A 5-hospital health system collaborated with a healthcare services company to reduce infection rates and increase patient satisfaction. They implemented initiatives like rapid diagnostic screening, expanded handwashing campaigns, and upgraded cleaning protocols using UV disinfection. As a result, MRSA infections decreased 64% and all device-related HAIs decreased 56% from 2010-2012. Patient satisfaction scores also improved significantly, increasing 14% on HCAHPS and gaining 63 percentile points on Press Ganey. The initiatives helped the system save over $2 million annually while improving outcomes.
How a 5 Hospital System Reduced Infection Rates, Saved Over $2 million and Increased Patient Satisfaction
1. How a 5-Hospital System
Reduced Infection Rates,
Saved Over $2 Million — and
Increased Patient Satisfaction
HEALTH CARE
2. In a collaborative effort, Cone Health and Sodexo
Health Care embarked on an initiative to reduce
hospital-acquired infections (HAIs) and increase
patient satisfaction. As a result, the system
achieved a 64% decrease in MRSA infections from
2010 to 2012 and a 56% decrease in all device-
related HAIs during the period. In addition, the
system’s HCAHPS scores improved 14%, while
more recent Press Ganey scores have gained 63
percentile points.
CONE HEALTH, Greensboro, NC
n Network of more than 100 locations in North
Carolina, includes…
• 5 hospitals: Moses H. Cone Memorial,
Wesley Long, Women’s, Annie Penn and
Behavioral Health
• 2 medical centers, 3 urgent care centers and
71 physician practices
n 1,100+ total beds
n 8,600 professionals, 1,000 physicians and
700 volunteers
n 2.2 million total sq. ft. of cleanable space
n 73% average occupancy rate
Healthcare Industry Challenges
Rising Rates of Hospital-Acquired
Infection (HAIs)
Deadly super-bugs such as MRSA, Clostridium
difficile (C. diff) and Acinetobacter infect approxi
mately one out of 20 hospital patients each year.
Nationwide, HAIs are the fourth leading cause of
death, killing over 100,000 patients each year.
Aside from the high mortality rate, HAI survivors
are likely to experience longer hospital stays, with
an average of 22 days. Hospital readmission rates
are almost 30% for patients with HAIs, compared
to just 6% for patients without these infections.
Many patients who recover from HAIs continue to
experience health problems and incur additional
medical costs.
Disengaged Healthcare Staff
Regardless of the screening, cleaning or treatment
tools used, the reality of successful infection
prevention is that protocols must be executed by
highly engaged staff — clinical and non-clinical.
According to Press Ganey, at the average hospital
nearly half of all employees feel distanced from, or
are discontent with, their jobs. With disengagement
among healthcare workers at epidemic levels, and
the average Environmental Services budget being
composed of 75-90% labor expense, it is imperative
for caregiving staff to be efficient, motivated
and continuously educated on new standards,
regulations and best practices.
Staggering Financial Impact
HAIs create significant cost management issues
whether maintaining current prevention methods
or investing in new approaches.
(1) Maintaining the status quo has resulted in
HAIs now costing the U.S. healthcare system
$35 to $88 billion annually. According to the
Centers for Medicare and Medicaid Services
(CMS), each HAI case costs a hospital $23,228.
Contributing to this cost, many HAIs are the
subject of litigation, and it is estimated that
one of every six claims against healthcare
facilities is related to HAIs and HACs (hospital-
acquired conditions), accounting for 12.2% of
legal liability costs.
(2) On the other hand, implementation costs for
the personnel, processes and technologies to
enable complete eradication can be equally
daunting and frequently represent a barrier
for hospitals faced with revenue and budget
pressures. As such, the typical and more
appropriate approach is the selective targeting
of high-impact issues.
Lack of Focus on Patient Experience Limits
Satisfaction Scores
Research indicates that more than 80% of the
time a patient spends in the hospital is not related
to direct medical care. At the same time, patients
who report any problem with their room or hospital
staff rate their overall experience 39% lower
than patients with no problems. This downtime
presents many opportunities to influence patient
perceptions, educate, and create an experience
that makes patients feel comfortable and cared for
within a safe, curative setting, particularly for those
patients recovering from an HAI or HAC.
Not surprisingly, many hospitals focus more on
their technical and clinical approaches to infection
prevention, while giving inadequate attention to the
largest driver of patient satisfaction — the patient
experience and attitude of their staff.
Cone Health Challenges
Inability to Significantly Impact MRSA
As compared to other infection types, the MRSA
transmission rate at Cone Health had remained
unacceptably high, even after more targeted
reduction efforts. From December 2007 through
September 2010, Cone Health participated in the
VHA initiative to prevent healthcare associated MRSA
infections. As part of the initiative, they implemented
a number of interventions such as requiring all ICU
patients to bathe in chlorhexidine gluconate (CHG),
hand hygiene programs for healthcare providers
and new standards for portable equipment cleaning.
Despite all of these efforts, the MRSA transmission
rate remained stagnant — ranging from 0.05 to 0.72
per 1,000 patient days. Cone Health consistently
ranked in the lowest performing 10% of hospitals
participating in the VHA initiative. By 2010, MRSA
infections outnumbered BSI, CAUTI and VAP device-
related infections.
Higher-than-Average HAI-related Costs
As compared to the CMS average of $23,228 per
case, in 2010 Cone Health calculated their average
cost per HAI to be $38,889. With a higher-than-
average cost per case, Cone Health’s collective
HAI-related costs exceeded $4 million annually in
2010 and were projected to increase year over year
without intervention.
Lower-than-Desired Patient Satisfaction
With high infection rates as a contributor, patient
satisfaction suffered as well. HCAHPS scores
for “Recommends Hospital” and “Cleanliness of
Environment” in November 2011 were 72 and 70,
respectively — well below Cone Health’s standards.
2 3
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
Sept 10June 10Mar 10Dec 09Sept 09June 09Mar 09Dec 08Sept 08June 08Mar 08Dec 07
Cone Health MRSA Infection Rate (December 2007 – September 2010)
No Real Decrease in MRSA Rates
3. In a collaborative effort, Cone Health and Sodexo
Health Care embarked on an initiative to reduce
hospital-acquired infections (HAIs) and increase
patient satisfaction. As a result, the system
achieved a 64% decrease in MRSA infections from
2010 to 2012 and a 56% decrease in all device-
related HAIs during the period. In addition, the
system’s HCAHPS scores improved 14%, while
more recent Press Ganey scores have gained 63
percentile points.
CONE HEALTH, Greensboro, NC
n Network of more than 100 locations in North
Carolina, includes…
• 5 hospitals: Moses H. Cone Memorial,
Wesley Long, Women’s, Annie Penn and
Behavioral Health
• 2 medical centers, 3 urgent care centers and
71 physician practices
n 1,100+ total beds
n 8,600 professionals, 1,000 physicians and
700 volunteers
n 2.2 million total sq. ft. of cleanable space
n 73% average occupancy rate
Healthcare Industry Challenges
Rising Rates of Hospital-Acquired
Infection (HAIs)
Deadly super-bugs such as MRSA, Clostridium
difficile (C. diff) and Acinetobacter infect approxi
mately one out of 20 hospital patients each year.
Nationwide, HAIs are the fourth leading cause of
death, killing over 100,000 patients each year.
Aside from the high mortality rate, HAI survivors
are likely to experience longer hospital stays, with
an average of 22 days. Hospital readmission rates
are almost 30% for patients with HAIs, compared
to just 6% for patients without these infections.
Many patients who recover from HAIs continue to
experience health problems and incur additional
medical costs.
Disengaged Healthcare Staff
Regardless of the screening, cleaning or treatment
tools used, the reality of successful infection
prevention is that protocols must be executed by
highly engaged staff — clinical and non-clinical.
According to Press Ganey, at the average hospital
nearly half of all employees feel distanced from, or
are discontent with, their jobs. With disengagement
among healthcare workers at epidemic levels, and
the average Environmental Services budget being
composed of 75-90% labor expense, it is imperative
for caregiving staff to be efficient, motivated
and continuously educated on new standards,
regulations and best practices.
Staggering Financial Impact
HAIs create significant cost management issues
whether maintaining current prevention methods
or investing in new approaches.
(1) Maintaining the status quo has resulted in
HAIs now costing the U.S. healthcare system
$35 to $88 billion annually. According to the
Centers for Medicare and Medicaid Services
(CMS), each HAI case costs a hospital $23,228.
Contributing to this cost, many HAIs are the
subject of litigation, and it is estimated that
one of every six claims against healthcare
facilities is related to HAIs and HACs (hospital-
acquired conditions), accounting for 12.2% of
legal liability costs.
(2) On the other hand, implementation costs for
the personnel, processes and technologies to
enable complete eradication can be equally
daunting and frequently represent a barrier
for hospitals faced with revenue and budget
pressures. As such, the typical and more
appropriate approach is the selective targeting
of high-impact issues.
Lack of Focus on Patient Experience Limits
Satisfaction Scores
Research indicates that more than 80% of the
time a patient spends in the hospital is not related
to direct medical care. At the same time, patients
who report any problem with their room or hospital
staff rate their overall experience 39% lower
than patients with no problems. This downtime
presents many opportunities to influence patient
perceptions, educate, and create an experience
that makes patients feel comfortable and cared for
within a safe, curative setting, particularly for those
patients recovering from an HAI or HAC.
Not surprisingly, many hospitals focus more on
their technical and clinical approaches to infection
prevention, while giving inadequate attention to the
largest driver of patient satisfaction — the patient
experience and attitude of their staff.
Cone Health Challenges
Inability to Significantly Impact MRSA
As compared to other infection types, the MRSA
transmission rate at Cone Health had remained
unacceptably high, even after more targeted
reduction efforts. From December 2007 through
September 2010, Cone Health participated in the
VHA initiative to prevent healthcare associated MRSA
infections. As part of the initiative, they implemented
a number of interventions such as requiring all ICU
patients to bathe in chlorhexidine gluconate (CHG),
hand hygiene programs for healthcare providers
and new standards for portable equipment cleaning.
Despite all of these efforts, the MRSA transmission
rate remained stagnant — ranging from 0.05 to 0.72
per 1,000 patient days. Cone Health consistently
ranked in the lowest performing 10% of hospitals
participating in the VHA initiative. By 2010, MRSA
infections outnumbered BSI, CAUTI and VAP device-
related infections.
Higher-than-Average HAI-related Costs
As compared to the CMS average of $23,228 per
case, in 2010 Cone Health calculated their average
cost per HAI to be $38,889. With a higher-than-
average cost per case, Cone Health’s collective
HAI-related costs exceeded $4 million annually in
2010 and were projected to increase year over year
without intervention.
Lower-than-Desired Patient Satisfaction
With high infection rates as a contributor, patient
satisfaction suffered as well. HCAHPS scores
for “Recommends Hospital” and “Cleanliness of
Environment” in November 2011 were 72 and 70,
respectively — well below Cone Health’s standards.
2 3
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
Sept 10June 10Mar 10Dec 09Sept 09June 09Mar 09Dec 08Sept 08June 08Mar 08Dec 07
Cone Health MRSA Infection Rate (December 2007 – September 2010)
No Real Decrease in MRSA Rates
4. The Solutions
Responding to new Chief Operating Officer Terry
Akin’s challenge to become a “Top 10” system, a
multidisciplinary taskforce was formed in December
2010. Among the team charged with identifying
and removing process and financial barriers to
decrease MRSA were professionals from Sodexo
Health Care, which Cone Health selected in 2006
to manage multiple support services, including the
hospital’s Environmental Services program.
Calculating Cost
Focused on making improvements to people,
processes and tools, the team evaluated a
considerable number of options. Focusing on
making the most efficient investments, Cone Health
chose to first take a fiscally conservative approach
to defining their costs associated with HAIs. The $4
million+ in annual costs for Fiscal Year 2010 were
based strictly on clinical costs associated with the
treatment of patients contracting an HAI. The Cone
Health calculation did not include other revenue-
generating variables such as patient bed days saved
or cost-increasing variables such as litigation or
non-clinical labor. The inclusion of such variables
would have provided for an even more impressive
ROI on Cone Health’s HAI-reducing efforts.
Among the tactics chosen to be retained, improved
upon and added as new in 2011:
Continuations and Adjustments to Prior
Best Practices
n Reduce CHG baths from all admissions to only
patients colonized with MRSA and MSSA
n Continuation of the following practices:
• Cleaning checklist and equipment cleaning
standards for portable equipment
• Banners and red lines at all ICU entrances to
acknowledge the need for hand hygiene
• Sodexo SHINE cleaning protocols inclusive
of random audits using protein-based black
light inspections
• Sodexo TRAKKAR software for scheduling
cleaning and real-time reporting on efficacy
• Anti-microbial soap and Sodexo SHINE’s
eco-friendly, sustainable cleaning practices
• Data mining software to track screening and
treatment protocols for MRSA patients to
ensure proper procedures are being followed
n Provide tablet technology to enable “on floor”
monitoring by Infection Preventionist, ensuring
treatment protocols are executed
Rapid Diagnostic Screening
n Purchased laboratory technology to process
approximately 2,600 active surveillance
screening tests monthly
n Implemented screening for all ICU and high-risk
patients — those with documented infection
history or being admitted from a nursing home,
jail, prison, rehab or long-term acute care,
another acute care hospital or hemodialysis
n Added screening for all pre-admitted surgical
patients
New Protocols for MRSA and MSSA Patients
n For MRSA positive patients, an upgraded
decolonization protocol
• 5 days of bid Mupirocin intra-nasally.
• 6-cloth CHG bath daily for 5 days for all
positive S. aureus patients
• Isolation during entire admission
(MRSA positive only)
n For MRSA positive and high-risk patients,
on discharge or transfer, “terminal” room
cleans upgraded to include use of hands-free,
ultraviolet (UV) disinfection technology
• Xenex systems provide lowest cost,
“no-touch” disinfection
• 99% effective, mercury-free room
decontamination
• Portable units run in 2-3 separate positions per
room, for a total of 10-15 minutes per room
n Expansion of post terminal UV disinfection audits
to include 100% of all MRSA positive rooms
• Audit data integrated with scheduling and
reporting on facilities cleaning
Expanded Hand-washing Campaign
n “Wash Hands. Save Lives.” communicates with
staff, patients, and visitors on importance and
practices for infection prevention
n Extra 6th step added to World Health
Organization (WHO) 5-steps to hand hygiene
• Addressed steps to be taken upon entering or
exiting a patient room
n Mandatory computer-based learning
introducing “Professor Germoutski”
• Explains WHO recommendations
• Reviews the proper hand hygiene protocols
n Personal hand sanitizer wipes added to every
patient dietary tray
n Mandatory patient video education during
their admission process
4 5
5. The Solutions
Responding to new Chief Operating Officer Terry
Akin’s challenge to become a “Top 10” system, a
multidisciplinary taskforce was formed in December
2010. Among the team charged with identifying
and removing process and financial barriers to
decrease MRSA were professionals from Sodexo
Health Care, which Cone Health selected in 2006
to manage multiple support services, including the
hospital’s Environmental Services program.
Calculating Cost
Focused on making improvements to people,
processes and tools, the team evaluated a
considerable number of options. Focusing on
making the most efficient investments, Cone Health
chose to first take a fiscally conservative approach
to defining their costs associated with HAIs. The $4
million+ in annual costs for Fiscal Year 2010 were
based strictly on clinical costs associated with the
treatment of patients contracting an HAI. The Cone
Health calculation did not include other revenue-
generating variables such as patient bed days saved
or cost-increasing variables such as litigation or
non-clinical labor. The inclusion of such variables
would have provided for an even more impressive
ROI on Cone Health’s HAI-reducing efforts.
Among the tactics chosen to be retained, improved
upon and added as new in 2011:
Continuations and Adjustments to Prior
Best Practices
n Reduce CHG baths from all admissions to only
patients colonized with MRSA and MSSA
n Continuation of the following practices:
• Cleaning checklist and equipment cleaning
standards for portable equipment
• Banners and red lines at all ICU entrances to
acknowledge the need for hand hygiene
• Sodexo SHINE cleaning protocols inclusive
of random audits using protein-based black
light inspections
• Sodexo TRAKKAR software for scheduling
cleaning and real-time reporting on efficacy
• Anti-microbial soap and Sodexo SHINE’s
eco-friendly, sustainable cleaning practices
• Data mining software to track screening and
treatment protocols for MRSA patients to
ensure proper procedures are being followed
n Provide tablet technology to enable “on floor”
monitoring by Infection Preventionist, ensuring
treatment protocols are executed
Rapid Diagnostic Screening
n Purchased laboratory technology to process
approximately 2,600 active surveillance
screening tests monthly
n Implemented screening for all ICU and high-risk
patients — those with documented infection
history or being admitted from a nursing home,
jail, prison, rehab or long-term acute care,
another acute care hospital or hemodialysis
n Added screening for all pre-admitted surgical
patients
New Protocols for MRSA and MSSA Patients
n For MRSA positive patients, an upgraded
decolonization protocol
• 5 days of bid Mupirocin intra-nasally.
• 6-cloth CHG bath daily for 5 days for all
positive S. aureus patients
• Isolation during entire admission
(MRSA positive only)
n For MRSA positive and high-risk patients,
on discharge or transfer, “terminal” room
cleans upgraded to include use of hands-free,
ultraviolet (UV) disinfection technology
• Xenex systems provide lowest cost,
“no-touch” disinfection
• 99% effective, mercury-free room
decontamination
• Portable units run in 2-3 separate positions per
room, for a total of 10-15 minutes per room
n Expansion of post terminal UV disinfection audits
to include 100% of all MRSA positive rooms
• Audit data integrated with scheduling and
reporting on facilities cleaning
Expanded Hand-washing Campaign
n “Wash Hands. Save Lives.” communicates with
staff, patients, and visitors on importance and
practices for infection prevention
n Extra 6th step added to World Health
Organization (WHO) 5-steps to hand hygiene
• Addressed steps to be taken upon entering or
exiting a patient room
n Mandatory computer-based learning
introducing “Professor Germoutski”
• Explains WHO recommendations
• Reviews the proper hand hygiene protocols
n Personal hand sanitizer wipes added to every
patient dietary tray
n Mandatory patient video education during
their admission process
4 5
6. The Outcomes
DRAMATIC REDUCTION IN HAIs
Through their bundled approach to infection prevention at Cone Health, Sodexo was able to help reduce the
risk of HAIs and lower the costs associated with the deadly infections. The hospital saw zero MRSA cases
in its intensive care units, achieved an overall 71% decrease in MRSA infections from 2010 to 2012 and
reduced all device-related HAIs during that period by 56%.
0
20
40
60
80
100
86
2010
37
2011
25
2012
Total MRSA Infections by Calendar Year
0
10
20
30
40
50
60
70
80
VAPCAUTIBSI
20
2010
12
2011
67
2010
33
2011
23
2010 20
2011
Total Device-Related Infections 2010 vs. 2011
IMPRESSIVE INCREASE IN PATIENT SATISFACTION
HCAHPS scores increased from the low 70s to the high 70s and low 80s.
0
10
20
30
40
50
60
70
80
HCAHPS “Recommends Hospital”
Nov.
2010
July
2012
More engaged employees
The impact of Sodexo’s CARES Behavioral Training and SHINE work process on employee satisfaction,
engagement and perceived ability to deliver top-quality service and engagement was substantial.
MORE THAN $2 MILLION IN COST SAVINGS
The organization and community saved an estimated $2.3 million in infection-associated hospital costs.
0
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000 Total Cost of Infections per Fiscal Year
$4,277,853
FY 2010
$3,018,842
FY 2011
$2,266,424
FY 2012 TD
$1.26MM
SAVINGS
“Un-banked”
SAVINGS
$752K
SAVINGS
0
$500,000
$1,000,000
$1,500,000
$2,000,000
$2,500,000 Return on Investment
1.7 : 1
$2,011,429
2-YEAR
SAVINGS
FROM
HAI
REDUCTION
$1,169,141
2-YEAR
PROGRAM
COST
The future
Building on Success
Since inception of the more robust infection prevention program, positive results have led to expansion of
the program. Tactics either currently implemented, planned for deployment or under consideration are…
n Expanded rapid screening for flu and C. diff
n Extending use of hands-free, ultraviolet (UV)
disinfection systems
• At discharge or transfer for all C. diff patients
• Terminal cleans in O.R. and Ambulatory Centers
n Optimization of staff size and labor
management processes to ensure maximum
return from UV disinfection investment
n Refresh of Hand Hygiene Campaign
• 3 year campaign strategy focused on facts
and statistics
• Utilize Joint Commission Audit Program for
collecting Hand Hygiene Compliance data
systemwide
n Expansion of patient education to include bed-
side coaching on infection prevention practices
by Environmental Services staff
6 7
0
20
40
60
80
100
Cone Health Environmental Services Dept.
Employee Satisfaction Scores
FY 2010
FY 2012
0
10
20
30
40
50
60
70
80
HCAHPS “Cleanliness of Environment”
Nov.
2010
July
2012
“We want our patients to be as safe as
possible, and investing in new infection
control technologies was a priority. Now,
our patients are safer because their chance
of contracting an infection has been greatly
reduced. We are elated that the initiatives
are working.”
Dr. Mary Jo Cagle
Chief Quality Officer
Cone Health
7. The Outcomes
DRAMATIC REDUCTION IN HAIs
Through their bundled approach to infection prevention at Cone Health, Sodexo was able to help reduce the
risk of HAIs and lower the costs associated with the deadly infections. The hospital saw zero MRSA cases
in its intensive care units, achieved an overall 71% decrease in MRSA infections from 2010 to 2012 and
reduced all device-related HAIs during that period by 56%.
0
20
40
60
80
100
86
2010
37
2011
25
2012
Total MRSA Infections by Calendar Year
0
10
20
30
40
50
60
70
80
VAPCAUTIBSI
20
2010
12
2011
67
2010
33
2011
23
2010 20
2011
Total Device-Related Infections 2010 vs. 2011
IMPRESSIVE INCREASE IN PATIENT SATISFACTION
HCAHPS scores increased from the low 70s to the high 70s and low 80s.
0
10
20
30
40
50
60
70
80
HCAHPS “Recommends Hospital”
Nov.
2010
July
2012
More engaged employees
The impact of Sodexo’s CARES Behavioral Training and SHINE work process on employee satisfaction,
engagement and perceived ability to deliver top-quality service and engagement was substantial.
MORE THAN $2 MILLION IN COST SAVINGS
The organization and community saved an estimated $2.3 million in infection-associated hospital costs.
0
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000 Total Cost of Infections per Fiscal Year
$4,277,853
FY 2010
$3,018,842
FY 2011
$2,266,424
FY 2012 TD
$1.26MM
SAVINGS
“Un-banked”
SAVINGS
$752K
SAVINGS
0
$500,000
$1,000,000
$1,500,000
$2,000,000
$2,500,000 Return on Investment
1.7 : 1
$2,011,429
2-YEAR
SAVINGS
FROM
HAI
REDUCTION
$1,169,141
2-YEAR
PROGRAM
COST
The future
Building on Success
Since inception of the more robust infection prevention program, positive results have led to expansion of
the program. Tactics either currently implemented, planned for deployment or under consideration are…
n Expanded rapid screening for flu and C. diff
n Extending use of hands-free, ultraviolet (UV)
disinfection systems
• At discharge or transfer for all C. diff patients
• Terminal cleans in O.R. and Ambulatory Centers
n Optimization of staff size and labor
management processes to ensure maximum
return from UV disinfection investment
n Refresh of Hand Hygiene Campaign
• 3 year campaign strategy focused on facts
and statistics
• Utilize Joint Commission Audit Program for
collecting Hand Hygiene Compliance data
systemwide
n Expansion of patient education to include bed-
side coaching on infection prevention practices
by Environmental Services staff
6 7
0
20
40
60
80
100
Cone Health Environmental Services Dept.
Employee Satisfaction Scores
FY 2010
FY 2012
0
10
20
30
40
50
60
70
80
HCAHPS “Cleanliness of Environment”
Nov.
2010
July
2012
“We want our patients to be as safe as
possible, and investing in new infection
control technologies was a priority. Now,
our patients are safer because their chance
of contracting an infection has been greatly
reduced. We are elated that the initiatives
are working.”
Dr. Mary Jo Cagle
Chief Quality Officer
Cone Health
8. Sodexo Solutions
Sodexo’s Infection Prevention Service Model
As the world leader in environmental services and
employee development, Sodexo knows that delivering
the safest, highest quality experience with a hospital’s
brand means more than world-class clinical care. To
help Cone Health meet its goals, Sodexo implemented
its industry-leading, patient-focused infection
prevention service model. The model incorporates
a unique combination of employee engagement
(people), technology (tools) and operations (process)
best practices to provide the safest environment
for healing, improving operational efficiency and
increasing patient satisfaction.
Driving Employee Engagement:
CARES Behavioral-based Training
Cone Health employed Sodexo’s exclusive CARES
Behavioral Training program to instruct employees
on five key performance commitments:
1. Compassion: Demonstrate care and sensitivity
in words and actions.
2. Accountability:Beresponsiblefortheoutcomes
and the results of actions.
3. Respect: Have consideration and regard for the
rights, values, beliefs and property of all people.
4. Enthusiasm: Generate great excitement and
interest in creating exceptional experiences for
customers at all levels.
5. Service: Commit to delivering outcomes that
exceed expectations.
The CARES program has been pivotal to Sodexo
receiving some of the industry’s highest
engagement scores for environmental services.
Research has shown the CARES Behavioral Training
resulted in a 15% increase in overall job satisfaction
and increases in “positive department feelings” and
“ability to provide quality service” of approximately
25%.CAREShasalsobeenshowntohaveasignificant
impact on patient perceptions, with one U.S. hospital
recording an increase in patient satisfaction of 376%
two years after initiating CARES training.
Recruitment and selection of potential Sodexo
Environmental Services employees are critical
components of the CARES training process.
n Candidates for employment are selected on
the basis of having previously exhibited CARES
behaviors. Past performance is the greatest
indicator of future performance.
n All those responsible for hiring decisions must
attend the Frontline Employee Behavioral
Interviewing for Hiring Managers training
session. This four-hour, on-site training session
prepares managers to conduct interviews and
make legally sound hiring decisions.
Once hired, Environmental Services staff learns how
to positively interact with patients as well as with
families, visitors and each other. They are encouraged
to connect daily with patients as they perform their
cleaningdutiesandtoraiseawarenessamongpatients
and families about the integral role Environmental
Services plays in the recuperative process. At Cone
Health, Environmental Services staff gave patients
the opportunity to schedule the most convenient time
for their rooms to be cleaned. Other powerful tools of
engagement included concierge-style amenities such
as a welcome kit upon admission, complimentary
daily newspaper, Brighten Your Day cards and “thank
you” note at discharge. The patients’ perceptions of
their hospital stay improved as a result.
Within the CARES culture, the Cone Health staff
became more engaged in their jobs. They were
committed to doing their best work because they
understood their vital role in the patient experience.
Competent Technical Leadership: Employee
Accreditation Standards
Sodexo is the only environmental services contract
management company that requires CHESP
(Certified Healthcare Environmental Services
Professional) certification of all manager-level
staff. The CHESP is a national credential that
distinguishes an individual as being among the
elite in the healthcare environmental services
profession. To earn the CHESP, individuals must
satisfy eligibility requirements that incorporate
a blend of professional experience and education;
agree to adhere to the American Hospital
Association’s Professional Standards of Conduct;
and pass the CHESP certification examination. The
CHESP examination assesses knowledge required
of a competent healthcare environmental services
manager in the area of regulatory compliance;
design and construction; operations related to
environmental sanitation; operations related to
waste management; operations related to textile
management; finance; and administration.
Ahead of the CDC: SHINE Black Light
Inspection System
Clinical studies show that traditional manual
cleaning methods are only 50% effective at
removing deadly bacteria from high-touch
surfaces. Sodexo’s SHINE black light program is
the industry benchmark to meet the intent of the
Center for Disease Control’s (CDC) 2010 guidelines
for environmental monitoring. Used exclusively
by Sodexo since 2008, it is by far the most cost-
effective method for monitoring cleaning efficacy.
After a patient is discharged, an Environmental
Services manager “marks” high-touch areas (e.g.,
door knobs, sink faucets, TV remote controls,
telephones) with a protein-based, chemical-
free, fluorescent marker. After room cleaning is
performed, the manager uses a handheld black
light scanner to reveal contaminated areas that
cannot be seen but can cause HAIs. Post-black
light cleanings are 90% effective in eliminating all
harmful bacteria.
8 9
9. Sodexo Solutions
Sodexo’s Infection Prevention Service Model
As the world leader in environmental services and
employee development, Sodexo knows that delivering
the safest, highest quality experience with a hospital’s
brand means more than world-class clinical care. To
help Cone Health meet its goals, Sodexo implemented
its industry-leading, patient-focused infection
prevention service model. The model incorporates
a unique combination of employee engagement
(people), technology (tools) and operations (process)
best practices to provide the safest environment
for healing, improving operational efficiency and
increasing patient satisfaction.
Driving Employee Engagement:
CARES Behavioral-based Training
Cone Health employed Sodexo’s exclusive CARES
Behavioral Training program to instruct employees
on five key performance commitments:
1. Compassion: Demonstrate care and sensitivity
in words and actions.
2. Accountability:Beresponsiblefortheoutcomes
and the results of actions.
3. Respect: Have consideration and regard for the
rights, values, beliefs and property of all people.
4. Enthusiasm: Generate great excitement and
interest in creating exceptional experiences for
customers at all levels.
5. Service: Commit to delivering outcomes that
exceed expectations.
The CARES program has been pivotal to Sodexo
receiving some of the industry’s highest
engagement scores for environmental services.
Research has shown the CARES Behavioral Training
resulted in a 15% increase in overall job satisfaction
and increases in “positive department feelings” and
“ability to provide quality service” of approximately
25%.CAREShasalsobeenshowntohaveasignificant
impact on patient perceptions, with one U.S. hospital
recording an increase in patient satisfaction of 376%
two years after initiating CARES training.
Recruitment and selection of potential Sodexo
Environmental Services employees are critical
components of the CARES training process.
n Candidates for employment are selected on
the basis of having previously exhibited CARES
behaviors. Past performance is the greatest
indicator of future performance.
n All those responsible for hiring decisions must
attend the Frontline Employee Behavioral
Interviewing for Hiring Managers training
session. This four-hour, on-site training session
prepares managers to conduct interviews and
make legally sound hiring decisions.
Once hired, Environmental Services staff learns how
to positively interact with patients as well as with
families, visitors and each other. They are encouraged
to connect daily with patients as they perform their
cleaningdutiesandtoraiseawarenessamongpatients
and families about the integral role Environmental
Services plays in the recuperative process. At Cone
Health, Environmental Services staff gave patients
the opportunity to schedule the most convenient time
for their rooms to be cleaned. Other powerful tools of
engagement included concierge-style amenities such
as a welcome kit upon admission, complimentary
daily newspaper, Brighten Your Day cards and “thank
you” note at discharge. The patients’ perceptions of
their hospital stay improved as a result.
Within the CARES culture, the Cone Health staff
became more engaged in their jobs. They were
committed to doing their best work because they
understood their vital role in the patient experience.
Competent Technical Leadership: Employee
Accreditation Standards
Sodexo is the only environmental services contract
management company that requires CHESP
(Certified Healthcare Environmental Services
Professional) certification of all manager-level
staff. The CHESP is a national credential that
distinguishes an individual as being among the
elite in the healthcare environmental services
profession. To earn the CHESP, individuals must
satisfy eligibility requirements that incorporate
a blend of professional experience and education;
agree to adhere to the American Hospital
Association’s Professional Standards of Conduct;
and pass the CHESP certification examination. The
CHESP examination assesses knowledge required
of a competent healthcare environmental services
manager in the area of regulatory compliance;
design and construction; operations related to
environmental sanitation; operations related to
waste management; operations related to textile
management; finance; and administration.
Ahead of the CDC: SHINE Black Light
Inspection System
Clinical studies show that traditional manual
cleaning methods are only 50% effective at
removing deadly bacteria from high-touch
surfaces. Sodexo’s SHINE black light program is
the industry benchmark to meet the intent of the
Center for Disease Control’s (CDC) 2010 guidelines
for environmental monitoring. Used exclusively
by Sodexo since 2008, it is by far the most cost-
effective method for monitoring cleaning efficacy.
After a patient is discharged, an Environmental
Services manager “marks” high-touch areas (e.g.,
door knobs, sink faucets, TV remote controls,
telephones) with a protein-based, chemical-
free, fluorescent marker. After room cleaning is
performed, the manager uses a handheld black
light scanner to reveal contaminated areas that
cannot be seen but can cause HAIs. Post-black
light cleanings are 90% effective in eliminating all
harmful bacteria.
8 9
10. Aligned with the WHO: Mercury-free, Pulsed
Xenon Ultraviolet Disinfection System
Asagloballeaderinhealthcare,Sodexocontinuously
searches for new technologies and processes
that improve operational efficiencies and patient
outcomes. One such technology, the breakthrough
Xenex automated disinfection system, is offered
exclusively through Sodexo, and uses pulsed xenon
ultraviolet (UV) light to destroy viruses, bacteria
and spores in patient areas without contact
or chemicals. As a mercury-free solution, the
Xenex approach to generating the most effective
disinfection technology available today aligns with
the World Health Organization’s call for removal of
mercury in all healthcare settings.
With the Xenex system, the energy of each pulse
is substantially greater than that produced by
traditional mercury lamps, leading to a much higher
microbicidal effect while greatly reducing the total
time necessary for sterilization. Further, xenon gas
is inert and harmless, while mercury gas is highly
toxic, leading to health dangers if a mercury bulb
is broken. Pulsed xenon UV disinfection enables
“no touch” cleaning that is 99% effective in room
decontamination and over 30 times more effective
than traditional cleaning methods.
Sustainable, Eco-friendly Cleaning:
SHINE Floor Cleaning Service by Sodexo
Dedicated to creating and maintaining “best
practices,” SHINE is an Environmental Services
technical education and eco-friendly work process
that integrates cleaning methods, equipment and
products to produce predictable outcomes, promote
sustainability, optimize labor and maximize value.
Sodexo’s partnership with industry visionaries
and leaders allows for cutting-edge technology,
innovationandoperationalexcellenceinitsoperating
standards. SHINE has been shown to reduce the labor
associated with some housekeeping tasks by more
than 50%, reduce chemical usage by up to 90% and
reduce water usage and effluent by 75%.
10
SHINE has been shown to reduce
housekeeping labor by more than
50%
COMPARING DISINFECTION TECHNOLOGIES
Metric Hydrogen Peroxide Vapor Mercury Ultraviolet (UVC) Pulsed Xenon UV
Decontaminaiton
effectiveness
Studies showed 95%
reductions1
Low-end models (20 bulbs)
unproven. High-end models
studies showed 99% reductions1
Studies showed 99%
reductions1
Cost per room1
$110 $16 $3
Cycle time 3 to 4 hours per room1
1 hour, 12 min to
2 hours, 6 min1
Multiple position = 10 min
additional room1
time
Operators Specialized technician Housekeeper Housekeeper
Access to room
during operation
No Remote Stop;
Immediate Reentry
Remote Stop;
Immediate Reentry
Safety Vapor is dangerous until
cycle is complete; rooms
must be sealed with tape
UV light can irritate retina,
so staff must exit during
treatment
UV light can irritate retina,
so staff must exit during
treatment
Environmental
friendliness
Hydrogen peroxide degrades
into H2
O
WHO supports a ban on
mercury in healthcare settings
Certified “green” by Practice
Greenhealth1
Infection rate
impact
Unconfirmed Unconfirmed 67% reduction in C. diff.1
;
MRSA reduced to 0 in 2Qs1
1
Source studies, calculations other references/content available upon request.
Automation Driving Efficiency: TRAKKAR
Environmental Services Software
TRAKKAR performance analysis software tracks
cleaning performance and serves as a continuous
improvement tool. TRAKKAR uses computer
technology and handheld pocket PCs to engage staff
members in driving quality enhancements for every
area of the facility. The system includes more than
150 reports on people, spaces, training and quality,
which facilitate labor optimization by tracking
employees, their responsibilities and outcomes.
At the heart of the TRAKKAR program is a detailed
database of the facility’s spaces, Environmental
Services employees and Sodexo standards for
cleaning procedures, performance and training. The
software automatically calculates daily cleaning
times based on frequency and square footage;
easily orders and adjusts which rooms need to be
cleaned, when and how often; creates employee
printouts showing cleaning steps to be performed
in each room; and finds rooms that haven’t been
put on work assignments.
Individual staff performance is tracked in the quality
assurance process. Then, the TRAKKAR training
module supports continuous improvement by
matching quality issues with training needs. The
software schedules employee training and maintains
detailed records on attendance and test scores, all
easily found with a few clicks of the mouse.
The TRAKKAR quality assurance inspection process
enables managers and staff to know that the
facility is running at the highest levels of vigilance
and service every day. And TRAKKAR also has been
shown to positively impact employee behaviors
and, ultimately, HCAHPS scores.
More than
150
customizable reports
Mobile Audit Tools
Trakkar Report
Pulsed xenon disinfection is
30 times
more effective than
traditional cleaning methods
11. Aligned with the WHO: Mercury-free, Pulsed
Xenon Ultraviolet Disinfection System
Asagloballeaderinhealthcare,Sodexocontinuously
searches for new technologies and processes
that improve operational efficiencies and patient
outcomes. One such technology, the breakthrough
Xenex automated disinfection system, is offered
exclusively through Sodexo, and uses pulsed xenon
ultraviolet (UV) light to destroy viruses, bacteria
and spores in patient areas without contact
or chemicals. As a mercury-free solution, the
Xenex approach to generating the most effective
disinfection technology available today aligns with
the World Health Organization’s call for removal of
mercury in all healthcare settings.
With the Xenex system, the energy of each pulse
is substantially greater than that produced by
traditional mercury lamps, leading to a much higher
microbicidal effect while greatly reducing the total
time necessary for sterilization. Further, xenon gas
is inert and harmless, while mercury gas is highly
toxic, leading to health dangers if a mercury bulb
is broken. Pulsed xenon UV disinfection enables
“no touch” cleaning that is 99% effective in room
decontamination and over 30 times more effective
than traditional cleaning methods.
Sustainable, Eco-friendly Cleaning:
SHINE Floor Cleaning Service by Sodexo
Dedicated to creating and maintaining “best
practices,” SHINE is an Environmental Services
technical education and eco-friendly work process
that integrates cleaning methods, equipment and
products to produce predictable outcomes, promote
sustainability, optimize labor and maximize value.
Sodexo’s partnership with industry visionaries
and leaders allows for cutting-edge technology,
innovationandoperationalexcellenceinitsoperating
standards. SHINE has been shown to reduce the labor
associated with some housekeeping tasks by more
than 50%, reduce chemical usage by up to 90% and
reduce water usage and effluent by 75%.
10
SHINE has been shown to reduce
housekeeping labor by more than
50%
COMPARING DISINFECTION TECHNOLOGIES
Metric Hydrogen Peroxide Vapor Mercury Ultraviolet (UVC) Pulsed Xenon UV
Decontaminaiton
effectiveness
Studies showed 95%
reductions1
Low-end models (20 bulbs)
unproven. High-end models
studies showed 99% reductions1
Studies showed 99%
reductions1
Cost per room1
$110 $16 $3
Cycle time 3 to 4 hours per room1
1 hour, 12 min to
2 hours, 6 min1
Multiple position = 10 min
additional room1
time
Operators Specialized technician Housekeeper Housekeeper
Access to room
during operation
No Remote Stop;
Immediate Reentry
Remote Stop;
Immediate Reentry
Safety Vapor is dangerous until
cycle is complete; rooms
must be sealed with tape
UV light can irritate retina,
so staff must exit during
treatment
UV light can irritate retina,
so staff must exit during
treatment
Environmental
friendliness
Hydrogen peroxide degrades
into H2
O
WHO supports a ban on
mercury in healthcare settings
Certified “green” by Practice
Greenhealth1
Infection rate
impact
Unconfirmed Unconfirmed 67% reduction in C. diff.1
;
MRSA reduced to 0 in 2Qs1
1
Source studies, calculations other references/content available upon request.
Automation Driving Efficiency: TRAKKAR
Environmental Services Software
TRAKKAR performance analysis software tracks
cleaning performance and serves as a continuous
improvement tool. TRAKKAR uses computer
technology and handheld pocket PCs to engage staff
members in driving quality enhancements for every
area of the facility. The system includes more than
150 reports on people, spaces, training and quality,
which facilitate labor optimization by tracking
employees, their responsibilities and outcomes.
At the heart of the TRAKKAR program is a detailed
database of the facility’s spaces, Environmental
Services employees and Sodexo standards for
cleaning procedures, performance and training. The
software automatically calculates daily cleaning
times based on frequency and square footage;
easily orders and adjusts which rooms need to be
cleaned, when and how often; creates employee
printouts showing cleaning steps to be performed
in each room; and finds rooms that haven’t been
put on work assignments.
Individual staff performance is tracked in the quality
assurance process. Then, the TRAKKAR training
module supports continuous improvement by
matching quality issues with training needs. The
software schedules employee training and maintains
detailed records on attendance and test scores, all
easily found with a few clicks of the mouse.
The TRAKKAR quality assurance inspection process
enables managers and staff to know that the
facility is running at the highest levels of vigilance
and service every day. And TRAKKAR also has been
shown to positively impact employee behaviors
and, ultimately, HCAHPS scores.
More than
150
customizable reports
Mobile Audit Tools
Trakkar Report
Pulsed xenon disinfection is
30 times
more effective than
traditional cleaning methods