Association for the Healthcare Environment of the American Hospital Association 155 North Wacker Drive Chicago, IL 60606 Phone: 312.422.3860 Fax: 312.422.4578 E-mail:
[email protected] Website: www.ahe.org Healthcare Environmental Services Preparation Guide, Third Edition AHE Item Number 057960. © Copyright Association for the Healthcare Environment of the American Hospital Association 2014. All rights reserved. Permission to reproduce or transmit any portion of this book in any form or by any means, electronic or mechanical, including photocopying and recording, or by an information storage and retrieval system, must be obtained in writing from the Association for the Healthcare Environment.
Healthcare Environmental Services Preparation Guide | Third Edition
Table of Contents
About The CHESP Program
7
Sample Questions
9
Chesp Examination Outline
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1. Regulatory Compliance 22 2. Planning, Design, and Construction 42 3. Operations Related To Environmental Sanitation 49 4. Operations Related To Waste Management
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5. Operations Related To Textile Management
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6. Financial Stewardship
96
7. Administration
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Appendix 1: Web Sites
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Appendix 2: References
130
About AHE
133
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About the CHESP Program
T
he American Hospital Association Certification Center (AHA-CC) is a division of the American Hospital Association (AHA). Its mission is to create, facilitate, and administer the healthcare industry’s premier certification programs.
The AHA-CC Board of Directors is charged with governance of all certification programs conducted by the AHA-CC, including the CHESP. Board members are appointed to represent AHA’s professional certification program stakeholders. The CHESP program, along with all other certification programs in operation with the AHA-CC, has a Certification Program Committee that serves as content expert, program resource, and consultant to the AHA-CC regarding program development, examination content, test development, test administration, and evaluation. Members are appointed by the AHA-CC Board of Directors. The AHA-CC does not discriminate among candidates on the basis of age, gender, race, color, religion, national origin, disability, or marital status. The CHESP certification examination is designed to test a well-defined body of knowledge representative of professional practice in the discipline. Successful completion of the examination is an indicator of broad-based knowledge in the discipline and leads to a certification credential defined by a national role delineation study. The role delineation study surveyed practitioners in the field to identify tasks that are performed routinely and considered important to competent practice. Each edition of a certification examination is constructed in accordance with examination specifications that list content categories and tasks to be covered, and assign quantities of test items and cognitive complexity to content categories. Specifications are developed to represent tasks that are performed in professional practice. AHA-CC examinations are developed through a combined effort of qualified subject matter experts and testing professionals. They review the test items to ensure that they are accurate in their content, relevant to practice, and representative of good testing procedures. Individuals who meet eligibility requirements and who successfully pass this examination attain the Certified Healthcare Environmental Services Professional (CHESP) designation.
Eligibility Requirements Candidates who meet eligibility requirements fully and pass the CHESP Examination attain the CHESP designation. The AHA-CC reserves the right to verify accuracy of information supplied by or on behalf of a candidate. Eligibility for the CHESP Examination requires fulfilling one (1) of the following requirements: • Baccalaureate degree or higher from an accredited college or university plus three (3) years of environmental services experience*in a healthcare setting**. Two (2) of those years must have been in a management/supervisory/administrative role.
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• Associate degree or equivalent from an accredited college plus four (4) years of environmental services experience* in a healthcare setting**. Three (3) of those years must have been in a management/supervisory/administrative role. • High school diploma or equivalent plus five (5) years of environmental services experience* in a management/supervisory/administrative role in a healthcare setting**. * Environmental services experience refers to work experience in operations related to environmental sanitation, waste management, and textile management. ** Includes experience with a provider of environmental services or products to a healthcare facility (e.g., Consultants, Manufacturers, Vendors, Contract Services Providers, etc.).
Taking the Examination The AHA-CC contracts with Applied Measurement Professionals, Inc. (AMP) to assist in the development, administration, scoring, score reporting, and analysis of its CHESP Examination. Please contact AMP at 913-895-4600 or by e-mail at
[email protected] if you are interested in taking the CHESP Examination and/or to receive a copy of the CHESP Candidate Handbook. You may also download a copy of the CHESP Candidate Handbook through the AHE web site at www. ahe.org. AMP Assessment Centers are typically located in H&R Block offices. Specific address information will be provided when you schedule an examination appointment. Visit the Applied Measurement Professionals, Inc. (AMP) web site at www.goAMP.com for a detailed list of assessment center locations.
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Healthcare Environmental Services Preparation Guide | Third Edition
Sample Examination Items
1.
The authority that sets regulatory guidelines for incinerators is the
A. Environmental Protection Agency B. Department of Transportation C. Centers for Disease Control and Prevention D. The Joint Commission 2. When cleaning up a large blood spill in the laboratory, the appropriate personal protective equipment includes which of the following? 1) face shield and shoe covers 2) gloves and isolation gown 3) hair bonnet and scrubs 4) goggles and mask A. 1 and 2 only B. 1 and 3 only C. 2 and 4 only D. 3 and 4 only 3. Phenolic disinfectants contain synthetic phenolic compounds, and are NOT effective against which of the following? A. tuberculosis B. fungi C. spores D. bacteria 4.
What common group of items is pulled from the waste stream to be recycled?
A. grease, plastic, copper B. glass, old furniture, medical equipment C. cardboard, aluminum, office/computer paper D. mercury, xylene, refrigerant 5. In processing textiles, there has been an increase in lint. Which of the following items would be a starting point to resolve this situation? A. quality of linen B. amounts of chemicals C. condition of filters D. condition of heating elements in dryers
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Sodium hypo-chloride (chlorine bleach) may be used in specialized cases. The U.S. Occupational Health and Safety Administration (OSHA) Bloodborne Pathogen Standard issued in 1991 requires that “all equipment and environmental and working surfaces shall be cleaned and decontaminated after contact with blood or other potentially infectious materials.” (Section 1910.1030, (d) (4) (ii)) The CDC recommends using an EPA-registered hospital disinfectant with a tuberculocidal claim or a bleach solution diluted 1 part bleach to 10 parts water on a porous surface, 1 part bleach to 100 parts water on a non-porous surface. Bleach has also been demonstrated to be effective at elimination of C. difficile spores as part of a comprehensive cleaning regimen. Bleach is corrosive, and a bleach solution is very unstable, especially when exposed to light in a non-opaque container. A fresh solution should be mixed after 24 hours or it may be purchased in a ready-to-use form.
Other Chemical Products
Some of the other chemical products used could include:
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Floor finishes and sealers to protect resilient tile floor surfaces
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Burnishing or spray buffing products to refresh and restore floor finishes
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Floor finish removers or strippers designed to emulsify floor finishes for removal
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Soil retardant products that are applied to carpeting, upholstery, drapes, etc.
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Products to seal or maintain hard floor surfaces such as concrete, terrazzo, marble, etc.
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Products to protect or maintain wood floors, furniture and other wood surfaces
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Products to treat dust mops or cloths so they retain dust and soil better
The different surfaces and finishes in a facility will often dictate which chemical products are necessary, but it is always a good idea to minimize the number and variety of chemicals used when possible. This simplifies training and reduces the risk of the wrong chemical being used by a worker, as well as decreasing the risk of having dangerous combinations of chemicals being used. It is the responsibility of the Environmental Services professional to do everything possible to ensure the safety of ES workers and all people in a facility, and many chemical products can be dangerous if used improperly. In several cases, there may be suitable alternatives to these other chemicals. These “green” alternatives are more environmentally conscious and may reduce risks of exposure to employees.
Tools and Equipment Using the proper tools or equipment with the proper chemical products is the most effective and productive method of cleaning. The tools should always include protective gloves and other protective items as necessary, and can be as simple as a cloth, sponge, or brush. Equipment
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generally falls into the categories of powered and non-powered equipment. Ergonomics should be a major part of the consideration for evaluating tools and equipment. Many of the tools and equipment on the market today have ergonomic designs and features that weren’t available even a few years ago. Specialty equipment is also available for areas where procedures such as an MRI are performed, where non-metal equipment is necessary to prevent damage to the magnet and casing. Tools and equipment should be evaluated using the same criteria as all other purchases in the department: giving consideration to the initial price (acquisition cost), durability (useful life), suitability for the task as well as taking into account labor cost of use. An item may have a lower initial price, but if it doesn’t last as long as a similar item costing a little more, it may not cost less over the course of time. If an item requires more labor to use than a more expensive item it may not be the most cost-effective item, since labor is the most expensive (and valuable) resource in an ES Department.
Tools
Tools utilized by ES departments range from common items, like brushes, that are used in a wide variety of cleaning functions, to specialty items like window squeegees that are used only for cleaning glass surfaces. The quantity of these items purchased in a year may be significant, so standardizing on the specifications and purchasing from one or two primary sources will generally guarantee the best price and delivery service on these items. Long term or life cycle costing analysis should be used on these items as well as on more expensive items to control unnecessary costs.
Equipment
Non-powered equipment includes cleaning and transport carts, mop buckets and wringers, push sweepers, or any other equipment that requires the individual using it to provide the energy to make it function. Powered equipment used by ES departments traditionally is electrically powered, by either cords or batteries. Propane powered cleaning equipment is available on the market, but is not commonly used in healthcare facilities due to safety concerns. Fully automated equipment (robotics) is available and should be considered as it eliminates (or greatly reduces) the amount of labor needed to perform the designated task. Common powered equipment includes both wet and dry vacuum cleaners, carpet extractors, floor machines or “buffers,” high speed burnishers, sweepers, automatic floor scrubbers, etc.
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Healthcare Environmental Services Preparation Guide | Third Edition
4 Section
Operations Related to Waste Management
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4. Operations Related to Waste Management: 15 Items (Recall – 3, Application – 3, Analysis – 9)
A. Develop a waste management program to include (but not be limited
to) goals, operation requirements, reporting procedures, manifests, and documentation.
B. Integrate infection prevention standards with waste management
operations. C. Develop a process for monitoring and evaluation of the following: 1) Regulated Medical Waste (RMW) 2) Hazardous waste 3) Pharmaceutical waste 4) Chemotherapeutic waste 5) Pathological waste 6) Radioactive waste 7) Construction and demolition waste 8) “E-waste” (e.g. CRTs, other electronic devices) 9) Sharps 10) Recyclable materials 11) Municipal/solid waste removal 12) Confidential document destruction 13) Universal waste (e.g. mercury, bulbs, batteries)
D. Train environmental services personnel in the proper handling,
segregation, disposal, reduction, and treatment of all waste streams.
E. Train hospital staff in the proper handling, segregation, disposal, reduc-
tion, and treatment of all waste.
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Healthcare Environmental Services Preparation Guide | Third Edition
Operations Related to Waste Management
A
merica’s hospitals generate large amounts of waste. Each waste stream is defined and regulated by the state agency responsible for environmental enforcement. Definitions vary from state to state as to the material comprising Municipal Solid Waste (MSW).
You can obtain your own state definition and guidelines by contacting the agency that regulates waste management. Other agencies that influence waste management are:
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The Occupational Health and Safety Administration (OSHA) www.osha.gov
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The United States Environmental Protection Agency (EPA) www.epa.gov
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The United States Department of Transportation (DOT) www.dot.gov
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Centers for Disease Control and Prevention (CDC) www.cdc.gov
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The Joint Commission (TJC) www.jointcommission.org
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State and Local Departments of Health (DOH)
With the exception of OSHA, all of these agencies will have an impact on how and what you can put into a trash can or red bag. Some of the agencies will, in accordance with OSHA regulations, require you to provide employees a certain level of protection when handling infectious and/or hazardous material.
Municipal Solid Waste The largest volume of waste that hospitals generate is classified as Municipal Solid Waste (MSW). Usually, MSW is transported from the hospital for disposal in a sanitary landfill. MSW is regulated largely by the state environmental department with an oversight by the United States Environmental Protection Agency (EPA).
Infectious Waste Infectious waste is also known as biohazard waste, red bag waste, or medical waste. For purposes of discussion, we will use the term infectious waste. Infectious waste is defined by the state
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Job Assignment and Work Schedule
The information from the staffing worksheet and the daily non-productive time are used to determine the job assignment. Job assignments typically include detailed data accounting for every minute of an assignment. This detailed time flow may then be simplified to generate the daily area work schedule. There are several additional formulas used by the Environmental Services managers to assess and analyze departmental staffing needs and patterns:
Square feet cleaned per FTE = square feet of facility Total FTEs
Example: 500,000 sq. ft. / 100 FTEs = 5000 square feet per employee
FTE: Supervisor ratio =
Total # of FTEs
total # of supervisors
Example: 100 FTEs / 5 supervisors = 20 FTEs per supervisor
Turnover rate = Total number of employees during one given period who leave (voluntarily or involuntarily)
Total of number of employees at the start of the period
Example: At the beginning of April the ES dept. had 74 employees. At the end of April they had 72. Two employees were terminated. 2/74 = 2.7% turnover rate. Once ES management has this data, they can compare it to similar facilities, departments, etc., to determine if they are staffed and supervised adequately. New staffing tools are constantly being introduced to the marketplace to assist managers in determining and justifying staffing and supervisory positions.
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Healthcare Environmental Services Preparation Guide | Third Edition
