Identifying Gaps in the Ambulatory Room Cleaning Process of an Academic Medical Hospital

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      Ambulatory clinic visits make up a significant portion of health care activities in the United States. The most recent (2016) National Ambulatory Medical Care Survey found that there were 278 office based physician visits per 100 persons. Our hospital has over 70 ambulatory clinical practices and more than 1 million visits per year, and no standard practice for room turn over in the ambulatory setting. Lack of standardization can open gaps in the practice of individual clinics. We surveyed the practices in a variety of clinics, in order to identify best practices and opportunities for improvement.


      Our study was completed in 19 individual ambulatory clinics. We observed 58 separate room turn over events, completed by Nurses (RN) and Medical Assistants (MA). We identified a list of high-touch surfaces commonly cleaned in the clinics. During each event, we recorded the items that were cleaned, and those that were not. This data was compiled into a database to identify trends in cleaning processes.


      We found that items sorted into 3 general groups: Those that were regularly cleaned (60-84% cleaned), those that were regularly missed (9-35% cleaned), and those that were regularly marked N/A (40-70% N/A). We found the most common practice was that the paper that covers an exam table was changed (84%). The least cleaned items were otoscopes and ophthalmoscopes installed on the wall of each room (9%).


      The significant volume of patients in ambulatory areas creates a great opportunity for improvement by standardizing cleaning processes. Standardized cleaning processes would help ensure that a consistent level of safety and care is provided to all patients. A future aim for our Infection Prevention team is to assess the impact of a standardized protocol on room turn over, event consistency, and surface coverage.
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