indicated. Surfaces must be cleaned of any dirt/debris before they can be properly disinfected.

1. Floors are vacuumed or dust and wet-mopped daily.

2. Wastebaskets are cleaned as needed. Waste disposal receptacles are emptied and re-lined twice a day as necessary in acute care areas. Waste receptacles in clinic areas and non-patient care areas are emptied daily. Filled trash liners are tied close, placed in a collection cart and transported to the waste disposal site. Never use hands or feet to compress waste in receptacles.

3. Regulated Medical Waste (RMW) containers with a red liner are placed in each ward’s soiled utility room and other secured areas as appropriate, they are to be covered and collected daily.

4. Bathrooms, showers, utility rooms, toilets, urinals, sinks, mirrors, bathtubs and shower stalls are cleaned daily. Paper towel dispensers, toilet paper and soap dispensers are checked daily and refilled as needed. Doors and doorframes are cleaned weekly and as needed. Shower curtains are cleaned as soiled.

5. Furniture, window sills, ledges, radiators, fire extinguishers, external light fixtures, cubicle curtain tracks, mini-blinds, vents, light covers and horizontal surfaces are cleaned weekly by dusting with a vacuum cleaner or specially-treated dust cloth.

6. Ultra-violet (UV) lights are turned off and cleaned weekly with a specially-treated dust cloth.

7. Furniture in patient rooms is washed with an EPA-approved hospital-grade germicide/ disinfectant solution as part of the patient discharge procedure and as needed.

8. Handrails in corridors are cleaned with an EPA-approved hospital-grade germicide/ disinfectant solution weekly and as needed.

9. Horizontal surfaces including counter tops, over-bed tables, bedside tables and bed rails are cleaned as per local policy.

10. Rolling stock and Non-Critical Reusable Medical Equipment (RME) (wheelchairs, IV poles, etc.) is cleaned periodically.

11. Drinking fountains are cleaned daily and as needed. The exterior and drain tray of ice machines are cleaned as needed.

12. Patient beds are cleaned upon discharge or transfer. Ambulatory Care exam tables and hemo-dialysis treatment chairs are cleaned and as needed.

VAPAHCS Environmental Procedure Guide - 28 - Department of Veterans Affairs

13. Long-term care beds are cleaned monthly when Nursing Service notifies EMS that the patient is out of bed.

14. Cubicle curtains are changed quarterly and as needed. Draperies and blinds are washed as needed. Damaged curtains or draperies are repaired or replaced.

15. Walls and ceilings are cleaned as needed, i.e., when visibly soiled.

16. Ceiling Tiles showing visible signs of mold, stains, cracks or holes are to be replaced.

17. Isolation rooms are cleaned according to the protocol found in the EMS Manual.

18. Fans, vents and lights are cleaned as needed.

19. Needle disposal boxes are monitored daily and changed as needed by EMS personnel. When boxes are ¾ full, they are securely sealed and disposed of as Regulated Medical Waste.

VAPAHCS Environmental Procedure Guide - 29 - Department of Veterans Affairs

Section 3 – Service Policies Infection Control Program

1. Purpose: To establish policies, procedures and guidelines to provide a clean and sanitary environment for patients, staff and visitors in order to prevent cross-contamination and transmission of hospital-acquired (nosocomial) infectious disease.

Sanitation operations represent one of the most important facets of a multidisciplinary approach to infection control. The relationship between the sanitation of a healthcare facility and the nosocomial infection rate is difficult to quantify; however, a continuing program of soil removal (and its microbial load), the reduction of disease vectors and sanitizing of inanimate surfaces are integral components of an Infection Control Program.

The Chief, Environmental Management Service, is a member of the Infection Control Committee and is responsible for recommending policies, procedures and products relative to the infection control responsibilities of EMS and the Infection Control Program of the Medical Center.

2. Responsibility

a. EMS employees will receive an initial orientation, as well as annual updates, in infection control, and are responsible for compliance with all Medical Center Infection Control policies.

b. EMS Chief and supervisors will ensure employees comply with hospital policies and participate in mandatory yearly review. Compliance may be included in the employee performance appraisals.

c. EMS employees are required to practice Standard Precautions in the care of all patients and when handling all body fluids, excretions, secretions and contaminated equipment. The blood, body fluids, secretions, excretions, non-intact skin and mucous membranes of all patients are considered potentially infectious.

d. EMS employees are required to practice Transmission-Based Precautions when patients are infected or colonized with highly transmissible or epidemiological important pathogens. Transmission-Based Precautions include Airborne Precautions, Droplet Precautions and Contact Precautions. The exception is when the use of isolation techniques interferes with patient or employee safety.

e. EMS employees are responsible for compliance with the Blood Borne Pathogen Exposure Control Plan, which describes measures designed to protect employees from such exposures and provides evaluation and follow-up of employees, should such an exposure occur. The purpose of the Plan is to minimize or eliminate occupational exposure to blood borne pathogens by utilizing a combination of engineering and work

VAPAHCS Environmental Procedure Guide - 30 - Department of Veterans Affairs practice controls, personal protective clothing and equipment, education, medical follow-up of exposure incidents, vaccination and other provisions.

f. EMS employees are responsible for compliance with their institution’s Tuberculosis Control Plan, including annual PPD skin testing and particulate respirator training, as appropriate.

g. EMS employees are responsible for keeping current with required immunizations, and complying with the facility Employee Health policy.

h. EMS is responsible for the regular replacement of sharps disposal containers; scheduled cleaning of beds and other environmental surfaces to include rolling stock and non-medical reusable equipment items as described in individual hospital policy; disposal of general refuse and Regulated Medical Waste; and collection and laundering of linen.

3. Procedures

a. Standard Precautions

1) Standard precautions are used in all patient care areas to reduce transmission of micro-organisms from known and unknown sources of infection. The blood, body fluids, secretions, excretions, non-intact skin and mucous membranes of all patients are considered potentially infectious. Examples include urine, feces, sputum, blood, saliva, emesis, pus, drainage and any aspirate. All EMS employees are required to practice Standard Precautions when handling/touching blood, body fluids, excretions, secretions and contaminated equipment or environmental surfaces.

2) Fundamental infection control measures are used to reduce the risk of transmission of micro-organisms.

a) Hand hygiene is the single most important way to prevent the spread of infection in the hospital. The purpose of hand hygiene is to remove potentially harmful organisms. Hand hygiene with soap and water or use of alcohol gel must be performed prior to the start of cleaning procedures; before and after using gloves; immediately after contact with blood, body fluids, excretions, secretions and contaminated equipment/surfaces; and, after completing cleaning activities. Hand hygiene with soap and water is recommended if hands are grossly soiled.

b) The proper procedure for hand washing is: wet hands; apply hand washing agent; rub all surfaces of hands and fingers vigorously, paying particular attention to the areas between the fingers and under and around the nails for at least 15 to 20 seconds; rinse thoroughly under running water. Before turning off the faucet, dry hands with paper towels. Before discarding the paper towel, use it to turn off the faucet, and then discard.

VAPAHCS Environmental Procedure Guide - 31 - Department of Veterans Affairs

c) When water and/or sink are not available for hand washing, an alcohol based hand sanitizer containing at least 60% isopropyl or ethyl alcohol may be used for hand sanitation when hands are not visibly soiled.

3) Personal Protective Equipment (PPE) is used routinely in the practice of Standard Precautions. PPE is intended to protect the employee from contact with possible infectious materials. PPE includes gloves, eye protection, gowns, masks and masks with face-shields. All PPE used in the facility will be provided to employees without cost, and will be readily accessible to employees. PPE will be chosen based on the anticipated exposure to blood or other potentially-infectious materials. The protective equipment will be considered appropriate only if it does not permit blood or other potentially-infectious materials to pass through or reach the employee’s clothing, skin, eyes, mouth or other mucous membranes under normal conditions of use. All repairs and replacements will be made by the Medical Center at no cost to employee. All garments that are penetrated by blood will be removed immediately or as soon as feasible.