Long-Term Care Facilities

One in 43 long-term care (LTC) residents acquires a healthcare-associated infection, according to the Centers for Disease Control and Prevention. This risk makes cleaning LTC facilities a distinct challenge. “It’s a combination of healthcare, hospitality, and interactive residential cleaning,” explained Gosia Baran, president and owner of Elmhurst, Illinois-based Helping Hands Cleaning Services. “Since LTC residents are elderly, we must focus on their health. Quality must be raised because residents with compromised immune systems are vulnerable to diseases that may spread there.” Susceptible residents LTC facilities, unlike schools or offices, are never empty. “We must be very careful when we clean, how we clean, and who is around,” said Dominika Wandachowicz, Helping Hands Cleaning Services’ business development manager. For example, a vacuum cord could pose a hazard for residents in wheelchairs or who are unsteady on their feet. Team members may need to wear face masks in rooms housing residents with low immunity or use specific cleaning solutions around those who cannot tolerate fragrances. Jef Gordon, 4M Building Solutions regional vice president–operations, serves the Northeast, which is 4M’s highest-concentration area for long-term healthcare clients. He agrees that older adults with weakened immune systems are far more susceptible to infection, which means cleaning for health—not just appearance—must be the standard. “All-purpose products and general protocols don’t cut it in long-term care settings,” Gordon explained. “The chemicals, disinfectants, and procedures all need to be matched to a healthcare-level threat environment.” Additionally, teams must be trained to recognize at-risk residents, such as individuals with memory loss or Alzheimer’s, for example, and to handle unexpected situations, such as incontinence, with both skill and sensitivity. “Cleaning staff in these facilities are often in more daily contact with residents than doctors or nurses,” Gordon said. “That level of access carries real responsibility.” Facility complications Stratus Clean also recognizes that LTC facilities face unique challenges in maintenance and cleanliness. For example, the Occupational Safety and Health Administration (OSHA) requires LTC facilities to have an up-to-date written Infection Prevention & Control Program (IPCP) and a bloodborne pathogens (BBP) exposure control plan. LTC facilities also face budget challenges in maintaining the cleanliness required to ensure compliance with the IPCP and BBP plan. “While creating the plan is easy, execution and regular monitoring of the plan is more difficult,” explained Doug Flaig, Stratus Clean CEO. “This is especially true if the staff is doing the cleaning and there is a high rate of employee turnover.” Gordon finds that government reimbursement structures in many facilities create constant budget pressure. Furthermore, as operating expenses rise, reimbursements rarely keep pace. “These facilities are also among the most heavily regulated environments we work in, with requirements at both the state and federal levels that don’t exist in commercial settings,” he explained. Specific LTC facility requirements can include: Extensive background checks, including tuberculosis testing and vaccination requirements. State-mandated annual training. Rhode Island and Massachusetts, for example, require specific programs covering dementia care and resident-abuse prevention. Annual state survey audits conducted by the local department of health. These unannounced inspections are carried out by healthcare professionals, including registered nurses and social workers. “The result can affect a facility’s ability to take on new residents, so it places pressure on every department, housekeeping included,” Gordon said. Residential living also creates challenges, including an inability to move residents’ furniture for deeper cleaning, cluttered or decorated environments, and resident interference with cleaning staff. As LTC residents can wander throughout the facility, an ill patient can quickly spread illness. Residents can also resist hygiene practices, putting their peers at risk. These conditions necessitate frequent maintenance and disinfection of shared spaces to prevent the spread of pathogens. The most problematic areas are high-touch surfaces, such as doors, light switches, railings, elevator buttons, common area surfaces, therapy devices, chairs and other furniture, and TV remotes. Memory care areas require an even higher level of support and sanitation due to residents not remembering events, for example, if they vomited during the day in their room or had a bodily fluid accident in the shower. An overlooked area for infection is the common kitchen and dining areas. “Ensuring tables are cleaned between resident usage and following the seven principles of the Hazard Analysis and Critical Control Points plan will help ensure that the food cycle is not a risk to residents and staff,” Flaig said. With residents frequently spilling liquids and dropping other items, cleaning teams must also constantly monitor floors to avoid slip-and-fall accidents, Baran added. Established protocols 4M Building Solutions starts addressing these challenge areas before cleaning a single room. The building service contractor’s (BSC) transition process includes structured meetings with leadership at every level to establish expectations from day one. Facilities typically see measurable change, including: Standard operating procedures that are documented and followed. Posted work and training schedules. Daily oversight from a dedicated on-site manager. Weekly drop-ins from a regional manager auditing the work. “We maintain accountability through district manager oversight and regular safety audits,” Gordon said. “We also ask clients directly what frequency and level of service they’re looking for, including reporting. Expectations are very reasonable; people just want to know someone is paying attention.” Stratus Clean also addresses the challenges through a strong partnership program with the LTC facility team or primary BSC provider. The BSC builds customizable solutions, including: Porter services to monitor and clean high touch surfaces daily while residents are awake. Alignment with the IPCP and BBP exposure control plan to track and monitor compliance. Advanced communication of regularly scheduled cleaning plans to ensure deep cleaning of resident rooms with the residents’ compliance. Regular inspections of the facility by local management to ensure compliance with the scope of work and sanitation requirements. Training teams that look beyond cleaning to identify other issues that could pose risks. For example, a resident who has many products or extension cords plugged into a single outlet in their room, which could result in an electrical short. Helping Hands Cleaning Service ensures teams follow established protocols through frequent supervision. Additionally, day and

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