Beyond the Surface - an ISSA Podcast

Proving the Power of Clean: Validating Disinfection in Healthcare with Mike Staver

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What does it take to truly validate cleaning in healthcare? Join Linda Lybert and KleenMark COO Mike Staver as they reveal how real-world data and rigorous protocols are raising the bar for infection control and patient safety. This eye-opening episode dives into the science and strategy behind effective healthcare cleaning, spotlighting KleenMark’s rigorous case study and the critical role of data-backed practices in transforming outcomes.

SPEAKER_01:

Hello and welcome to Beyond the Surface. The Healthcare Surfaces Institute was founded nine years ago to examine a frequently overlooked foundational factor in the spread of HAIs. Over these years, we've gained valuable insight and effectively highlighted how surfaces and products can support and harbor microbes, along with the challenges healthcare professionals have encountered when attempting to clean and disinfect them. I'm Linda Liebert, the executive Executive Director of Healthcare Services Institute. On our podcast, we will interview healthcare experts, patients, thought leaders, researchers, and many others about the challenges we face in our ongoing battle to mitigate the spread of microbes that cause HAIs and solutions that are being introduced. I am joined today by Mike Staver, and I'll give you a little bit of background. Mike joined CleanMark in November of 2018 as the Director of Operations with a Bachelor of Science degree in Business Management, Administration, and a Vocational degree in bidding and estimating. Michael's knowledge of the industry and day-to-day operating processes to best achieve successful standards along with his education and background in labor productivity brings both an in-the-business and on-the-business perspective. Today, Mike is CleanMark's Chief Operating Officer and Integrator, responsible for holding the organization to a high clean standard. Beyond aesthetics, we clean for safety and health. He provides support, addresses challenges, ensures operational efficiency, and provides the tools and resources for CleanMark and its employees to succeed and excel. He has served as a mentor both internally at CleanMark and in previous roles, as well as mentoring developing leaders in different forms and organizations. Welcome, Mike.

SPEAKER_00:

Thank you, Linda. Thank you for having me. It's a pleasure.

SPEAKER_01:

It's great to have you. I'm really excited about our talk today. But first, let's start. Tell us a little bit about CleanMark.

SPEAKER_00:

Yeah, happy to. So CleanMark, and it's spelled not your traditional way of cleaning, C-L-E-A-N. It's spelled clean as in K-L-E-E-N. And we joke a lot of times because we We pride ourselves in being the best cleaning company, not the best scholars or grammar artists as it relates to punctuality and just spelling in general. But CleanMark has been around since 1966. It's a family owned company. It actually started as a distribution company, meaning like liners, chemicals, things of that nature. And in 2000, it transitioned into more of a full fledged janitorial arm, meaning service providing so building service contractor as well as holding on to that distribution side of the organization which helps us really have complete control so logistics manufacturer direct relationships costs you know obviously there's uh some some benefits to that piece but really just making sure that our operations always has what they need right um so we're based here in madison wisconsin we do cover national territories we have approximately 1200 165 employees, give or take. We're very fortunate to be in a multitude of verticals. So we're obviously in healthcare, a lot of life science, biotech, but we're also in higher education, private education as well, class A office space, production manufacturing, of course. And we do some fun stuff in the event cleanups, whether it's college stadiums like Wisconsin Badgers, but also some minor league baseball affiliates It's things of that nature and a variety of music venues and theaters and things of that nature. So we've evolved our verticals over the last decade, which has been a lot of fun. Awesome.

SPEAKER_01:

And you evolved one of your verticals in healthcare, which is why we're talking today, because there's some exciting things that you've actually done. You're working in operating rooms where the challenge there for healthcare professionals is the room turnover times and the requirement to meet those, but at the same time, actually be effective with cleaning and disinfection. So tell me a little bit about that story.

SPEAKER_00:

Yeah, that's actually great timing. We are getting ready to onboard. It's one it's one health care entity, but three facilities, basically back to back startups, two week breaks. We start on Tuesday after Memorial Day. So last week, this was very fresh because we put some new team members through our medical training. And how do you validate whether they are passing or failing? Right. So it's a lot different than office cleaning when you're doing a terminal cleaning, operating room cleaning. Right. So obviously, size is a big piece of it but at the end of the day everything needs to be clean sanitized and disinfected properly in order to be safe and that's how we pass right so it was quite an eye opener for some of not just new team members but already existing team members that are making that jump from office commercial into healthcare. So we were averaging typically one to three hours for an operating room cleaning. Most of the time, if you're below that two hour mark, that's because you have two individuals doing it. So we put our team, this new roster of staff through this independently so they could really understand what that looks like. Because on any given day, In any industry, somebody may get sick, somebody may not show up for work, whatever the case, the job still has to get done. So you can look at a job as if I'm collecting trash in a commercial setting, was the trash emptied or not? It's pretty easy to see that. In an operating room, you really don't know It's based on eyes and that's scary. So what we've been doing internally at CleanMark with help of ISSA with some great introductions, we're doing A3 testing. So traditionally you had that ATP testing, right? And now what we're seeing is more of a testing that's looking at what happens to the bacteria on the surfaces over time. Sometimes those things, which is ATP, transition into other things like AMP and ADP. And that can also give you a a false sense of security if you're not picking up that bacteria, right? And it's typically looked at as counts and there's a cut rate that gets assigned to these. So we've incorporated this, we've adapted into our cleaning program for the greater part of the last 18 months. Before that, we were still using this, but just not to the scale and not looking at it as an internal investment to make sure that we were always making progress and seeing success, meaning numbers decreasing. That's how we look at passing and failing.

SPEAKER_01:

So a couple of things, let me just, for our listeners. So a terminal clean is at the end of the day. We still have cleaning in between patients, which is typically done by the staff and in a short period of time. But the end of the day, the terminal clean is really key. And one of the reasons why I always say, if I ever have to have surgery, I wanna be the first one in, in the morning, early. 4.30 or not, that's where I wanna be. The other thing that you talked about was, that was really important and key, what you're doing is you're actually validating clean. So you're validating that your team has been effective in reducing microbes and bioburden.

SPEAKER_00:

That's correct. Just a little bit on that. So we've always built in the ATP testing in some sort of a frequency. And I'd say a year plus ago, we were looking at more like on a monthly basis, let's do a joint walkthrough with our client. We're going to pick 10 spots and we have to pass 90% of those. And at that time, you know, just using typical ATP below 50 is what the mark would be. We also have, we've also, built in the glow gel which is a great way of testing if something has been cleaned because you can see the removal however what that doesn't give you is a true like luma test data reading because i might be able to remove gel with a lot of elbow grease but maybe i was using water maybe i wasn't using something that is actually going to kill the bacteria so that's that's where you take it to the next level in our opinion is let's make sure it's purely genuinely disinfected it's just not aesthetically appearing clean, right? So what we've done is we built this into our daily repertoire. So now when we meet with our clients at the end of the month, this isn't something we haven't been doing. We're typically Monday through Friday in most of our hospitals. We're doing this on average 21.7 days a month because it's part of our internal KPI. to do this on a random audit, but make sure that we're hitting all those touch points at the end of the night. So then when we show up with our clients, we're really looking for a 10 out of 10, right? If we miss something during the week, we don't just chalk it up to a miss and then carry forward. We have our staff redo this. And that is the return on investment piece, because this isn't something you're asked to do in most of the hospitals. Not everybody goes by the same guidelines, but this is how we try to separate ourselves. And to your point, Linda, like we want to make sure whoever that patient is the next day, their family, the surgeon, the staff, everybody involved, control everything we can to make sure that it's a very safe environment for them to have an operation. Because what we want is them to go home and get better. We don't want somebody to leave and then have another situation that brings them back into the hospital, which we've seen. And that's, you know, that's the last thing we want to see. Our goal is to make sure people can be healthy, right? And this is our part in doing it.

SPEAKER_01:

Yeah. And that, you know, surgical site infections are the number one HAI globally. And because of that, it's when you really evaluate, I gave a presentation last week to a healthcare facility and It was really interesting because their director of OR actually raised her hand when I was giving my portion of the presentation. Let me just stage this a little bit. What it was was the infection prevention team was opening the door for the nursing team to begin communicating about things that they were seeing and recognizing that may keep infection rates up there when they're trying so hard to reduce them. And the operating room, the director of OR, actually raised her hand and she said, I don't mean to interrupt you, but she said, our timetable is we actually have a timer. So when wheels come in, they hit that timer. And when wheels go out, they hit the timer again. So that is how tight they actually are. And she said, my job performance is based on being meeting that timeline. But as you say, and the way that you're doing it, we don't know how clean is that room with that kind of a timeframe behind it and how do you validate? And the thing I like about your program is the validation component.

SPEAKER_00:

Yeah. That is the key, because you can have these conversations all day, but not until we started running these case studies internally. We asked for permission. Can we do this? We're not sharing anything publicly, but you're going to see us enhancing the audits, and we're going to bring in a third party that's not an operator, that's not a CleanMark employee, that's not biased. They don't want to see anything. false scores. That's not what we brought them in. So that was another investment. And now that person actually works for us today because it was such an eye-opener for us. So this helps us make sure that we're not asking people to wear two hats, but that's kind of a different story when you look at an accountability chart, right? You don't want to pile too much on people when we're talking about this significance of importance here. But when we were able to sit down with our clients and show them what we've been doing, right? And when we are asked to take on a new operating room. They could be within the same facility where they had in-house or maybe supplemental. A lot of times you're up against the gun on the timer, right? Not until you can show this is the results when we are using the amount of time that we need, right? Or the amount of labor. If you need us to be in a shorter window, I gotta have additional labor. I have to have more people. because I can only go so fast. I can get faster, I can get more efficient, but you can never meet that timer and do it with high efficacy, right? So when we were able to do that, and you look at it from that bigger picture, we were successful to get more time and more labor. We came into a balance here. The other thing that was really cool is we had a portfolio that was pretty much split. here in Madison, Wisconsin, between us and another company. And they really don't have a lot of in-house that focuses directly on hands-on cleaning. So it's pretty much all outsourced. And we've been working with this partner for two and a half decades, but they've had some leadership changes. And when those things happen, you want to get to them right away. You want to let them know this is what we're doing, right? And it was quick to find out that at the end of the month, when we would do our joint inspections, we were crushing it. These ATP tests, these KPIs, we were hitting nine out of 10, 10 out of 10. You can't hit below a nine out of 10, two consecutive months. The other company wasn't. They weren't hitting it because they weren't doing it 21.7 times a month. They were basically cleaning, maybe disinfecting in some cases, but at the end of the month, they were failing some of these audits. So over time, we gained the trust and now we're looking at a full renewal but to take 100% of the portfolio because of the trust, because they can go home at night and they can rest assured that they can trust CleanMark is doing it properly and they're validated. Even if we're not asking them to, now my gut tells me this new renewal, it's gonna bake in a nightly audit, but we signed up for that. And for us to do that, I think it speaks levels. Being a BSC, it keeps the competition at bay. But more importantly, this is not about just cleaning for eyes. It's for health. And I have family here, right? I don't want anybody to ever go into a hospital setting. And I'm wondering if we are going too fast and it's not safe. You know, like I just... I can't live with that. You know, so this is something that we have high integrity. And because of it, I think the pride is super high. So we kind of look at it as you rise through the rankings when you can adapt and move into the medical cleaning. And, you know, we're proud of it. We've been doing it for a long time and speaks levels to having a vice president of medical who's now been here 32 years in September. So, you know, it's just that high level of care. And you can see it by the clients.

SPEAKER_01:

Couple of things I want to compliment you on. Number one, the fact that you, number one, take such care in making sure that you are meeting what is needed. But the other thing is, is your open communication with members of the healthcare team and your willingness to sit down and review what you're finding, because there's a lot of disconnect within healthcare, not intentionally, but just there is. And so you're educating them at the same time as you are fixing or bringing a solution to them. So what you're doing is amazing and you're saving lives as a result of that.

SPEAKER_00:

Yeah, it's it sure helps when you're recruiting and we do a lot of employee recognition and things like that. And that's what we tell our people, you know, like you're actually you are saving lives from the communication aspect to the clients. The more that you do these things proactively, and show them that you really care, the better opportunities you're gonna have to meet with more individuals in the facility and have some good conversations. And we talk about this as you've got EVS, you've got facility managers, you have sourcing and CFOs, but having that infection control seat, If you can get them in the room as well, like now you're really able to work through things because not everyone has all the funds or the means to do everything. But this is a great way for everybody to understand kind of the pain points that we deal with and how can we help balance this and understand, you know, for you to do good at your job, you know, for you to be successful, here's some things that I'll need to do and yada, yada, yada. And I feel like, you know, that's been the biggest thing that the hurdle that we've gotten over over this. And I wouldn't, I did not believe that that was going to be the case necessarily 16, 18 months ago. We looked at it as we got to get better. We need to be the best and let's take it really serious. Not that we weren't, but again, from a distribution standpoint, we always look at how do we, how can we help bring things together? And we're always looking at innovations. And when we learned of A3 versus your traditional ATP, well, let's explore it. And I got to say it's taken off and I've seen infection prevention be very excited when they hear about these things and that And that does help you when you get into these conversations around, I need a little bit more, right? I need a little bit more time or I need a little bit more labor. And this is what that outcome is. And what we don't want is an HAI to come back to you. Because now talk about money that you're holding on to. Well, that's a huge ROI if you don't have any HAIs that are being broadcast. And nobody wants that, right?

SPEAKER_01:

Yeah. Yeah. Well, it's also extremely expensive

SPEAKER_00:

for the

SPEAKER_01:

hospital. I mean, it is. It's horribly expensive. So we've only got a few minutes left, but I want you to tell me a little bit about your case study that you're in the process of doing.

SPEAKER_00:

Yeah, so it's, I don't like to get too fixated on the cut rates all the time because there's a lot of things, as we've learned, that this is why I brought in third party to do the consulting. If I'm pushing down on a swab and you're pushing down on a swab, our pressure could be different. So even if we do it over and over the same way, sometimes our numbers are not exactly the same. So what we really look for is being consistent on what we're checking, whatever those touch points are, We want to be consistent, but we want to have a variety of the rooms. And what we're really measuring is decrease in the values of the numbers. So as long as you're seeing those numbers going down, and we do measure against the cut rate, 583.50 in your traditional HyGia ATP. That's what we're using. That's what our clients are using. That's what's prescribed by ISSA as well as what we see from the manufacturers. So we shoot for that. we want to obviously just see the numbers continuously go down. We'll swab test with A3 as well as ATP. So we're using two systems, both, both, you know, high reputation systems. They've been around for a long time. One's more focused in food manufacturing. Obviously that's very important to make sure the food lines that we're working off of the assembly lines, the atmospheres, they gotta be, they gotta be, safe, right? Because you don't want to get that infection said either. There's other ways to get infections other than just having surgery. But that's what we really look at. So as we measure this out, every night we're doing the testings. Every week on Friday, we review the audits. Nothing that we test that scores above the cut rate or we see an increase passes. And that means we don't let it go through the next day. Now, sometimes what we'll do is on Fridays, we'll select a room and we'll say, we're not going to clean this room tonight. So this route, because there's not going to be any patients on Saturday, but we notify the hospital and we say, we're going to come in on Saturday and clean it. Again, this is on us to do it. If we have to pay premium for staff to come in, that's fine. But what we wanted to do is test the theory of ATP transition to ADP and AMP versus just A3. So what that would mean, and if you could visualize a line graph, over time, ATP is going to start to decrease because it's channeling, it's transporting into ADP and AMP, right? So if a room was dirtied up on Friday and a lot of surgeries, we're not cleaning it Friday night, okay? Now, whatever that ATP number is, we're gonna test that and then we're gonna come back in on Saturday about eight to 12, 16 hours later and we're gonna test it again. And what we were seeing is that number was reducing. So just think about that over eight to 16 hours. Now let's say we didn't clean it Saturday, we didn't clean it Sunday, and heck, we don't even clean it before Monday. What you would see is a very low number, which could give you a false status of clean, right? Now by running the A3 meter parallel to it, we would see consistent in scoring Okay, because that ATP, it's trailed off into AMP ADP, but you're still picking up on that. So that was one of the things that we really learned is it's very important to test yourself quickly after a cleaning. Not right away while it's still dwelling, but within one to two hours is the right time to do that. So you're getting a really true reading. Again, the numbers may, they may sway a little because there's a lot of variables, lighting, temperature, pressures, things of that nature. But the theory as a whole stands, if the numbers are going down, that's good, right? And it's good to take multitudes of ways of testing. The glow gel is great, but that's just showing you soil remove. That's not showing you like clean disinfectant surfaces, right? So to use that, but you just, I don't hang my head on only one approach. I like to always look what is out there and how do we take that innovation and apply it so we can make ourselves better.

SPEAKER_01:

And that's awesome. Well, Mike, unfortunately, we're at the end of our time. I am so grateful. It is so exciting to hear someone like you with the passion for cleaning and disinfecting. And too bad I don't live in Madison, Wisconsin, if I ever were to have to have surgery. But it is so great to hear what you are doing and how you've taken your teams to the next level. And I know that the hospital is probably thanking you as well. So thank you for having the time to join us today. And I'm sure we're going to have you back again in the future.

SPEAKER_00:

I love that. It's always a pleasure. Thank you so much. And honestly, on behalf of NetCleanMark and just janitorial as a whole, this has given us a bit, I'd say, you know, a louder voice in a good way, right? So to feel that we're really a part of this, you know, anybody can get behind this initiative. This is for the greater good. So thank you so much. It's always time for you, Linda. Thank you.

SPEAKER_01:

Thank you for listening to Beyond the Surface. This podcast is brought to you by ISSA the Worldwide Cleaning and Facility Solutions Association. Please subscribe and write a review for us on whatever platform you enjoyed this podcast on. For more information, go to healthcare surfaces institute.org.