As of Wednesday morning, Brookfield Zoo Chicago has reached a tentative agreement with Teamsters Local 727 to end a three-day strike of about 100 staff workers from the grounds, custodial, and facilities teams, CBS News reported. The zoo and more than 200 union-represented employees in the zoo’s grounds, custodial, and facilities teams reached a four-year collective bargaining agreement that includes a 20% wage increase over the contract.

The agreement includes enhancements to staffing for the zoo’s animal care and facilities teams, in addition to three positions already posted for hiring. The terms also include a continuation of a healthcare plan through increased contributions from the zoo. Teamsters Local 727 now need to vote on the agreement, but zoo operations have continued through this process. Employees will return to work once the agreement is finalized.

“Today is an important and positive moment for Brookfield Zoo Chicago, and we are excited to welcome our team members back as we move forward together in our shared dedication to our people, the animals in our care, and the communities we serve,” said Dr. Mike Adkesson, president and CEO of Brookfield Zoo Chicago. “This zoo has always been powered by people who care deeply about one another and our mission, and this agreement reflects a commitment to continuing to provide exceptional care and educational experiences for our guests while supporting the long-term health and sustainability of the zoo.”

“We appreciate the dedication of our staff, the professionalism of the bargaining teams, and the patience and support of our guests and community during this time,” Adkesson said. “We are focused on continuing the important work of our mission and advancing our animal care, conservation, and education priorities.”

One out of every 31 patients admitted to a U.S. hospital experiences harm in the form of a healthcare-acquired infection (HAI), such as C. difficile or methicillin-resistant Staphylococcus aureus (MRSA), according to Centers for Disease Control and Prevention statistic shared by Dr. Omrana Pasha-Razzak, a hospitalist and medical professor at the City University of New York (CUNY) School of Medicine.

In a keynote talk opening the Healthcare Surfaces Summit this week at ISSA headquarters in Rosemont, Illinois, Pasha-Razzak advocated for the inclusion of environmental services (EVS) leaders in hospital conversations and decisions regarding the protection of patients from HAIs. She spoke of four barriers keeping EVS staff out of these conversations.

Status is a key barrier excluding EVS workers from daily huddles and other meetings that address patient information and safety. Pasha-Razzak explained that, historically, medical professionals have been very status conscious, with the input of white male physicians given the predominant voice.

Meanwhile, EVS workers, who spend the most time inside patient rooms, more than nurses and doctors, had not been given a voice, due to their perceived lower status as a workforce that is 70% female and 75% minority. “This is a workforce the literature has called forgotten and invisible,” Pasha-Razzak said.

Fortunately, she noted that EVS staff are getting a larger voice in daily huddles and other healthcare specialists beyond physicians are sharing their observations and suggestions.

Language is the second barrier working against EVS involvement in HAI solutions. Pasha-Razzak explained that English is the default language in clinical medical settings. However, 50% of EVS staff are foreign born, so English is not their predominant language.

Making accommodations for non-English speakers opens the discussions to hospital staff that don’t normally have a voice, Pasha-Razzak said.

The third barrier is gender. The 70% female makeup of hospital EVS workers not only limits their voice, it also threatens their health. A long-term study published in the American Journal of Respiratory and Critical Care Medicine found that women who worked as professional cleaners were at a higher risk of developing lung cancer from exposure to cleaning chemicals, Pasha-Razzak said, with risks similar to smoking 10 to 20 cigarettes daily. Exposure to these chemicals can also lead to breast cancer and miscarriages.

The system EVS staff members work within forms the fourth barrier. Pasha-Razzak explained that EVS works within the structures of the facilities system while other healthcare professionals in the HAI-prevention team work within the clinical system. This system silos staff who should be working together for the benefit of patient safety. It also complicates the working day for EVS staff, who must run between multiple huddles if they cover multiple hospital units.

“EVS belongs in the same room as clinical workers,” Pasha-Razzak said. “I am trying to pull EVS into the clinical system.”

Overcoming these four barriers and giving EVS a voice in patient safety decisions will not only benefit EVS staff, it will benefit the patients. Pasha-Razzak said she has noticed the difference when EVS leaders were included in patient care discussions.

“Better communication—not more staffing, not more money, not more people cleaning—drove a 25% drop in C. diff cases on two oncology units when the clinical team began sharing real-time feedback with environmental services workers,” she said.