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Special report
We make the difference
09.01.13 by Bob Kehoe
Geisinger Medical Center's ES team lives its motto

2. Serving about 2.6 million residents of northeastern and
central Pennsylvania, Geisinger Health System has long been recognized as one of the more innovative
care delivery systems nationally. The physician-led organization was reshaping its care delivery models
well before the Affordable Care Act became part of health care's vocabulary.
Geisinger is squarely focused on improving quality, satisfaction and efficiency by redesigning and re-
engineering care delivery. It offers bundled pricing for many of its ProvenCare procedures, which are
centered on administering a coordinated bundle of evidence-based best practices.
This organizational commitment to quality and safety extends far beyond the operating room. At
Geisinger Medical Center (GMC), the system's 560-bed flagship hospital campus in Danville, the
environmental services (ES) team employs a "bundled cleaning" approach to patient rooms.
ES associates follow a carefully defined six-step cleaning process with checklists for patient rooms,
created by researcher Philip Carling, M.D. Every cleaning cart has a visual and text chart of Carling's 14
high-touch points that need to be cleaned as well as infection control checklists for daily cleans,
discharges and isolation rooms. Supervisors use fluorescent marking gel and ultraviolet light to measure
cleaning thoroughness of the high-touch points.
"We conduct 14 high-touch point fluorescent marker inspections, which are generated and then recorded
into spreadsheets in various forms for reporting out to our infection control and performance improvement
committees," explains Jack VanReeth, GMC's director of ES and surgical cleaning services.
Bundled cleaning
This bundled cleaning approach has become part of GMC's culture. The ES team has a consistently high
success rate: More than 90 percent of GMC's rooms are 100 percent compliant for thoroughly cleaning all
14 high-touch points, ES department data from 2012 show.
Elsewhere, ES leaders working with the infection prevention team have widely implemented other
technologies to improve safety.
Automated room sterilization technologies are deployed routinely to combat Clostridium difficile,
methicillin-resistant Staphylococcus aureus (MRSA) and other health care-associated infections. GMC

3. uses three ultraviolet-C (UVC) light units and three hydrogen peroxide (HP) vapor sterilization units
across its facilities.
"The primary focus is on isolation discharges of various types and also to see if a room needs to be
treated retroactively," VanReeth says. "All patient room isolation discharge cleanings always include wall
washing and changing cubicle curtains. General isolation discharges receive a supplemental UVC
disinfection. C. difficile discharges after the regular isolation cleaning receive a supplemental disinfection
with a sporicidal product. Then, as a final step, the C. difficile room receives a hydrogen peroxide
fumigation treatment."
High-tech sterilization
The HP vapor units take far longer to sterilize a room — typically 90 minutes to two hours. VanReeth
notes that it's because there is no short-term exposure time limit established with HP, which is one part
per million. As such, once the room is decontaminated, patients aren't admitted until the space reaches
the one-part-per-million threshold or less.
This closely monitored approach and careful coordination with the infection prevention team is paying
dividends. Since implementing the HP vapor system in mid-December 2011, GMC's C. difficile rate has
been cut by 30 percent to 0.23 percent of unit discharges, VanReeth says, adding that no other changes
were made to cleaning protocols. Since implementing UVC technology in 2012, MRSA rates have
decreased 25 percent to 0.4 percent of discharges, again with no other changes to established cleaning
and disinfection protocols.
This commitment to performance improvement on reducing health care-associated infections (HAIs),
consistently adhering to defined protocols and overall safety is one key reason GMC has been selected
winner of the 2013 ES Department of the Year competition. Presented by Health Facilities Management
and the Association for the Healthcare Environment (AHE), the award is sponsored by Cintas Corp.
"Achieving ES Department of the Year status is no easy feat. The determination of the Geisinger Medical
Center ES team is outstanding," says Patti Costello, executive director of the AHE.

4. Training is key
That GMC has seen such consistent results on room cleaning and working closely with the infection
prevention team to reduce HAIs can be traced back to the fundamentals. Detailed training of new hires
from ES team leadership helps to set the tone for expectations and departmental standards. Current staff
also participate in regular training.
"Our greatest strength is our people. We have to invest as much as we can in our staff because it's a
service we're providing and people are providing the service," says Tamara D. Almquist, Geisinger Health
System senior director of environmental services and surgical services.
That investment starts before employees are hired. GMC, which is one of the employers of choice in this
economically challenged area of Pennsylvania, developed a departmental recruitment video. It's used to
help give applicants comprehensive information to determine whether to proceed with the application
process.
Once on board, new hires go through intensive education at a training site off campus.
"It's a classroom style with eight modules presented by the ES management team. There's a session
where they observe a discharge room being completely cleaned and an occupied patient room being
cleaned," says Jane Martin, R.N., CIC, manager of performance improvement, projects and training for
Geisinger System environmental services.
Attendees also are taken through a product display room to learn about the cleaning and disinfectant
agents they'll be using in their daily routine. Once entered into the workforce, ES associates log into the
hospital's online education program goals system and take a survey. Based on the answers provided by
the associate, a list of hospital courses are provided that the employee will need to take on an annual
basis. Continuing education expectations are similarly high for experienced employees.
Employee retention
Based on GMC data, this approach to giving ES associates a strong foundation in working efficiently and
effectively is connecting with staff. GMC's ES associate retention rate over the past three years has
averaged nearly 80 percent. And many of those who end up leaving the ES department moved on to
higher positions within GMC.
More importantly, having well-trained and motivated staff has helped GMC to maintain a consistently
strong success rate in reducing room turnaround and response times to meet the demands for increased
throughput on this extremely busy campus.
Response times in 2012 were routinely in the 10-minute range for "clean next" rooms, based on GMC's
bed tracking data. Stat clean response times in 2012 routinely were in the two-minute range or less — an
impressive feat for a team responsible for more than 2.4 million square feet of cleaning space.
"This is a significant responsibility for us because, being a regional trauma center, our emergency rooms
are constantly packed and we have very busy operating rooms, so turnover is absolutely critical,"
VanReeth says.
And with an extensive array of tertiary facilities, including ever-expanding outpatient services, GMC's ES
department is responsible for covering a lot of ground outside the main hospital walls — all of which can
make maintaining consistently high levels of patient satisfaction challenging.
After achieving Press Ganey Associates Inc. room cleanliness scores in the 89th percentile for institutions
with 500 beds or above in 2011, GMC's numbers dipped in 2012.

5. But as with other areas of operation, the team leadership has taken steps, in working with the Studer
Group, Gulf Breeze, Fla., to implement training and tracking mechanisms designed to boost performance
on cleanliness and courtesy. Finally, GMC's ES team continues to make significant strides in
environmental stewardship. An effort to reduce regulated or red bag medical waste, begun in 2011, led to
a reduction of 584,000 pounds or 292 tons of this waste for an annual savings of about $82,000. In 2012,
red bag waste was reduced by another 160 tons, bringing additional savings of nearly $45,000.
Making a difference
The effort to reduce red bag waste involved ES employees throughout the campus. As with its other
areas of operation, it's an example of how GMC's ES team lives its motto of "We make the difference."
Bob Kehoe is associate publisher of Health Facilities Management.
Winner
Geisinger Medical Center
• Danville, Pa.
• Jack VanReeth, director of environmental services and surgical cleaning services
Finalist
Blanchard Valley Hospital
• Findlay, Ohio
• Robin Cramer, environmental services/communications manager
Certificate of Merit
MD Anderson Cancer Center
• Houston
• Alonzo Gonzalez, CHESP, CHFM, director of patient care facilities properties
Huntsman Cancer Hospital
• Salt Lake City
• Linda C. Rogers, manager of environmental services
Judges
• Laurie Bowe, CHESP, environmental services supervisor, Shriners Hospitals for Children, Erie, Pa.
• J. Hudson Garrett Jr., Ph.D., senior director, clinical affairs, PDI Inc., Orangeburg, N.Y.
• Ali Khan, CHESP, manager of environmental services, University of Maryland Shore Medical Center at
Easton
• Doug Rothermel, MBA, CHESP, director of environmental services, St. Joseph's Hospital, Tampa, Fla.
FINALIST
'Extraordinary people. Exceptional care'
Blanchard Valley Hospital ES team goes the extra mile