Housekeeping audits for health facilities in the region show that most are above the auditor’s acceptable benchmark score, though all facilities have individual rooms that fall below that score.
Castlegar News spoke with both the president of Westech Systems FM, Inc. — the company that conducts the housekeeping audits for health authorities in B.C. — and the corporate director of support services at the Interior Health Authority to learn more about the auditing process, what the scores mean and what Interior Health does with the audit reports.
Results from the 2017-18 audit show that Talarico Place in Castlegar, Kootenay Boundary Regional Hospital (KBRH) in Trail, Kootenay Lake Hospital (KLH) in Nelson and Boundary Hospital in Grand Forks all scored above the benchmark score of 85 per cent, while Arrow Lakes Hospital (ALH) in Nakusp scored below the benchmark:
• Talarico Place scored 90.03 — nine out of 30 rooms came in under 85 per cent, three of which were very high or high-risk rooms;
• KBRH scored 87.78 — 19 out of 58 rooms came in under 85 per cent, 11 of which were very high or high-risk rooms;
• KLH scored 87.78 — 14 out of 40 rooms came in under 85 per cent, 10 of which were very high or high-risk rooms;
• Boundary Hospital scored 89.87 — five out of 25 rooms came in under 85 per cent, all of which were very high or high-risk rooms;
• ALH scored 83.92 — 11 out of 18 rooms came in under 85 per cent, 10 of which were very high or high-risk rooms.
Dean Waisman, president of Westech Systems, provided context on the benchmark of 85.
“This is an industry standard benchmark based on the scoring system developed by the BC Health Authorities [and] Westech. Please realize that the average score of all the rooms audited in a site provides the indication as to whether a site passes or fails not individual rooms,” he said.
Westech’s auditors go through a “rigorous certification program,” according to Waisman and “are trained to look at all cleanable surfaces in a room to determine if they have been adequately cleaned.”
Each room can be broken down into up to 19 different inspection categories and each of those categories is subject to eight decision making criteria. If an inspection category fails, that will negatively impact a room’s score and Waisman explained that it’s easier for a room with fewer inspection categories to fall below the benchmark score.
“The number of inspection elements varies depending on the room type so the number of items that could cause a room to fail changes,” said Waisman.
Each room is also assigned to one of four risk categories: Risk 1 — Very High Risk; Risk 2 — High Risk; Risk 3 — Moderate Risk; and Risk 4 — Low Risk.
“Every hospital is divided into four different risk categories. So anything like an OR or an ER is Risk 1 and anything that’s Risk 4 would be like an admin area. However, the way that that whole risk category works is let’s say there’s an office, which is technically an admin area, in an OR area or in an ER, it’s still Risk 1. Because theoretically, a doctor could go into his office and then go into a high-risk area. So you don’t want to have that transfer of infectious diseases so that’s the way the process works,” said Waisman.
The inspection elements in higher risk rooms are weighted in a such a way that it easier for them to fail than it is in lower risk rooms.
As an example, the ER Treatment A room at Talarico Place received a score of 82.22 — it was Risk 1 and had 12 inspection elements, two of which failed. But Conference 12, where two of the inspection elements also failed, received a score of 92.06. The difference is that it is Risk 4 and had 14 inspection elements.
The average score of all the rooms is then used to score the overall facility, but asked if individual room scores are a concern, Waisman said, “If I was a housekeeping manager and I got my audit results and I see a room with a low score, I would want to explore that and definitely go in there and do corrective action.”
Andrew Pattison is corporate director of support services at the Interior Health Authority and oversees the food and housekeeping departments.
He said that when the leads at the different IH sites receive the audit reports they pass them on to the supervisors.
“They should be reviewed by the supervisors and where there’s any issues or opportunities, they are expected to follow up. If an audit fails in a specific area … then they re-clean the room and its re-audited,” explained Pattison.
The staff has 48 hours to clean the failed room and the reinspection is done in-house.
All of IH’s housekeeping is done by in-house, unionized employees and each site also conducts four in-house audits a year.
Waisman also explained that as part of the eight decision-making criteria for each element, there are things that can cause an inspection element to automatically fail.
One of those things is dried blood found on a surface.
If the blood is still wet, then the reaction is slightly different.
“If it’s wet blood, then our job as an independent auditor is to call the nursing staff right away and then they come and address that,” explained Waisman. “Because realistically if it’s wet then that probably just happened. So that’s something that we would call a time of day issue … and that’s one of the decision-making factors. So time of day means that theoretically, we’re in there sometime during the day, the cleaners were in there in the morning and so something like that could have happened after the cleaners left. So we have to factor that into our decision-making process.
“But even if the cleaner was in there in the morning, cleaned the room up perfectly and there’s blood spilled and we get there later and the blood’s dried, it still fails. So that’s just part of our decision-making process. Same if we go into a washroom and into a toilet stall and we see that there’s no toilet paper in that particular cubicle, that’s an automatic fail,” he added.
If any element automatically fails then Pattison said it’s addressed right away.
“If it’s an immediate fail like that then the auditor finds the housekeeping supervisor or nearest housekeeper and it’s expected that it’s immediately rectified,” he said.
Pattison said that in general, IH uses the audit process as a learning opportunity for its staff.
“We take those audits, we share them with the staff and the cleaners and it allows us to sort of pinpoint what some areas might be missing and then work through them from there. So I would say the audits would help identify some opportunities and the team would have collectively come together and worked through those,” he said.