How a 5-Hospital system Reduced infection Rates, saved oveR $2 million — and incReased patient satisfaction

HealtH caRe

In a collaborative effort, Cone Health and Sodexo Health Care embarked on an initiative to reduce hospital-acquired infections (HAIs) and increase patient satisfaction. As a result, the system achieved a 64% decrease in MRSA infections from 2010 to 2012 and a 56% decrease in all device-related HAIs during the period. In addition, the system’s HCAHPS scores improved 14%, while more recent Press Ganey scores have gained 63 percentile points.

CONE HEALTH, Greensboro, NC

n Network of more than 100 locations in North Carolina, includes…

•5hospitals:MosesH.ConeMemorial,Wesley Long, Women’s, Annie Penn and Behavioral Health

•2medicalcenters,3urgentcarecentersand71 physician practices

n 1,100+ total beds

n 8,600 professionals, 1,000 physicians and 700 volunteers

n 2.2 million total sq. ft. of cleanable space

n 73% average occupancy rate

HEALTHCArE INdusTry CHALLENGEs

Rising Rates of Hospital-acquiRed infection (Hais)

Deadly super-bugs such as MRSA, Clostridium difficile (C. diff) and Acinetobacter infect approxi-mately one out of 20 hospital patients each year. Nationwide, HAIs are the fourth leading cause of death, killing over 100,000 patients each year. Aside from the high mortality rate, HAI survivors are likely to experience longer hospital stays, with an average of 22 days. Hospital readmission rates are almost 30% for patients with HAIs, compared to just 6% for patients without these infections. Many patients who recover from HAIs continue to experience health problems and incur additional medical costs.

disengaged HealtHcaRe staff

Regardless of the screening, cleaning or treatment tools used, the reality of successful infection prevention is that protocols must be executed by highly engaged staff — clinical and non-clinical. According to Press Ganey, at the average hospital nearly half of all employees feel distanced from, or are discontent with, their jobs. With disengagement among healthcare workers at epidemic levels, and the average Environmental Services budget being composed of 75-90% labor expense, it is imperative for caregiving staff to be efficient, motivated and continuously educated on new standards, regulations and best practices.

staggeRing financial impact

HAIs create significant cost management issues whether maintaining current prevention methods or investing in new approaches.

(1) Maintaining the status quo has resulted in HAIs now costing the U.S. healthcare system $35 to $88 billion annually. According to the Centers for Medicare and Medicaid Services (CMS), each HAI case costs a hospital $23,228. Contributing to this cost, many HAIs are the subject of litigation, and it is estimated that one of every six claims against healthcare facilities is related to HAIs and HACs (hospital-acquired conditions), accounting for 12.2% of legal liability costs.

(2) On the other hand, implementation costs for the personnel, processes and technologies to enable complete eradication can be equally daunting and frequently represent a barrier for hospitals faced with revenue and budget pressures. As such, the typical and more appropriate approach is the selective targeting of high-impact issues.

lack of focus on patient expeRience limits satisfaction scoRes

Research indicates that more than 80% of the time a patient spends in the hospital is not related to direct medical care. At the same time, patients who report any problem with their room or hospital staff rate their overall experience 39% lower than patients with no problems. This downtime presents many opportunities to influence patient perceptions, educate, and create an experience that makes patients feel comfortable and cared for within a safe, curative setting, particularly for those patients recovering from an HAI or HAC.

Not surprisingly, many hospitals focus more on their technical and clinical approaches to infection prevention, while giving inadequate attention to the largest driver of patient satisfaction — the patient experience and attitude of their staff.

CONE HEALTH CHALLENGEs

inability to significantly impact mRsa

As compared to other infection types, the MRSA transmission rate at Cone Health had remained unacceptably high, even after more targeted reduction efforts. From December 2007 through September 2010, Cone Health participated in the VHA initiative to prevent healthcare associated MRSA infections. As part of the initiative, they implemented a number of interventions such as requiring all ICU patients to bathe in chlorhexidine gluconate (CHG), hand hygiene programs for healthcare providers and new standards for portable equipment cleaning. Despite all of these efforts, the MRSA transmission

rate remained stagnant — ranging from 0.05 to 0.72 per 1,000 patient days. Cone Health consistently ranked in the lowest performing 10% of hospitals participating in the VHA initiative. By 2010, MRSA infections outnumbered BSI, CAUTI and VAP device-related infections.

HigHeR-tHan-aveRage Hai-Related costs

As compared to the CMS average of $23,228 per case, in 2010 Cone Health calculated their average cost per HAI to be $38,889. With a higher-than-average cost per case, Cone Health’s collective HAI-related costs exceeded $4 million annually in 2010 and were projected to increase year over year without intervention.

loweR-tHan-desiRed patient satisfaction

With high infection rates as a contributor, patient satisfaction suffered as well. HCAHPS scores for “Recommends Hospital” and “Cleanliness of Environment” in November 2011 were 72 and 70, respectively — well below Cone Health’s standards.

2 3

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

Sept 10June 10Mar 10Dec 09Sept 09June 09Mar 09Dec 08Sept 08June 08Mar 08Dec 07

Cone Health MRSA Infection Rate (December 2007 – September 2010)

No Real Decrease in MRSA Rates

In a collaborative effort, Cone Health and Sodexo Health Care embarked on an initiative to reduce hospital-acquired infections (HAIs) and increase patient satisfaction. As a result, the system achieved a 64% decrease in MRSA infections from 2010 to 2012 and a 56% decrease in all device-related HAIs during the period. In addition, the system’s HCAHPS scores improved 14%, while more recent Press Ganey scores have gained 63 percentile points.

CONE HEALTH, Greensboro, NC

n Network of more than 100 locations in North Carolina, includes…

•5hospitals:MosesH.ConeMemorial,Wesley Long, Women’s, Annie Penn and Behavioral Health

•2medicalcenters,3urgentcarecentersand71 physician practices

n 1,100+ total beds

n 8,600 professionals, 1,000 physicians and 700 volunteers

n 2.2 million total sq. ft. of cleanable space

n 73% average occupancy rate

HEALTHCArE INdusTry CHALLENGEs

Rising Rates of Hospital-acquiRed infection (Hais)

Deadly super-bugs such as MRSA, Clostridium difficile (C. diff) and Acinetobacter infect approxi-mately one out of 20 hospital patients each year. Nationwide, HAIs are the fourth leading cause of death, killing over 100,000 patients each year. Aside from the high mortality rate, HAI survivors are likely to experience longer hospital stays, with an average of 22 days. Hospital readmission rates are almost 30% for patients with HAIs, compared to just 6% for patients without these infections. Many patients who recover from HAIs continue to experience health problems and incur additional medical costs.

disengaged HealtHcaRe staff

Regardless of the screening, cleaning or treatment tools used, the reality of successful infection prevention is that protocols must be executed by highly engaged staff — clinical and non-clinical. According to Press Ganey, at the average hospital nearly half of all employees feel distanced from, or are discontent with, their jobs. With disengagement among healthcare workers at epidemic levels, and the average Environmental Services budget being composed of 75-90% labor expense, it is imperative for caregiving staff to be efficient, motivated and continuously educated on new standards, regulations and best practices.

staggeRing financial impact

HAIs create significant cost management issues whether maintaining current prevention methods or investing in new approaches.

(1) Maintaining the status quo has resulted in HAIs now costing the U.S. healthcare system $35 to $88 billion annually. According to the Centers for Medicare and Medicaid Services (CMS), each HAI case costs a hospital $23,228. Contributing to this cost, many HAIs are the subject of litigation, and it is estimated that one of every six claims against healthcare facilities is related to HAIs and HACs (hospital-acquired conditions), accounting for 12.2% of legal liability costs.

(2) On the other hand, implementation costs for the personnel, processes and technologies to enable complete eradication can be equally daunting and frequently represent a barrier for hospitals faced with revenue and budget pressures. As such, the typical and more appropriate approach is the selective targeting of high-impact issues.

lack of focus on patient expeRience limits satisfaction scoRes

Research indicates that more than 80% of the time a patient spends in the hospital is not related to direct medical care. At the same time, patients who report any problem with their room or hospital staff rate their overall experience 39% lower than patients with no problems. This downtime presents many opportunities to influence patient perceptions, educate, and create an experience that makes patients feel comfortable and cared for within a safe, curative setting, particularly for those patients recovering from an HAI or HAC.

Not surprisingly, many hospitals focus more on their technical and clinical approaches to infection prevention, while giving inadequate attention to the largest driver of patient satisfaction — the patient experience and attitude of their staff.

CONE HEALTH CHALLENGEs

inability to significantly impact mRsa

As compared to other infection types, the MRSA transmission rate at Cone Health had remained unacceptably high, even after more targeted reduction efforts. From December 2007 through September 2010, Cone Health participated in the VHA initiative to prevent healthcare associated MRSA infections. As part of the initiative, they implemented a number of interventions such as requiring all ICU patients to bathe in chlorhexidine gluconate (CHG), hand hygiene programs for healthcare providers and new standards for portable equipment cleaning. Despite all of these efforts, the MRSA transmission

rate remained stagnant — ranging from 0.05 to 0.72 per 1,000 patient days. Cone Health consistently ranked in the lowest performing 10% of hospitals participating in the VHA initiative. By 2010, MRSA infections outnumbered BSI, CAUTI and VAP device-related infections.

HigHeR-tHan-aveRage Hai-Related costs

As compared to the CMS average of $23,228 per case, in 2010 Cone Health calculated their average cost per HAI to be $38,889. With a higher-than-average cost per case, Cone Health’s collective HAI-related costs exceeded $4 million annually in 2010 and were projected to increase year over year without intervention.

loweR-tHan-desiRed patient satisfaction

With high infection rates as a contributor, patient satisfaction suffered as well. HCAHPS scores for “Recommends Hospital” and “Cleanliness of Environment” in November 2011 were 72 and 70, respectively — well below Cone Health’s standards.

2 3

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

Sept 10June 10Mar 10Dec 09Sept 09June 09Mar 09Dec 08Sept 08June 08Mar 08Dec 07

Cone Health MRSA Infection Rate (December 2007 – September 2010)

No Real Decrease in MRSA Rates

THE sOLuTIONs

Responding to new Chief Operating Officer Terry Akin’s challenge to become a “Top 10” system, a multidisciplinary taskforce was formed in December 2010. Among the team charged with identifying and removing process and financial barriers to decrease MRSA were professionals from Sodexo Health Care, which Cone Health selected in 2006 to manage multiple support services, including the hospital’s Environmental Services program.

calculating cost

Focused on making improvements to people, processes and tools, the team evaluated a considerable number of options. Focusing on making the most efficient investments, Cone Health chose to first take a fiscally conservative approach to defining their costs associated with HAIs. The $4 million+ in annual costs for Fiscal Year 2010 were based strictly on clinical costs associated with the treatment of patients contracting an HAI. The Cone Health calculation did not include other revenue-generating variables such as patient bed days saved or cost-increasing variables such as litigation or

non-clinical labor. The inclusion of such variables would have provided for an even more impressive ROI on Cone Health’s HAI-reducing efforts.

Among the tactics chosen to be retained, improved uponandaddedasnewin2011:

continuations and adjustments to pRioR best pRactices

n Reduce CHG baths from all admissions to only patients colonized with MRSA and MSSA

n Continuationofthefollowingpractices:

•Cleaningchecklistandequipmentcleaningstandards for portable equipment

•BannersandredlinesatallICUentrancestoacknowledge the need for hand hygiene

•SodexoSHINEcleaningprotocolsinclusiveof random audits using protein-based black light inspections

•SodexoTRAKKARsoftwareforschedulingcleaning and real-time reporting on efficacy

•Anti-microbialsoapandSodexoSHINE’s eco-friendly, sustainable cleaning practices

•Dataminingsoftwaretotrackscreeningandtreatment protocols for MRSA patients to ensure proper procedures are being followed

n Provide tablet technology to enable “on floor ” monitoring by Infection Preventionist, ensuring treatment protocols are executed

Rapid diagnostic scReening

n Purchased laboratory technology to process approximately 2,600 active surveillance screening tests monthly

n Implemented screening for all ICU and high-risk patients — those with documented infection history or being admitted from a nursing home, jail, prison, rehab or long-term acute care, another acute care hospital or hemodialysis

n Added screening for all pre-admitted surgical patients

new pRotocols foR mRsa and mssa patients

n For MRSA positive patients, an upgraded decolonization protocol

•5daysofbidMupirocinintra-nasally.

•6-clothCHGbathdailyfor5daysforallpositive S. aureus patients

•Isolationduringentireadmission (MRSA positive only)

n For MRSA positive and high-risk patients, on discharge or transfer, “terminal” room cleans upgraded to include use of hands-free, ultraviolet (UV) disinfection technology

•Xenexsystemsprovidelowestcost, “no-touch” disinfection

•99%effective,mercury-freeroomdecontamination

•Portableunitsrunin2-3separatepositionsperroom, for a total of 10-15 minutes per room

n Expansion of post terminal UV disinfection audits to include 100% of all MRSA positive rooms

•Auditdataintegratedwithschedulingandreporting on facilities cleaning

expanded Hand-wasHing campaign

n “Wash Hands. Save Lives.” communicates with staff, patients, and visitors on importance and practices for infection prevention

n Extra 6th step added to World Health Organization (WHO) 5-steps to hand hygiene

•Addressedstepstobetakenuponenteringorexiting a patient room

n Mandatory computer-based learning introducing “Professor Germoutski”

•ExplainsWHOrecommendations

•Reviewstheproperhandhygieneprotocols

n Personal hand sanitizer wipes added to every patient dietary tray

n Mandatory patient video education during their admission process

4 5

THE sOLuTIONs

Responding to new Chief Operating Officer Terry Akin’s challenge to become a “Top 10” system, a multidisciplinary taskforce was formed in December 2010. Among the team charged with identifying and removing process and financial barriers to decrease MRSA were professionals from Sodexo Health Care, which Cone Health selected in 2006 to manage multiple support services, including the hospital’s Environmental Services program.

calculating cost

Focused on making improvements to people, processes and tools, the team evaluated a considerable number of options. Focusing on making the most efficient investments, Cone Health chose to first take a fiscally conservative approach to defining their costs associated with HAIs. The $4 million+ in annual costs for Fiscal Year 2010 were based strictly on clinical costs associated with the treatment of patients contracting an HAI. The Cone Health calculation did not include other revenue-generating variables such as patient bed days saved or cost-increasing variables such as litigation or

non-clinical labor. The inclusion of such variables would have provided for an even more impressive ROI on Cone Health’s HAI-reducing efforts.

Among the tactics chosen to be retained, improved uponandaddedasnewin2011:

continuations and adjustments to pRioR best pRactices

n Reduce CHG baths from all admissions to only patients colonized with MRSA and MSSA

n Continuationofthefollowingpractices:

•Cleaningchecklistandequipmentcleaningstandards for portable equipment

•BannersandredlinesatallICUentrancestoacknowledge the need for hand hygiene

•SodexoSHINEcleaningprotocolsinclusiveof random audits using protein-based black light inspections

•SodexoTRAKKARsoftwareforschedulingcleaning and real-time reporting on efficacy

•Anti-microbialsoapandSodexoSHINE’s eco-friendly, sustainable cleaning practices

•Dataminingsoftwaretotrackscreeningandtreatment protocols for MRSA patients to ensure proper procedures are being followed

n Provide tablet technology to enable “on floor ” monitoring by Infection Preventionist, ensuring treatment protocols are executed

Rapid diagnostic scReening

n Purchased laboratory technology to process approximately 2,600 active surveillance screening tests monthly

n Implemented screening for all ICU and high-risk patients — those with documented infection history or being admitted from a nursing home, jail, prison, rehab or long-term acute care, another acute care hospital or hemodialysis

n Added screening for all pre-admitted surgical patients

new pRotocols foR mRsa and mssa patients

n For MRSA positive patients, an upgraded decolonization protocol

•5daysofbidMupirocinintra-nasally.

•6-clothCHGbathdailyfor5daysforallpositive S. aureus patients

•Isolationduringentireadmission (MRSA positive only)

n For MRSA positive and high-risk patients, on discharge or transfer, “terminal” room cleans upgraded to include use of hands-free, ultraviolet (UV) disinfection technology

•Xenexsystemsprovidelowestcost, “no-touch” disinfection

•99%effective,mercury-freeroomdecontamination

•Portableunitsrunin2-3separatepositionsperroom, for a total of 10-15 minutes per room

n Expansion of post terminal UV disinfection audits to include 100% of all MRSA positive rooms

•Auditdataintegratedwithschedulingandreporting on facilities cleaning

expanded Hand-wasHing campaign

n “Wash Hands. Save Lives.” communicates with staff, patients, and visitors on importance and practices for infection prevention

n Extra 6th step added to World Health Organization (WHO) 5-steps to hand hygiene

•Addressedstepstobetakenuponenteringorexiting a patient room

n Mandatory computer-based learning introducing “Professor Germoutski”

•ExplainsWHOrecommendations

•Reviewstheproperhandhygieneprotocols

n Personal hand sanitizer wipes added to every patient dietary tray

n Mandatory patient video education during their admission process

4 5

THE OuTCOmEs

dRamatic Reduction in Hais

Through their bundled approach to infection prevention at Cone Health, Sodexo was able to help reduce the risk of HAIs and lower the costs associated with the deadly infections. The hospital saw zero MRSA cases in its intensive care units, achieved an overall 71% decrease in MRSA infections from 2010 to 2012 and reduced all device-related HAIs during that period by 56%.

0

20

40

60

80

100

862010

372011

252012

Total MRSA Infections by Calendar Year

0

10

20

30

40

50

60

70

80

VAPCAUTIBSI

202010

122011

672010

332011

232010 20

2011

Total Device-Related Infections 2010 vs. 2011

impRessive incRease in patient satisfaction

HCAHPS scores increased from the low 70s to the high 70s and low 80s.

0

10

20

30

40

50

60

70

80HCAHPS “Recommends Hospital”

Nov. 2010

July 2012

moRe engaged employees

The impact of Sodexo’s CARES Behavioral Training and SHINE work process on employee satisfaction, engagement and perceived ability to deliver top-quality service and engagement was substantial.

moRe tHan $2 million in cost savings

The organization and community saved an estimated $2.3 million in infection-associated hospital costs.

0

$1,000,000

$2,000,000

$3,000,000

$4,000,000

$5,000,000 Total Cost of Infections per Fiscal Year

$4,277,853FY 2010

$3,018,842FY 2011

$2,266,424FY 2012 TD

$1.26MMSAVINGS

“Un-banked”SAVINGS

$752KSAVINGS

0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000 Return on Investment1.7 : 1

$2,011,429

2-YEARSAVINGS

FROMHAI

REDUCTION

$1,169,141

2-YEARPROGRAM

COST

THE fuTurE

building on success

Since inception of the more robust infection prevention program, positive results have led to expansion of the program. Tactics either currently implemented, planned for deployment or under consideration are…

n Expanded rapid screening for flu and C. diff

n Extending use of hands-free, ultraviolet (UV) disinfection systems

•AtdischargeortransferforallC. diff patients

•TerminalcleansinO.R.andAmbulatoryCenters

n Optimization of staff size and labor management processes to ensure maximum return from UV disinfection investment

n Refresh of Hand Hygiene Campaign

•3yearcampaignstrategyfocusedonfactsand statistics

•UtilizeJointCommissionAuditProgramforcollecting Hand Hygiene Compliance data systemwide

n Expansion of patient education to include bed-side coaching on infection prevention practices by Environmental Services staff

6 7

0

20

40

60

80

100Cone Health Environmental Services Dept.

Employee Satisfaction Scores

FY 2010

FY 2012

0

10

20

30

40

50

60

70

80HCAHPS “Cleanliness of Environment”

Nov. 2010

July 2012

“We want our patients to be as safe as possible, and investing in new infection control technologies was a priority. Now, our patients are safer because their chance of contracting an infection has been greatly reduced. We are elated that the initiatives are working.”

Dr.MaryJoCagle Chief Quality Officer

Cone Health

THE OuTCOmEs

dRamatic Reduction in Hais

Through their bundled approach to infection prevention at Cone Health, Sodexo was able to help reduce the risk of HAIs and lower the costs associated with the deadly infections. The hospital saw zero MRSA cases in its intensive care units, achieved an overall 71% decrease in MRSA infections from 2010 to 2012 and reduced all device-related HAIs during that period by 56%.

0

20

40

60

80

100

862010

372011

252012

Total MRSA Infections by Calendar Year

0

10

20

30

40

50

60

70

80

VAPCAUTIBSI

202010

122011

672010

332011

232010 20

2011

Total Device-Related Infections 2010 vs. 2011

impRessive incRease in patient satisfaction

HCAHPS scores increased from the low 70s to the high 70s and low 80s.

0

10

20

30

40

50

60

70

80HCAHPS “Recommends Hospital”

Nov. 2010

July 2012

moRe engaged employees

The impact of Sodexo’s CARES Behavioral Training and SHINE work process on employee satisfaction, engagement and perceived ability to deliver top-quality service and engagement was substantial.

moRe tHan $2 million in cost savings

The organization and community saved an estimated $2.3 million in infection-associated hospital costs.

0

$1,000,000

$2,000,000

$3,000,000

$4,000,000

$5,000,000 Total Cost of Infections per Fiscal Year

$4,277,853FY 2010

$3,018,842FY 2011

$2,266,424FY 2012 TD

$1.26MMSAVINGS

“Un-banked”SAVINGS

$752KSAVINGS

0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000 Return on Investment1.7 : 1

$2,011,429

2-YEARSAVINGS

FROMHAI

REDUCTION

$1,169,141

2-YEARPROGRAM

COST

THE fuTurE

building on success

Since inception of the more robust infection prevention program, positive results have led to expansion of the program. Tactics either currently implemented, planned for deployment or under consideration are…

n Expanded rapid screening for flu and C. diff

n Extending use of hands-free, ultraviolet (UV) disinfection systems

•AtdischargeortransferforallC. diff patients

•TerminalcleansinO.R.andAmbulatoryCenters

n Optimization of staff size and labor management processes to ensure maximum return from UV disinfection investment

n Refresh of Hand Hygiene Campaign

•3yearcampaignstrategyfocusedonfactsand statistics

•UtilizeJointCommissionAuditProgramforcollecting Hand Hygiene Compliance data systemwide

n Expansion of patient education to include bed-side coaching on infection prevention practices by Environmental Services staff

6 7

0

20

40

60

80

100Cone Health Environmental Services Dept.

Employee Satisfaction Scores

FY 2010

FY 2012

0

10

20

30

40

50

60

70

80HCAHPS “Cleanliness of Environment”

Nov. 2010

July 2012

“We want our patients to be as safe as possible, and investing in new infection control technologies was a priority. Now, our patients are safer because their chance of contracting an infection has been greatly reduced. We are elated that the initiatives are working.”

Dr.MaryJoCagle Chief Quality Officer

Cone Health

sOdExO sOLuTIONs

sodexo’s infection pRevention seRvice model

As the world leader in environmental services and employee development, Sodexo knows that delivering the safest, highest quality experience with a hospital’s brand means more than world-class clinical care. To help Cone Health meet its goals, Sodexo implemented its industry-leading, patient-focused infection prevention service model. The model incorporates a unique combination of employee engagement (people), technology (tools) and operations (process) best practices to provide the safest environment for healing, improving operational efficiency and increasing patient satisfaction.

dRiving employee engagement: caRes beHavioRal-based tRaining

Cone Health employed Sodexo’s exclusive CARES Behavioral Training program to instruct employees onfivekeyperformancecommitments:

1. compassion: Demonstrate care and sensitivity in words and actions.

2. accountability: Be responsible for the outcomes and the results of actions.

3. Respect: Have consideration and regard for the rights, values, beliefs and property of all people.

4. enthusiasm: Generate great excitement and interest in creating exceptional experiences for customers at all levels.

5. service: Commit to delivering outcomes that exceed expectations.

The CARES program has been pivotal to Sodexo receiving some of the industry’s highest engagement scores for environmental services. Research has shown the CARES Behavioral Training resulted in a 15% increase in overall job satisfaction

and increases in “positive department feelings” and “ability to provide quality service” of approximately 25%. CARES has also been shown to have a significant impact on patient perceptions, with one U.S. hospital recording an increase in patient satisfaction of 376% two years after initiating CARES training.

Recruitment and selection of potential Sodexo Environmental Services employees are critical components of the CARES training process.

n Candidates for employment are selected on the basis of having previously exhibited CARES behaviors. Past performance is the greatest indicator of future performance.

n All those responsible for hiring decisions must attend the Frontline Employee Behavioral Interviewing for Hiring Managers training session. This four-hour, on-site training session prepares managers to conduct interviews and make legally sound hiring decisions.

Once hired, Environmental Services staff learns how to positively interact with patients as well as with families, visitors and each other. They are encouraged to connect daily with patients as they perform their cleaning duties and to raise awareness among patients and families about the integral role Environmental Services plays in the recuperative process. At Cone Health, Environmental Services staff gave patients the opportunity to schedule the most convenient time for their rooms to be cleaned. Other powerful tools of engagement included concierge-style amenities such as a welcome kit upon admission, complimentary daily newspaper, Brighten Your Day cards and “thank you” note at discharge. The patients’ perceptions of their hospital stay improved as a result.

Within the CARES culture, the Cone Health staff became more engaged in their jobs. They were committed to doing their best work because they understood their vital role in the patient experience.

competent tecHnical leadeRsHip: employee accReditation standaRds

Sodexo is the only environmental services contract management company that requires CHESP (Certified Healthcare Environmental Services Professional) certification of all manager-level staff. The CHESP is a national credential that distinguishes an individual as being among the elite in the healthcare environmental services profession. To earn the CHESP, individuals must satisfy eligibility requirements that incorporate a blend of professional experience and education; agree to adhere to the American Hospital Association’s Professional Standards of Conduct; and pass the CHESP certification examination. The CHESP examination assesses knowledge required of a competent healthcare environmental services manager in the area of regulatory compliance; design and construction; operations related to environmental sanitation; operations related to waste management; operations related to textile management; finance; and administration.

aHead of tHe cdc: sHine black ligHt inspection system

Clinical studies show that traditional manual cleaning methods are only 50% effective at removing deadly bacteria from high-touch surfaces. Sodexo’s SHINE black light program is the industry benchmark to meet the intent of the Center for Disease Control’s (CDC) 2010 guidelines for environmental monitoring. Used exclusively by Sodexo since 2008, it is by far the most cost-effective method for monitoring cleaning efficacy.

After a patient is discharged, an Environmental Services manager “marks” high-touch areas (e.g., door knobs, sink faucets, TV remote controls, telephones) with a protein-based, chemical-free, fluorescent marker. After room cleaning is performed, the manager uses a handheld black light scanner to reveal contaminated areas that cannot be seen but can cause HAIs. Post-black light cleanings are 90% effective in eliminating all harmful bacteria.

8 9

sOdExO sOLuTIONs

sodexo’s infection pRevention seRvice model

As the world leader in environmental services and employee development, Sodexo knows that delivering the safest, highest quality experience with a hospital’s brand means more than world-class clinical care. To help Cone Health meet its goals, Sodexo implemented its industry-leading, patient-focused infection prevention service model. The model incorporates a unique combination of employee engagement (people), technology (tools) and operations (process) best practices to provide the safest environment for healing, improving operational efficiency and increasing patient satisfaction.

dRiving employee engagement: caRes beHavioRal-based tRaining

Cone Health employed Sodexo’s exclusive CARES Behavioral Training program to instruct employees onfivekeyperformancecommitments:

1. compassion: Demonstrate care and sensitivity in words and actions.

2. accountability: Be responsible for the outcomes and the results of actions.

3. Respect: Have consideration and regard for the rights, values, beliefs and property of all people.

4. enthusiasm: Generate great excitement and interest in creating exceptional experiences for customers at all levels.

5. service: Commit to delivering outcomes that exceed expectations.

The CARES program has been pivotal to Sodexo receiving some of the industry’s highest engagement scores for environmental services. Research has shown the CARES Behavioral Training resulted in a 15% increase in overall job satisfaction

and increases in “positive department feelings” and “ability to provide quality service” of approximately 25%. CARES has also been shown to have a significant impact on patient perceptions, with one U.S. hospital recording an increase in patient satisfaction of 376% two years after initiating CARES training.

Recruitment and selection of potential Sodexo Environmental Services employees are critical components of the CARES training process.

n Candidates for employment are selected on the basis of having previously exhibited CARES behaviors. Past performance is the greatest indicator of future performance.

n All those responsible for hiring decisions must attend the Frontline Employee Behavioral Interviewing for Hiring Managers training session. This four-hour, on-site training session prepares managers to conduct interviews and make legally sound hiring decisions.

Once hired, Environmental Services staff learns how to positively interact with patients as well as with families, visitors and each other. They are encouraged to connect daily with patients as they perform their cleaning duties and to raise awareness among patients and families about the integral role Environmental Services plays in the recuperative process. At Cone Health, Environmental Services staff gave patients the opportunity to schedule the most convenient time for their rooms to be cleaned. Other powerful tools of engagement included concierge-style amenities such as a welcome kit upon admission, complimentary daily newspaper, Brighten Your Day cards and “thank you” note at discharge. The patients’ perceptions of their hospital stay improved as a result.

Within the CARES culture, the Cone Health staff became more engaged in their jobs. They were committed to doing their best work because they understood their vital role in the patient experience.

competent tecHnical leadeRsHip: employee accReditation standaRds

Sodexo is the only environmental services contract management company that requires CHESP (Certified Healthcare Environmental Services Professional) certification of all manager-level staff. The CHESP is a national credential that distinguishes an individual as being among the elite in the healthcare environmental services profession. To earn the CHESP, individuals must satisfy eligibility requirements that incorporate a blend of professional experience and education; agree to adhere to the American Hospital Association’s Professional Standards of Conduct; and pass the CHESP certification examination. The CHESP examination assesses knowledge required of a competent healthcare environmental services manager in the area of regulatory compliance; design and construction; operations related to environmental sanitation; operations related to waste management; operations related to textile management; finance; and administration.

aHead of tHe cdc: sHine black ligHt inspection system

Clinical studies show that traditional manual cleaning methods are only 50% effective at removing deadly bacteria from high-touch surfaces. Sodexo’s SHINE black light program is the industry benchmark to meet the intent of the Center for Disease Control’s (CDC) 2010 guidelines for environmental monitoring. Used exclusively by Sodexo since 2008, it is by far the most cost-effective method for monitoring cleaning efficacy.

After a patient is discharged, an Environmental Services manager “marks” high-touch areas (e.g., door knobs, sink faucets, TV remote controls, telephones) with a protein-based, chemical-free, fluorescent marker. After room cleaning is performed, the manager uses a handheld black light scanner to reveal contaminated areas that cannot be seen but can cause HAIs. Post-black light cleanings are 90% effective in eliminating all harmful bacteria.

8 9

aligned witH tHe wHo: meRcuRy-fRee, pulsed xenon ultRaviolet disinfection system

As a global leader in healthcare, Sodexo continuously searches for new technologies and processes that improve operational efficiencies and patient outcomes. One such technology, the breakthrough Xenex automated disinfection system, is offeredexclusively through Sodexo, and uses pulsed xenon ultraviolet (UV) light to destroy viruses, bacteria and spores in patient areas without contact or chemicals. As a mercury-free solution, the Xenex approach to generating the most effectivedisinfection technology available today aligns with the World Health Organization’s call for removal of mercury in all healthcare settings.

With the Xenex system, the energy of each pulseis substantially greater than that produced by traditional mercury lamps, leading to a much higher microbicidal effect while greatly reducing the total time necessary for sterilization. Further, xenon gas is inert and harmless, while mercury gas is highly

toxic, leading to health dangers if a mercury bulb is broken. Pulsed xenon UV disinfection enables “no touch” cleaning that is 99% effective in room decontamination and over 30 times more effective than traditional cleaning methods.

sustainable, eco-fRiendly cleaning: sHine flooR cleaning seRvice by sodexo

Dedicated to creating and maintaining “best practices,” SHINE is an Environmental Services technical education and eco-friendly work process that integrates cleaning methods, equipment and products to produce predictable outcomes, promote sustainability, optimize labor and maximize value. Sodexo’s partnership with industry visionaries and leaders allows for cutting-edge technology, innovation and operational excellence in its operating standards. SHINE has been shown to reduce the labor associated with some housekeeping tasks by more than 50%, reduce chemical usage by up to 90% and reduce water usage and effluent by 75%.

10

SHINE has been shown to reduce housekeeping labor by more than

50%compaRing disinfection tecHnologies

metric Hydrogen peroxide vapor mercury ultraviolet (uvc) pulsed xenon uv

decontaminaiton effectiveness

Studies showed 95% reductions1

Low-end models (<20 bulbs) unproven. High-end models studies showed 99% reductions1

Studies showed 99% reductions1

cost per room1 $110 $16 $3

cycle time 3 to 4 hours per room1 1 hour, 12 min to 2 hours, 6 min1

Multiple position = 10 min additional room1 time

operators Specialized technician Housekeeper Housekeeper

access to room during operation

No Remote Stop; Immediate Reentry

Remote Stop; Immediate Reentry

safety Vapor is dangerous until cycle is complete; rooms must be sealed with tape

UV light can irritate retina, so staff must exit during treatment

UV light can irritate retina, so staff must exit during treatment

environmental friendliness

Hydrogen peroxide degrades into H2O

WHO supports a ban on mercury in healthcare settings

Certified “green” by Practice Greenhealth1

infection rate impact

Unconfirmed Unconfirmed 67% reduction in C. diff.1; MRSA reduced to 0 in 2Qs1

1Source studies, calculations & other references/content available upon request.

automation dRiving efficiency: tRakkaR enviRonmental seRvices softwaRe

TRAKKAR performance analysis software trackscleaning performance and serves as a continuous improvement tool. TRAKKAR uses computertechnology and handheld pocket PCs to engage staff members in driving quality enhancements for every area of the facility. The system includes more than 150 reports on people, spaces, training and quality, which facilitate labor optimization by tracking employees, their responsibilities and outcomes.

AttheheartoftheTRAKKARprogramisadetaileddatabase of the facility’s spaces, Environmental Services employees and Sodexo standards for cleaning procedures, performance and training. The software automatically calculates daily cleaning times based on frequency and square footage; easily orders and adjusts which rooms need to be cleaned, when and how often; creates employee printouts showing cleaning steps to be performed in each room; and finds rooms that haven’t been put on work assignments.

Individual staff performance is tracked in the quality assurance process. Then, the TRAKKAR trainingmodule supports continuous improvement by matching quality issues with training needs. The software schedules employee training and maintains detailed records on attendance and test scores, all easily found with a few clicks of the mouse.

TheTRAKKARqualityassuranceinspectionprocessenables managers and staff to know that the facility is running at the highest levels of vigilance andserviceeveryday.AndTRAKKARalsohasbeenshown to positively impact employee behaviors and, ultimately, HCAHPS scores.

More than

150customizable reports

mobile audit tools

tRakkaR RepoRt

Pulsed xenon disinfection is

30 times more effective than

traditional cleaning methods

aligned witH tHe wHo: meRcuRy-fRee, pulsed xenon ultRaviolet disinfection system

As a global leader in healthcare, Sodexo continuously searches for new technologies and processes that improve operational efficiencies and patient outcomes. One such technology, the breakthrough Xenex automated disinfection system, is offeredexclusively through Sodexo, and uses pulsed xenon ultraviolet (UV) light to destroy viruses, bacteria and spores in patient areas without contact or chemicals. As a mercury-free solution, the Xenex approach to generating the most effectivedisinfection technology available today aligns with the World Health Organization’s call for removal of mercury in all healthcare settings.

With the Xenex system, the energy of each pulseis substantially greater than that produced by traditional mercury lamps, leading to a much higher microbicidal effect while greatly reducing the total time necessary for sterilization. Further, xenon gas is inert and harmless, while mercury gas is highly

toxic, leading to health dangers if a mercury bulb is broken. Pulsed xenon UV disinfection enables “no touch” cleaning that is 99% effective in room decontamination and over 30 times more effective than traditional cleaning methods.

sustainable, eco-fRiendly cleaning: sHine flooR cleaning seRvice by sodexo

Dedicated to creating and maintaining “best practices,” SHINE is an Environmental Services technical education and eco-friendly work process that integrates cleaning methods, equipment and products to produce predictable outcomes, promote sustainability, optimize labor and maximize value. Sodexo’s partnership with industry visionaries and leaders allows for cutting-edge technology, innovation and operational excellence in its operating standards. SHINE has been shown to reduce the labor associated with some housekeeping tasks by more than 50%, reduce chemical usage by up to 90% and reduce water usage and effluent by 75%.

10

SHINE has been shown to reduce housekeeping labor by more than

50%compaRing disinfection tecHnologies

metric Hydrogen peroxide vapor mercury ultraviolet (uvc) pulsed xenon uv

decontaminaiton effectiveness

Studies showed 95% reductions1

Low-end models (<20 bulbs) unproven. High-end models studies showed 99% reductions1

Studies showed 99% reductions1

cost per room1 $110 $16 $3

cycle time 3 to 4 hours per room1 1 hour, 12 min to 2 hours, 6 min1

Multiple position = 10 min additional room1 time

operators Specialized technician Housekeeper Housekeeper

access to room during operation

No Remote Stop; Immediate Reentry

Remote Stop; Immediate Reentry

safety Vapor is dangerous until cycle is complete; rooms must be sealed with tape

UV light can irritate retina, so staff must exit during treatment

UV light can irritate retina, so staff must exit during treatment

environmental friendliness

Hydrogen peroxide degrades into H2O

WHO supports a ban on mercury in healthcare settings

Certified “green” by Practice Greenhealth1

infection rate impact

Unconfirmed Unconfirmed 67% reduction in C. diff.1; MRSA reduced to 0 in 2Qs1

1Source studies, calculations & other references/content available upon request.

automation dRiving efficiency: tRakkaR enviRonmental seRvices softwaRe

TRAKKAR performance analysis software trackscleaning performance and serves as a continuous improvement tool. TRAKKAR uses computertechnology and handheld pocket PCs to engage staff members in driving quality enhancements for every area of the facility. The system includes more than 150 reports on people, spaces, training and quality, which facilitate labor optimization by tracking employees, their responsibilities and outcomes.

AttheheartoftheTRAKKARprogramisadetaileddatabase of the facility’s spaces, Environmental Services employees and Sodexo standards for cleaning procedures, performance and training. The software automatically calculates daily cleaning times based on frequency and square footage; easily orders and adjusts which rooms need to be cleaned, when and how often; creates employee printouts showing cleaning steps to be performed in each room; and finds rooms that haven’t been put on work assignments.

Individual staff performance is tracked in the quality assurance process. Then, the TRAKKAR trainingmodule supports continuous improvement by matching quality issues with training needs. The software schedules employee training and maintains detailed records on attendance and test scores, all easily found with a few clicks of the mouse.

TheTRAKKARqualityassuranceinspectionprocessenables managers and staff to know that the facility is running at the highest levels of vigilance andserviceeveryday.AndTRAKKARalsohasbeenshown to positively impact employee behaviors and, ultimately, HCAHPS scores.

More than

150customizable reports

mobile audit tools

tRakkaR RepoRt

Pulsed xenon disinfection is

30 times more effective than

traditional cleaning methods

healthcareinnovation.usa@sodexo.com 800 432 6663 infectionfree.sodexo.com

0003-6F