ASHES at 25: Celebrating and Championing the Environmental Services Profession

ICT spoke with Patti Costello, executive director of the American Society for Healthcare Environmental Services (ASHES), about the 25th anniversary of the organization, as well as imperatives for the healthcare environmental services industry.

Q: How has ASHES as an organization evolved over the last 25 years?

A: ASHES has evolved into the professional group of choice for environmental services (ES) leadership. The success of ASHES is attributed to the commitment level of the members who leverage expertise to provide membership-driven collaborative solutions. ASHES has revolutionized the way in which ES professionals are recognized by the c-suites of healthcare. ASHES has provided an extremely high caliber professional certification which is recognized as the leader in EVS certification. ASHES has been the industry leader in regards to healthcare environmental services, and has continually adapted, improvised and overcome relentless changes in healthcare delivery for the past 25 years. ASHES has also proactively positioned itself for the next 25 years by actively engaging its membership. Since 1998 ASHES have evolved from a good organization to a great one. The educational component has progressed substantially and our conferences offer some of the best sessions available in healthcare. Through the American Hospital Association (AHA), ASHES developed the content for its certification program which has become a requisite for many job openings. The organization also has excellent training videos and publications, online courses, a Web site that provides cutting edge information about best practice, issues, regulatory changes and updates. The board, staff and committees work diligently to keep informed so they can help the membership succeed in their field. ASHES offers educational opportunities for leadership training (including the annual conferences) as well as publications for the field, including the recent Practice Guidance for Healthcare Environmental Cleaning.

Q: How has the discipline of environmental services evolved over the last 25 years?

A: The profession has had a dramatic change in the past 25 years, moving from basic cleaning responsibilities to scientifically driven cleaning processes that support positive patient outcomes. The ES professional of 2010 is much more knowledgeable regarding multiple regulatory compliance requirements and provides leadership to their team to succeed in todays complex healthcare delivery system.

ES has evolved from the basement to the boardroom in regards to being an equal partner in patient safety, positive patient outcomes, efficiency and stellar customer service. There is a great deal more to an ES department than just keeping it clean. ES began as housekeeping and now the profession represents multiple disciplines, including but not limited to waste management, linen distribution and processing, security, transportation, decorating and design, facility support, grounds and landscaping, safety, oftentimes security and some even have materials management and food and nutrition.

The profession is more committed to managing for the cleaning for infection prevention and control. With the new healthcare models and payment structures this has become an essential piece of our operations. We are now partners in the fight against healthcare-acquired infections (HAIs). We are consultants to schools, churches and many outside agencies as the threat of multidrug-resistant organisms moves into the general population. Bed turnaround is essential to patient flow and satisfaction scores as well as the organizations financial margin. It is our responsibility to ensure staff gets the rooms ready for the next patient expeditiously both on patient floors, the emergency department and in the operating room. Essentially we have evolved from a "mom-and-pop" operation to a mega-corporation.

The major evolution is that the ES field is moving further into the executive professional arena into the executive suite. Leaders in our field are carrying advanced degrees in addition to being certified.

Q: What will be the top three critical challenges that the discipline will face in the coming decade and how can the organization help its members face them?

A: First, the most critical challenge in the next decade is financial pressure on the healthcare delivery system that is already trickling down to reduced budgets and program funding. ASHES can support the profession and in particular its membership through continued education. Additionally, communication is key to professional success and ASHES continues to provide up-to-date communication tools such as the bulletin board on the Web site to its members, thereby adding value. The second most critical challenge is the science behind the services we deliver. ASHES can support its membership once again through education on the emerging pathogens and how to collaboratively support the Infection Prevention initiatives/challenges at their respected institutions. The third most critical challenge for the discipline is the aging leadership and the fact that ES is not really considered a "cool" career path for the younger generation. ASHES is developing a career progression path including exploration of college-credited curricula that will open professional doors to the younger generation.

Q: What are the top issues as perceived by the membership, especially relating to infection prevention and control?

A: The top issue is that membership is cleaning more square footage and facing the eradication of resistant organisms; the challenge is to ensure that ES staff are trained to clean appropriately with the right cleaning products. The science of our profession changes continually as new pathogens emerge, so it is our memberships responsibility to be up to date on these clinical challenges and provide processes to address. Other issues include:

-- Evidence-based information availability -- some members do not have a seat on the infection control committee at their facilities and they are expected to carry out decisions of the committee without front-end input.

-- Finding and purchasing new products which retard or resist the growth of infection-producing organisms.

-- Green practices which allow the germs to be killed and still protect the environment.

-- Finding cost-effective waste management solutions.

-- Knowing what to use to control any invading microbes. There seems to be some confusion lingering among the membership on this, especially with new members coming on board. Along with this is pest control measures and how to use them (such as bed bug invasion in healthcare facilities).

Q: The message of the importance of proper and thorough environmental hygiene in the healthcare setting is finally getting out there but compliance is still a significant challenge what can ES directors and infection preventionists do to address this disparity between knowledge and practice? What could facilitate better collaboration between these two stakeholders?

A: The ES profession needs to be actively and consistently engaged in the infection prevention and control strategies of their organization. Participation on the infection prevention and control committee is a starting point, however the communication needs to be broader than that, with ongoing collaboration on evidence-based practices. They need to work in the spirit of partnership and realize that they both support the same mission and customers. They need to present a collaborative message in regards to healthcare environmental hygiene in the workplace. Everyone must step up to the plate and have the courage to remind staff, physicians and visitors with regard to the role of the environment in the spread of infection I believe that one of the major barriers is that a number of ES directors and infection preventionists are not working collaboratively, which is a large problem. When this occurs within a facility, infection prevention efforts greatly improve. It is the teamwork of these two departments that can improve practices. The two departments need to sit down together as peers, have weekly meetings, be involved in infection control-related investigations, and assist and support each other.

Q: How can the wide variation in environmental cleaning practices be addressed?

A: Purchasing the ASHES Practice Guidance for Healthcare Environmental Cleaning (a manual and CD) could be helpful. This manual is a step-by-step procedures manual. Additionally, ASHES has a recommended practice being published this fall titled, "Carts, Closets, Equipment and Supplies." This recommended practice outlines a generic list of best practice supplies and equipment based on sustainability, infection prevention and efficiencies. Both manuals will go a long way in "standardizing" to best practice.

Costello says that the ASHES membership has a number of issues on their minds, including:

-- Sustainable operations in the hospital environment, including microfiber programs, neutral cleaners, and waste-minimization efforts

-- Staffing based on task frequencies versus square footage that needs to be cleaned

-- Partnering with the infection prevention and control department

-- Using proper disinfects for the killing of bacteria, including dwell times

-- Using an integrated pest management program

-- Earning professional respect while promoting education, training and certification at all levels and demonstrating competency

-- Securing support at the executive and administrative levels in the healthcare organization

-- Strategizing to be involved in the business of the medical center on multiple levels with fewer resources

-- Addressing emerging pathogens by staying well versed in eradication efforts at all levels locally and globally from an evidence-based perspective

-- Operating the ES department as lean as possible while still providing quality services, ensuring good outcomes and maintaining customer satisfaction

-- Using data to improve, revamp and rethink how the ES department works

-- Addressing generational issues, as several generations are working together, and learning how to use this diversity to the ED department advantage

-- Keeping up with regulation-related changes that impact the healthcare institution

-- Working with fewer resources and smaller budgets, and accomplishing more despite these challenges