Many of them face COVID-19 every day at Texas Health hospitals, performing vital work for the safety of both clinicians and patients.
Environmental services workers clad in personal protective equipment enter rooms where persons under investigation and COVID-19-positive patients lie, taking out trash and cleaning up quickly. But their skills are particularly important when they perform what’s called a terminal clean, the meticulous work required when the patient has left.
The term was in use before the COVID19 pandemic and the process is used after any infectious disease patient, regardless of the outcome of the case.
“We have to do the whole room, 100 percent,” said Gloria Morales, environmental services director at Texas Health Harris Methodist Hospital Southwest Fort Worth.
To miss even a tiny area could potentially expose the next patient.
Patricia Silva, an EVS worker at Texas Health Presbyterian Hospital Denton, cleans in the Emergency Department, where she’s finishing 20-25 rooms during her shift — not all terminal cleans —many of them wearing PPE.
“I enjoy protecting everybody,” she said. “The work is harder, but I’m not afraid.”
Nothing Left to Chance
The clean is a nine-step process, each of them detailed and specific.
For example, step 3: “Clean bed, furniture, phone, shelves, trashcans, T.V., all high use touch points (i.e. light switches, TV remotes, push buttons, etc.) and spot clean walls, using appropriate cleaning disinfectant. Using Oxivir TB Disinfecting Cleaner, spray patient privacy curtain, especially focusing in on the area where curtain is grabbed by hand to pull/close.” 
Nothing is left to chance. Even the mopping must be done using an “S” method with a particular type of mop, moving from the back of the room toward the doorway, first with a dust mop, then with a wet mop.
The walls also are cleaned top to bottom, moving around the room in a counter-clockwise direction, said Darrell Stoker, Patricia’s supervisor and director of environmental services at Texas Health Denton.
UV robots
Finally, when all the manual work is completed, the workers bring in either a robot or another type of ultraviolet germ irradiation device that streams light so intense it kills all the pathogens it reaches. The light is so powerful workers must close any curtains and the door for safety.
“We roll the robot in, put a safety cone outside the room. It pulsates, so the UV light is killing everything in the room. There could be virus still active on a surface. This will take care of it,” said Edward Flores, director, environmental services, Texas Health Arlington Memorial Hospital.
He said Texas Health Arlington Memorial purchased its first two robots in 2015 and developed a standard operating procedure for their use, starting with the intensive care unit, operating rooms, the emergency department and oncology. They also focused on isolation rooms, to handle cleans after patients with methicillin-resistant staphylococcus aureus (MRSA) and clostridium difficile (C. diff).
Today they’re busier than ever before, he said.
Adapting to change
Gloria and Darrell said the workers don’t express much fear, despite the new hazards of the job.
“We communicate to them on a continuous basis and they understand things are fluid at this time,” Darrell said. “They’ve pretty much adapted to it. We cohort patients in certain areas and do our best to try to evenly distribute the workload so one doesn’t feel inundated.”
Gloria added, “They are proud of what they’re doing every single day.”
Victor Burnett, a floor tech at Texas Health Harris Methodist Hospital Fort Worth, who was waiting for a UV machine to finish its cycle on a recent day in an ICU where most patients were either PUI or COVID-19 confirmed, said, “It’s not a comfortable feeling, but we have a job to do and it’s what you have to do.”
By Judy Wiley • Posted April 21, 2020
