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How a 5-Hospital System
Reduced Infection Rates,
Saved Over $2 Million — and
Increased Patient Satisfaction
HEALTH CARE
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
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
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
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
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
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
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
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
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
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
healthcareinnovation.usa@sodexo.com
800 432 6663
infectionfree.sodexo.com
0003-6F

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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