Teresa Daniels

Empowering EVS to Eliminate HA-CDI

Teresa Daniels, MSN, RN, CIC, CPPS, T-CHEST
Clark Regional Medical Center and Bourbon Community Hospital
Winchester, Kentucky

Teresa Daniels dramatically improved patient safety at her facility by creating a novel program that educates and engages environmental services (EVS) staff.

When Daniels joined Clark Regional Medical Center as an infection preventionist in 2010, the facility was struggling to contain healthcare-associated Clostridioides difficile infection (HA-CDI) rates. Isolation and hand hygiene interventions had little impact. “It dawned on me, ‘What about EVS?,” said Daniels. “When I asked EVS staff about infection prevention practices, I often heard, ‘I don’t know, I’m just a housekeeper.’ I had to make them part of the healthcare team. Without a clean environment, infection prevention is not going to succeed.”

Daniels started by hosting a lunch and learn for EVS staff. “I thought if I empowered them through education, they would understand their impact on patient safety so things could change,” she said. Convinced she was on the right track, Daniels developed an educational program focusing on environmental surfaces contamination, multidrug-resistant organisms, high-touch cleaning, and terminal cleaning. “We used CDC environmental surfaces cleaning guidelines and APIC guidelines,” said Daniels. HA-CDI rates fell dramatically the following year. When Daniels initiated the program at a second hospital, their HA-CDI rate fell to zero.

Based on these successes, Daniels collaborated with her EVS team to create a three-level ladder program, focused on continuing education, certification, and performance improvement. To expand awareness about the importance of EVS in patient safety, Daniels recommended statewide “train-the-trainer” training for EVS staff to the Kentucky Hospital Association and the Association for the Health Care Environment. In 2018 Daniels hosted the first statewide training in the U.S. for Certified Healthcare Environmental Services Technicians (T-CHEST).

“It has been so fulfilling to watch EVS staff embrace their patient safety role, and to see hospital leadership embrace their role as well,” said Daniels.