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Privacy Curtains

The EVs Perspective: Why it Takes so Long to Get Patients Out of the ED

By June 7th, 2023No Comments

By: Darrel Hicks

Upon searching the internet for lean processes for terminally cleaning the rooms of patients on droplet precaution isolation and finding none, I am left to speculate on best practices regarding necessary privacy curtain exchanges. My conclusions are guided by 34 years of experience leading hospital Environmental Services departments that processed hundreds of terminal cleanings every week.

8:58 a.m.

First, focus on admitting the patient who has a severe respiratory tract infection as an inpatient. After blood work, examination by the physician and, perhaps, a chest X-ray, the order is written to admit the patient to Room 4004 and will be placed on “Droplet Precaution” isolation. The clock on the ED treatment room wall shows 8:58 a.m.

By now, 2-3 hours might have passed in the Exam/Treatment Room or perhaps the corridor. The patient is uncomfortable on the gurney, has a temperature of 101°, is wearing a mask and has an uncontrollable cough. They want to get to their room and into a warm, comfortable bed. But they are told, “We’re waiting on Housekeeping to get the room ready.”

Second, focus on the Environmental Services Tech (EST) whose job is to hunt and destroy fomites in order to break the chain of infection from one person to the next. Fomites are the objects or surfaces (porous and nonporous) that may get contaminated with pathogens and serve as a vehicle in transmitting the disease from one person to another. When a person is ill with respiratory illnesses, their nasal fluid, cough or saliva shed the virus. While coughing or sneezing, the infected droplets come out from their mouth and settle on fomites or objects present around them (i.e., privacy curtains).

9:20 a.m.

The EST is told that the ED wants Room 4004 done “STAT” for an admission. She hurries to complete the daily clean on the room she is in and arrives at the doorway to room 4004; it’s 9:30 a.m.

She notices a hospital isolation sign stating, “Contact Plus Droplet Precaution” which is posted for patients with RSV, COVID, adenovirus, or influenza.  Droplet precautions are intended to prevent transmission of pathogenic organisms spread through close respiratory or mucous membrane contact with respiratory secretions.

She knows it will take her an hour or longer to process the room, but she dons her Personal Protective Equipment (PPE) and begins stripping the room of disposable patient care items, trash, and soiled linens.

The instructions on the isolation sign state that “privacy curtains must be removed and replaced with clean curtains.” At 9:40 a.m. she notifies her supervisor that she needs a “Curtain change in 4004.” After hanging up the phone, she pushes the “contaminated” curtain against the wall and begins processing the room as she is trained to do. The curtain exchange will require a different EVS tech to bring a clean curtain and a step ladder on wheels to remove the contaminated curtain and replace it with a fresh curtain.

After performing the “above floor” high dusting, the disinfection of 16 high-touch surfaces and the restroom, she begins wiping down the mattress and bed frame. Next, she checks and replaces soap and hand sanitizer dispensers, as necessary, and restocks paper towels and toilet tissue.

When she is done decontaminating the room, arranging the furniture, and mopping the floor, she doffs her PPE, washes her hands, and looks at the clock wondering, “Where’s the guy that changes the curtains? It’s 10:15 a.m.!”

At 11:00 a.m. she’s done making the patient’s bed and stocking bath linens. As far as she is concerned, the room is ready for the ED patient. But, what about the contaminated curtain that has not been removed and replaced? The room can’t be reported as “Clean and READY” until the curtain is exchanged. The sick patient in the ED must wait another 30 minutes.

Real-World Example of a Wasteful Practice That Should Be Eliminated

Third, at 11:10 the man, the ladder and a clean curtain arrive at Room 4004. It’s not his fault that the room status in the Bed Control system can’t be changed to “Clean and Ready” yet. He was doing his assigned tasks on another floor when his pager notified him of a curtain change in Room 4004 at 10:05.

According to hospital protocols, he had to put his vacuum cleaner away in the custodial closet and then travel down to the basement of a different building to the curtain storage area (which is almost always an unorganized hot mess). There, in all the chaos he had to locate the right curtain pattern, length, height, and number of curtains. Now he’s ready to head up to 4004 when he notices that the rolling ladder that he needs isn’t in its usual spot by the elevator; he must find it. After contacting his supervisor he’s told where he can find the ladder.

He heads out to the known ladder location, grabs the ladder and heads to the 4th floor. By 11:20 he has bagged the contaminated curtains and replaced them with clean ones. As he passes the Nurse’s Station he tells the Unit Clerk, “The curtain in 4004 is done.”

Now the status of Room 4004 can be changed from “Dirty” to “Clean and Ready” and the transport staff can bring the patient to her room. It’s 11:40 when the patient gets into her clean room.

But wait.. the “curtain guy” must still take the soiled curtain to the drop off location, return the ladder to its rightful location and take his lunch break. After lunch, he is back to his assigned tasks at 12:35 after being gone for two hours and 30 minutes.