Here’s an in-depth look at the key environmental hygiene issues and trends coming out of the 2026 annual meeting of the Association for the Healthcare Environment (AHE).

The Sept-Oct 2026 issue of Healthcare Hygiene magazine, to be released in early September, will also feature a focus on environmental hygiene. Until then, be sure to check out the Environmental Hygiene columns from Healthcare Hygiene magazine HERE

A session presented at AHE Exchange26 (New Orleans, August 16–19, 2026) by Bernardino Guerrero, deputy director of environmental programs service/healthcare environment and facilities programs, and Trina Zabarsky, RN, MSN, CIC, FAPIC, infection preventionist at the Northeast Ohio VA Healthcare System, both of the U.S. Department of Veterans Affairs, Veterans Health Administration, offered one of the more granular looks at disinfection practice presented at this year’s summit — and the data behind it should give every EVS and infection prevention leader pause.

Guerrero and Zabarsky framed their presentation, “Disinfection in the Healthcare Environment: Challenges, Barriers, and Solutions,” around a deceptively simple premise: disinfection failures in healthcare facilities are rarely failures of intent. They are failures of system design — in training, in product standardization, in dispensing equipment, and in the adoption pathways for newer technologies. The session’s real value lay in how directly it named those systems and backed its recommendations with published, peer-reviewed evidence rather than vendor talking points.

Where Disinfection Breaks Down

The presenters organized common obstacles into several categories that will be familiar to anyone managing an EVS department, but rarely quantified this precisely.

Knowledge gaps topped the list — inconsistent training and competency assessment, limited staff understanding of which products are indicated for which pathogens, and a proliferation of products with differing contact times that creates confusion at the point of care. Layered on top of that are variations in technique, where inconsistent cleaning practices directly undermine disinfectant efficacy, and inconsistent contact times, where staff either don’t know the required dwell time for a given product or are pressured by fast patient turnover to wipe surfaces dry before the disinfectant has had time to work.

The presenters were also candid about a category that gets less attention in typical EVS training curricula: inadequate disinfectant concentrations. This is where the session’s evidence base became most compelling.

The Numbers Behind “Dilution Dysfunction”

Citing a November 2024 study published in Infection Control & Hospital Epidemiology — co-authored by Zabarsky and Guerrero themselves, alongside Cadnum, Kaple, Eckstein, Saade, Ray, Yassin, and Donskey — the presentation shared findings from an evaluation of automated disinfectant dispenser systems across 10 hospitals. Of 107 automated dispensers tested, only 52 delivered a “just right” concentration. Twenty-six delivered disinfectant at too high a concentration, 14 delivered too low a concentration, and 15 dispensed no disinfectant at all — effectively water.

The picture for in-use disinfectants tested directly (80 samples) was somewhat better but still concerning: 49 were within the correct range, 13 were too low, 14 contained no disinfectant, and 4 turned out to be the wrong product entirely.

The study’s authors, and the presenters echoing them, drew a direct conclusion: improved monitoring of automated disinfectant dispensers is needed. Contributing factors identified included cloths left soaking in solution — which leads to a phenomenon called quat binding, where quaternary ammonium compounds are absorbed by cloth fibers and depleted from the working solution — along with faulty dispenser connections, empty reservoir bottles, and a general lack of routine quality assurance testing. The presenters pointed to simple, low-cost verification tools already available to EVS departments: quat test strips and pH test paper, both of which can confirm whether a diluted solution falls within its expected concentration range before it’s used on a patient care surface.

What “Fixing” Training Actually Looks Like

Rather than treating training as a single onboarding event, the session pushed for something more durable: initial and annual competency assessments, collaboration with professional organizations and chemical manufacturers on process- and product-specific instruction, and simulation-based, hands-on training. Notably, the presenters called out a common but flawed default — the informal “train the way I was trained” shadowing method, where new EVS staff simply observe and mimic a more senior colleague without any standardized competency check. That approach, they argued, propagates whatever errors already exist in current practice rather than correcting them.

To reinforce knowledge over time, the presenters recommended job aids, competency validation, performance feedback, on-the-spot recognition, and structured QA monitoring using tools such as fluorescent markers (applied before cleaning and checked under black light for missed surfaces), ATP monitoring (swabbing after cleaning to detect residual organic material), and direct observation with real-time coaching.

Adjunct Technologies: Real Promise, Real Limits

A substantial portion of the session addressed emerging and adjunct disinfection technologies — always with the caveat, repeated across nearly every category, that none of these tools replace manual cleaning and disinfection. They supplement it.

Ultraviolet-C devices were presented in two forms. Traditional UV-C at 253.7 nm has the deeper evidence base: broad-spectrum efficacy against healthcare-associated pathogens, reduced reliance on human technique, and usefulness during outbreak response. Its limitations are practical — it requires direct line-of-sight exposure, shadowing significantly reduces efficacy, and rooms must be unoccupied during treatment, which creates workflow and time constraints. A related VA study, published in Infection Control & Hospital Epidemiology in 2025 (Dukes, Hockett Sherlock, Goedken, et al., with Guerrero and Zabarsky among the co-authors), examined the facilitators and barriers to UV-C adoption for patient room cleaning across VA hospitals through qualitative analysis — underscoring that the technology’s success depends as much on workflow integration as on the hardware itself.

Far UV at 222 nm is the newer entrant, with demonstrated efficacy against airborne pathogens and the potential to operate continuously in occupied spaces without requiring room closure — a meaningful operational advantage. But the presenters were direct about its limitations: fewer evidence-based trials than traditional UV-C, no long-term human exposure data currently available, and the same shadowing vulnerability as its predecessor.

The session also covered electrostatic sprayers, misting systems, and fog/vapor technologies, which offer shorter contact times and are increasingly available in ready-to-use formulations that reduce dilution error — directly addressing the concentration problems documented earlier in the presentation. Antimicrobial surfaces (copper, silver, chlorhexidine gluconate, zinc, titanium dioxide, and nanomaterials) and enhanced chemicals, including continuously active disinfection (CAD) products, rounded out the technology overview. A 2020 study by Redmond, Silva, Cadnum, Carlisle, and Donskey, also cited in the reference list, evaluated a continuously active disinfectant specifically for mobile equipment disinfection — a category of surface that traditional cleaning protocols often struggle to address consistently.

The Real Barrier Isn’t the Technology

Perhaps the most useful section of the presentation for EVS and IP leaders navigating budget conversations was the frank accounting of why adjunct technologies stall in adoption. The list was long and organizational rather than technical: limited room turnover time, staffing shortages and turnover, perceived workflow complexity, upfront equipment costs, uncertainty about return on investment, lack of standardized implementation guidance, insufficient leadership support, difficulty securing stakeholder buy-in, and — notably — staff concern that new technology signals a reduction in headcount rather than an enhancement of protection.

The presenters’ proposed countermeasures track closely with sound change-management practice: identify executive, infection prevention, and EVS champions; build a clear business case; pilot in high-risk areas before facility-wide rollout; solicit frontline staff feedback early and often; collect baseline and post-intervention data to demonstrate measurable outcomes; and repeatedly reinforce — to staff and leadership alike — that these tools supplement, rather than substitute for, the technician’s own cleaning and disinfection work.

The Takeaway

What distinguishes this session from a typical product-agnostic disinfection overview is its willingness to quantify failure. A near-25-percent rate of incorrect concentration across more than 100 tested automated dispensers is not a minor operational footnote — it is a patient safety finding with direct implications for every facility relying on automated dilution systems without a routine QA testing program. Combined with the qualitative UV-C adoption research and the clear-eyed accounting of organizational barriers, the presentation offers EVS and IP departments a genuinely evidence-based roadmap rather than a technology sales pitch.

References:

Cadnum JL, Kaple CE, Eckstein EC, Saade EA, Ray AJ, Zabarsky TF, Guerrero BJ, Yassin MH, Donskey CJ. Dilution dysfunction: evaluation of automated disinfectant dispenser systems in 10 hospitals demonstrates a need for improved monitoring to ensure that correct disinfectant concentrations are delivered. Infection Control & Hospital Epidemiology. 2024;45(11):1362-1365.

Dukes KC, Hockett Sherlock SM, Goedken CC, Racila AM, Walhof JF, Suh D, Goto M, Guerrero BJ, Zabarsky TF, Perencevich EN. Facilitators and barriers for the use of ultraviolet-C disinfection for patient room cleaning at VA hospitals: a qualitative analysis. Infection Control & Hospital Epidemiology. Published online 2025:1-4.

Redmond S, Silva SY, Cadnum J, Carlisle M, Donskey C. Evaluation of a Continuously Active Disinfectant for Disinfection of Mobile Equipment. Infection Control & Hospital Epidemiology. 2020;41(S1):s225-s226. doi:10.1017/ice.2020.770

This article is based on a session presented at AHE Exchange26, the AHE Education & Solution Summit, New Orleans, August 16–19, 2026. The views expressed by the presenters reflect their own analysis based on published research and industry practice, and do not necessarily represent the official position of the U.S. Department of Veterans Affairs or the Veterans Health Administration.

A session presented at AHE Exchange26 (New Orleans, August 16–19) by Robert Campbell, PharmD, BCSCP, vice president of accreditation certification program development and management at The Joint Commission, delivered a message that environmental services professionals have long argued for themselves: the physical environment is not a peripheral compliance concern. It is, by Joint Commission’s own data, the single most frequently cited category in hospital accreditation surveys — and cleanliness sits at the center of it.

Campbell’s presentation arrived at a moment of significant institutional change for The Joint Commission, which is rolling out Accreditation 360, described in the session as the most substantial evolution of its accreditation process since the Medicare program began in 1965. But rather than treating EVS as one item among many swept up in that transformation, the session gave the discipline a spotlight rarely afforded it in accreditation-focused presentations.

“Before the First Clinical Interaction, the Environment Speaks”

The presentation opened with a framing that will resonate with anyone who has spent a career arguing that EVS is clinical infrastructure, not janitorial overhead. Clean spaces, Campbell emphasized, are welcoming, safe, and memorable — they set a tone of trust and dignity, reduce risk through reliable readiness, and leave a lasting impression of quality before a single clinical interaction takes place. The framing positioned environmental services not as a support function operating in the background, but as the first and most immediate signal an organization sends about whether it is, in fact, ready to care for the patient in front of it.

The Numbers That Make the Case

The presentation’s most consequential disclosure was quantitative. According to data Campbell shared from 2026 Joint Commission accreditation surveys, the physical environment is the top-scored regulatory category across all surveys conducted. Specifically, 44 percent of hospital accreditation surveys and 30 percent of critical access hospital accreditation surveys included a physical environment observation related specifically to cleanliness.

That statistic reframes the conversation for hospital leadership in a way editorial coverage and training materials rarely manage to do. It isn’t a hypothetical risk. It is, at present, the most commonly cited compliance gap in the accreditation process — meaning EVS performance is functioning as one of the more decisive variables in whether a hospital passes or fails its survey outcomes cleanly.

Where Infection Control and Environment of Care Meet

Campbell’s presentation included a Venn diagram that captures something EVS advocates have struggled to articulate cleanly: Infection control and the environment of care are distinct programs with distinct scopes, but they overlap substantially, and that overlap is where EVS lives.

Infection control, in the Joint Commission’s framing, centers on preventing and reducing healthcare-associated infections through hand hygiene, surveillance and monitoring, personal protective equipment, cleaning and disinfection, and immunization. Environment of Care centers on providing a safe, functional, and healing environment through safe design and construction, equipment safety and maintenance, water safety, waste management, and hazard prevention. The intersection — where the two circles meet — is described as a safe, clean environment, risk reduction, evidence-based practices, quality and patient safety, and staff education and accountability. The session’s own language for this space was direct: this is where the two programs are “stronger together for safer care.”

For EVS leaders making the case for departmental investment or standing on interdisciplinary committees, this framework offers something concrete: an accrediting body’s own acknowledgment that environmental services sits at the structural junction of two programs that hospitals are required to maintain, rather than being a subordinate function of either one.

The Standards Behind the Statistics

The session walked through several specific standards that translate the “clean and orderly” mandate into enforceable requirements, and the specificity is instructive for any EVS director building or auditing a compliance program.

Under the infection prevention and control standard (IC.04.01.01, EP 2), the infection preventionist bears responsibility for developing and implementing hospital-wide surveillance and control policies, documenting program activities, delivering competency-based training to staff — including contracted personnel — and collaborating across departments including sterile processing and water management. That standard alone underscores how tightly IP and EVS functions are meant to be integrated at a policy level, not simply coordinated informally.

The physical environment standard (PE.01.01.01, EP 3) requires that hospital premises remain clean and orderly, defined to include properly stored equipment and supplies, prompt attention to spills, and generally neat conditions. A related set of standards (PE.02.01.01, EPs 1 through 4) governs hazardous materials and waste specifically: hospitals must maintain a current written inventory of the hazardous materials they use, store, or generate; hold the permits, licenses, manifests, and safety data sheets required by law; label hazardous materials and waste with contents and hazard warnings; and develop policies addressing safe handling, storage, transport, and disposal — including precautions and PPE requirements in the event of a spill or exposure.

Staff orientation and competency requirements round out the framework. Under National Performance Goal 12 (staff orientation, EPs 1 and 2), hospitals must orient staff to relevant policies, job-specific duties — including infection prevention responsibilities — and patient rights, with completion documented and performance evaluated at least once every three years. A parallel human resources standard (HR.11.04.01, EP 1) requires that staff competence be initially assessed and documented at orientation, then reassessed on the same three-year cycle at minimum.

Education, Training, and Competency are Not the Same Thing

One of the more useful frameworks Campbell presented distinguishes among three terms that are frequently used interchangeably in EVS training programs but answer fundamentally different questions. Education focuses on knowledge acquisition — degree programs, continuing education, reading standards — and answers “what do I know?” Training focuses on skill development through onboarding, workshops, and simulations, answering “how do I do it?” Competency focuses on performance demonstration through direct observation, return demonstrations, and audits, answering the question that actually matters for patient safety: can I do it correctly and reliably?

The presentation’s core assertion here is one that should inform every EVS training program in the country: knowledge alone does not equal competence. Education provides knowledge, training builds skills, but only competency validates the consistent application of both in actual practice. A technician who has completed a course and can describe proper disinfection technique has not yet demonstrated that they perform it correctly, every time, under real working conditions — and Joint Commission’s standards explicitly require the third step, not just the first two.

Practical Scenarios Surveyors Are Trained to Probe

The session’s scenario-based content offered a rare, direct look at the kinds of questions a surveyor may actually ask on the floor. On chemical security and safety: are chemicals secured against unauthorized access, is required PPE available for the chemicals in use, are resources readily available in the event of accidental exposure, and has anything relevant been incorporated into the workplace violence risk assessment? In psychiatric and behavioral health units specifically, the same questions apply with additional scrutiny given patient population risk, alongside a check for policy conflicts with items prohibited in those units. In security-sensitive and restricted-access areas, surveyors may ask whether staff are trained to prevent tailgating and whether staff know who is and isn’t authorized to access a given space — a detail with direct EVS relevance given how frequently housekeeping carts and staff move through restricted corridors.

On routine cleaning itself, the presentation flagged the questions surveyors are prepared to ask directly: when is routine room and surface cleaning required, what is the process, what chemicals are used, and — pointedly — what are the dilution requirements for those chemicals? The same line of questioning extends to terminal cleaning and to isolation precautions, where PPE requirements and chemical use both vary by isolation type, and dilution requirements again surface as a specific compliance checkpoint. For readers following Healthcare Hygiene’s ongoing coverage of automated dispenser performance and disinfectant concentration failures, this is a notable convergence: dilution accuracy isn’t only an infection-prevention efficacy question, it’s an active line of accreditation surveyor inquiry.

Candor About the Relationship

Campbell’s presentation included a candid section titled “Sometimes the Truth Hurts,” acknowledging that many hospital leaders did not realize Joint Commission wanted a more collaborative relationship, that the organization has heard clear feedback on modernizing its technology to reduce administrative burden, and that some long-circulated “urban legends” about survey requirements — down to questions as specific as whether staff can keep water bottles or IV fluids in a trauma bay — have proven persistent and difficult to dislodge. Consistency, the presentation noted, remains one of the organization’s most frequently cited Requirements for Improvement against itself.

That admission, paired with the Accreditation 360 initiative’s stated goals of streamlining processes, better supporting healthcare organizations, and more efficiently sharing best practices across the healthcare ecosystem, suggests an accrediting body attempting to recalibrate its own relationship with the organizations it oversees — a dynamic worth watching as EVS and IPC departments navigate survey preparation under the new framework.

Why This Matters for EVS

Taken as a whole, the session offers EVS leaders something they can bring directly into budget and staffing conversations: an accrediting body’s own data showing that physical environment and cleanliness observations are the most common finding in hospital surveys today, a standards framework that treats EVS competency validation as a documented, recurring requirement rather than a one-time onboarding task, and explicit surveyor scenarios that test exactly the kind of process knowledge — dilution requirements, contact times, chemical security — that has occupied much of this publication’s own recent coverage. The message from Joint Commission’s own accreditation leadership is consistent with the argument EVS advocates have made for years: the environment is not incidental to care. It is often the first and most consequential thing a patient, a family member, or a surveyor actually observes.

This article is based on a presentation delivered by Robert Campbell, PharmD, BCSCP, Vice President, Accreditation Certification Program Development and Management, The Joint Commission. Standards references (IC.04.01.01, PE.01.01.01, PE.02.01.01, NPG.12.05.01, HR.11.04.01) reflect Joint Commission requirements as presented in the session materials, current as of 2026.

When environmental services budgets come under pressure, the instinct is often to look for savings in the obvious places: headcount, supply contracts, capital spending. Presenter Carolyn Quinn CHESP, president of Pike Systems, Inc., said that the biggest savings usually aren’t in the budget at all — they’re hidden in the daily friction of how the department actually operates. Her session walked through three categories where capacity quietly leaks out of EVS operations — people, process, and products — and offered a practical framework for recovering it without touching quality or headcount.

Why This Matters Right Now

Quinn opened by grounding the conversation in the pressures every EVS leader is already feeling. According to the 2026 AHE Supply Chain Leaders Survey, 60% of health system supply chain leaders cite rising costs as a top challenge. Layered on top of that are expectations that keep climbing, labor challenges that continue to grow, and a patient experience mandate that, as Quinn put it, never takes a day off. Against that backdrop, a day in the life of an EVS manager is really three simultaneous jobs — people, operations, and everything else — all happening at once, all day long. The framework she offered was designed to help managers find capacity within that chaos rather than asking them to do more with less.

People: Recovering Capacity Already in the Operation

The first category addressed a problem nearly every EVS department recognizes: chronic understaffing that never seems to resolve, no matter how much recruiting effort goes into it. Quinn illustrated the math with a simple example: a department budgeted for 100 FTEs might actually need roughly 140 to fully cover every shift, weekend, and PTO day — while the average daily show-rate is only 78. The insight, she argued, is that once a manager knows the real number, a staffing problem becomes a math problem rather than a mystery, and that reframing alone opens the door to a solution.

Quinn then broke down where the minutes actually go during a shift — what she called “death by a thousand minutes.” Small, largely invisible tasks accumulate into real lost time: stocking a cart consumes about 10 minutes a day, filling chemicals another 5, walking to an assignment 12, break travel 20, and chasing down missing supplies 15 — a total of 62 minutes per person, per day. None of it shows up as a line item, but multiplied across a department, it represents a meaningful chunk of paid time that never touches a patient room. She posed a set of structural questions every EVS leader should be able to answer: Can the shift huddle happen in the building where staff are actually working? Is the cart stocked and staged in advance, or does each person assemble their own? How far are break areas from work areas? Is there a process for flagging supply shortages before they turn into mid-shift trips? If a manager can’t answer these questions confidently, Quinn’s advice was simple: track one shift, and the hidden time will surface on its own.

A second people-focused opportunity involves discharge timing. Discharge cleaning volume, Quinn noted, is highly predictable — but staffing deployment usually isn’t matched to it. Data on discharge cleans by time of day typically reveals a clear surge window (in her example, 10 a.m. to 3 p.m.), while staffing coverage often peaks and troughs on a different schedule entirely, creating a “handover gap” precisely where the surge meets a staffing lull. Her recommended fix has three steps: chart discharge cleans by hour for 30 days to identify the actual surge window; size the team to match that window rather than the daily average; and define and drive discipline around the process — making the first shift own discharge responsibility, defining what counts as a STAT clean, and tracking the reasons behind each discharge (patient discharged, transferred, or repositioned) to understand true demand rather than assumed demand.

Training rounded out the people section as what Quinn called “the easy win” — a discipline most departments skip entirely. Her recommended structure is deliberately lightweight: a five-minute huddle, focused on one skill topic, reinforced daily, which over time builds better consistency across the team. The underlying point was pointed but simple: most staffing problems that departments treat as staffing problems are actually math problems, training problems, or demand problems in disguise — and each of those has a very different fix than simply hiring more people.

Process: Removing the Friction That Steals Productivity

The second section turned to process — the workflows, tools, and standards that either support frontline staff or quietly work against them. Quinn framed rework as “the silent capacity drain”: every time work has to be redone, or can’t be completed as planned, capacity disappears from the operation. She illustrated three common triggers — a dirty mop that spreads contamination instead of removing it, a clogged vacuum that runs without actually pulling soil out of carpet, and the wrong product or tool used for a task, which creates damage instead of cleanliness. Each of these, on its own, seems minor. But Quinn emphasized that an obstacle rarely affects just one employee — it ripples through the entire operation, since a single floor tech depends on functioning fleet equipment, available supplies, and a working process all at once.

She made this concrete with what she called “the domino effect”: a rider scrubber with a dead battery forces the operator to switch to a walk-behind machine; that walk-behind is already in use elsewhere, so a second technician has to wait; the wait delays cleaning in a hallway; and the delay eventually surfaces as an emailed complaint from a department or unit. Quinn’s pointed question — did the dead battery cause the complaint? — had a clear answer: no, the process did. A single equipment failure, absent a backup process, cascades into a customer-facing problem that looks, on paper, like a performance issue.

The antidote is standardized work. Quinn’s example showed six technicians operating a floor machine six different ways — each deciding for themselves when to dust mop, when to refill solution, when to inspect equipment, and when to escalate issues — versus a single standard work sequence covering dust mopping, machine inspection, solution filling, floor cleaning, pad changes, recovery tank cleaning, and issue reporting, performed the same way every time. Different decisions produce different results; one defined process produces consistent execution and consistent outcomes. She extended the same logic to fleet readiness, contrasting a machine that’s charged, stocked, and defect-free at the start of a shift — which lets a technician spend 100% of the shift actually cleaning — against a machine with a dead battery, discovered only when the shift begins, which triggers a cascading sequence (searching for a charger, switching to a walk-behind, taking longer to clean, losing the machine for the next shift, delaying a hallway, and ultimately generating overtime) that costs 22 minutes before the first square foot gets cleaned. Her closing point for this section was direct: employees don’t create most inefficiency — processes do — and every obstacle removed from a process becomes recovered capacity.

Products: Reducing Consumption Without Reducing Outcomes

The final category addressed consumable spending, starting with a simple provocation: if Quinn walked into your supply room, could she tell where you were wasting money? Her first example centered on paper towel dispenser settings — a detail most departments never revisit after installation. A dispenser set to dispense a 12-inch towel yields about 800 towels per roll; at 14 inches, that drops to 685 towels (a 14% reduction in yield); at 16 inches, 600 towels (25% fewer); and at 30 inches, just 320 towels — a 60% reduction in yield from a single setting. The downstream effect isn’t just paper cost: more consumption means more cases purchased, more frequent restocking, more empty dispensers mid-shift, more interruptions for EVS staff responding to those shortages, and ultimately higher cost with no corresponding improvement in hand hygiene outcomes. Quinn was careful to frame this as an operational problem rather than simply a paper problem — the setting itself is trivial to change, but its ripple effects touch purchasing, staffing time, and service quality alike.

Trash liners offered a similar lesson in scale. Quinn’s illustrative math: a 250-bed hospital with 1,200 receptacles generates millions of liner decisions over the course of a year. An oversized liner uses roughly 25% more plastic than a properly fitted one, with no added performance benefit — it simply costs more and wastes material. Scaled across a facility using 100 liner cases annually, that 25% oversizing translates to 25 entirely unnecessary cases purchased every year, for every wrong-size decision made at the receptacle level. As with the paper towel example, Quinn’s conclusion was that this isn’t a purchasing problem — it’s an operations problem, since processes, not products, create waste when the wrong products are matched to the wrong applications.

Microfiber told a related story, but with an added complication of loss and improvised use. Quinn described a familiar refrain from EVS supervisors: “we’re short.” But the real story that emerges when a department actually counts inventory can look very different from the perceived shortage. In her example, a facility was renting 450 orange towels, 450 blue towels, and 400 mops — but tracking down what was actually in use turned up only 250 orange towels, 250 blue towels, and 180 mops. The gap wasn’t a supply problem; it was a loss problem masquerading as one, driven by a self-reinforcing cycle: product goes missing, creating a perceived rental shortage, which prompts an increase in rental volume, which increases total inventory, which creates more opportunities for loss, which drives demand back up again — a cycle that, left unaddressed, never resolves on its own. Quinn illustrated where that missing microfiber often ends up: behind locker doors, tucked above ceiling tiles, left in storage closets, clipped to personal carts, sitting unused at nurses’ stations, or repurposed on a supervisor’s desk — none of it doing the job it was purchased to do. She also noted that microfiber demand isn’t flat throughout the year; it spikes with winter surges, flu season, construction projects, and respiratory illness season, while most hospitals budget for it as though demand were constant — a mismatch that produces a recurring cycle of manager panic, emergency inventory infusions, worsening loss, renewed demand spikes, and disruptive shortages. Her conclusion: the fix isn’t buying more microfiber — it’s breaking the cycle that’s driving the perceived shortage in the first place.

Across all three product examples — roll towels, liners, and microfiber — Quinn drew the same throughline: none of these are purchasing problems. They’re consumption problems, and consumption is shaped by process discipline, not by vendor selection or unit pricing.

The Takeaway: Reclaiming Capacity, Not Cutting It

Quinn’s closing framework tied the three sections together: people work recovers capacity, process work removes friction, and product work reduces consumption — and all three feed into the same outcome, more usable capacity within the existing operation. She offered a thought experiment to make the scale tangible: if every hospital in the room recovered just 10% in labor, 10% in supplies, 10% in rework, and 10% in interruptions, what would that department look like? Instead of hiring, buying, or cutting to solve a capacity problem, the department simply recovers what was already there. Her final message to EVS leaders was unambiguous: savings don’t come from doing more with less — they come from reclaiming capacity that the operation is already generating and losing, day after day, in the small, unmeasured places most departments never think to look.

The session “Accelerating Patient Throughput Through High-Performing EVS Operations,” made the case that bed turnaround time is not a housekeeping metric — it’s a capacity lever that hospitals are not manipulating.

At a hospital that is running near capacity, an empty bed with a discharge order attached to it is not empty at all — it is, in the words of one industry benchmark cited at this year’s AHE Exchange26 summit, a source of more than $2,000 a day in lost revenue. That figure, along with a growing body of data linking bed turnaround time to emergency department boarding, operating room delays, and patient safety risk, framed a session by Donald Sipp, senior director at Ruck-Shockey Associates, and Alison Manger-Weikel, system director of nutrition and environmental services at Riverside Health.

Their argument was straightforward: in an era when adding beds is rarely an option, the fastest and cheapest way to create capacity is to get the beds already on the floor back into service faster. And the department that controls that speed, they said, is EVS.

Throughput Is a System — But EVS Is the Bottleneck

Sipp opened by reframing patient throughput as an interdepartmental relay rather than a single department’s job. Emergency departments manage boarding and long waits; bed management handles room assignment; nursing determines patient readiness; transport executes the final move to a unit. EVS sits in the middle of that chain, controlling how quickly a discharged room re-enters circulation — and a delay anywhere in the sequence, he noted, ripples through all of it.

The session cited several figures underscoring the stakes: roughly one in three hospitals report daily operating-room delays tied to bed unavailability, and emergency department boarding beyond four hours is associated with measurably higher adverse-event risk. Against that backdrop, the presenters argued, EVS’s role is not “owning” throughput outright but controlling one of its most decisive levers — how fast a room returns to service after discharge.

Where the Time Actually Goes

Perhaps the most pointed argument in the presentation was that cleaning speed is rarely the real problem. Citing operational data, Sipp noted that up to 60 percent of total turnaround time can elapse before a cleaning technician ever enters the room — lost to late discharge notifications, unclear dispatch ownership, and staffing that is built around shift tradition rather than actual demand.

A walk-through of a hypothetical — but common — afternoon discharge illustrated the pattern: a 2:00 p.m. discharge order, a 15-minute gap before nursing notifies EVS, a further five minutes before EVS receives the notification, a 20-minute wait for a technician to finish a prior room, a compliant 38-minute clean at the Association for the Health Care Environment’s (AHE) standard, and then a lag before the room’s status is updated in the system. Total elapsed time from discharge order to a patient being assigned the bed: 85 minutes — well over the industry’s roughly 60-minute goal, despite a clean that met the benchmark on its own.

The Staffing Math Behind a Demand-Aligned Model

The presenters worked through a staffing scenario to make a broader point: total labor hours are often sufficient to meet demand, but poorly timed. In their example, 25 discharge rooms clustered across an afternoon peak, at AHE’s 37.8-minute standard discharge clean, translate to roughly 15.75 hours of required EVS labor. A crew of six staffed evenly across the day has more than enough total hours to cover that — nearly 24 staff-hours — yet delays still occur at peak, because coverage isn’t concentrated where and when demand spikes.

The alternative the presenters proposed was four to five technicians dedicated specifically to the 1 p.m. to 4 p.m. discharge window, paired with a dispatcher who sequences rooms by priority rather than by habit. In that model, the same total labor produces no backlog and keeps every clean within standard. “Total hours are not the problem,” the presenters emphasized. “Timing is. Distribution is the fix.”

The session also flagged a structural constraint often overlooked in staffing plans: supervisor span of control. A supervisor managing more than roughly 12 staff, Sipp argued, cannot simultaneously dispatch rooms in real time and round the floor to validate readiness. AHE Exchange26 attendees were pointed toward an 8-to-1 or 10-to-1 ratio as more supportive of active throughput management.

Dispatch as a Dedicated Role, Not a Tool

A recurring theme of the session was that active dispatching is a staffing decision, not a technology purchase. A dedicated dispatcher — separate from the supervisor — continuously monitors open discharges, assigns rooms within about two minutes, prioritizes by clinical urgency (ED holds and direct admissions first, then ICU and critical-care units, surgical-impact rooms, high-demand medical-surgical units, and finally routine discharges), tracks staff location, updates room status after every clean, and serves as the connective tissue between EVS, nursing, and bed management.

Without that ownership, the presenters warned, a department risks running what amounts to a cleaning operation rather than a throughput strategy — technically compliant with cleaning standards, but still contributing to bed delays through gaps that occur entirely outside the cleaning process itself.

Case Study: Riverside Health’s Path from 93 to 58 Minutes

The session’s centerpiece was a case study from Manger-Weikel’s own system, Riverside Health, which tracked its discharge-to-clean turnaround from an October 2021–March 2022 baseline through a multi-phase transformation.

Riverside’s starting point was familiar to many departments in the room: a 93-minute average turnaround against a 60-minute goal, built on inconsistent unit-to-unit performance, staffing based on shift preference rather than discharge patterns, no consistent case prioritization, and no live visibility into room status — bed management, Manger-Weikel said, was reduced to calling EVS directly to check whether a room was ready.

The transformation unfolded in phases, and notably, it got harder before it got better. Turnaround initially rose to 96 minutes during the transition phase, as staff resistance to the new dispatch model set in — some staff described it as a loss of autonomy, and supervisor adoption was inconsistent, with some reverting to old habits under pressure. Leadership’s decision to stay the course publicly through that dip, paired with daily (rather than monthly) accountability and weekly joint meetings between EVS and nursing to rebuild trust, was credited with turning the trajectory around. By the adjustment phase, turnaround had dropped to 79 minutes; in the optimization phase, with all four pillars fully implemented, Riverside reached a sustained average of 58 minutes, with peak-hour performance holding between 45 and 50 minutes.

Phase	Avg. Turnaround	Note
Baseline (Phase 1)	93 min	No dispatch function; reactive staffing
Transition (Phase 2)	96 min	Change resistance temporarily worsened performance
Adjustments (Phase 3)	79 min	Leadership reinforcement takes hold
Optimization (Phase 4)	58 min	All systems fully implemented
Sustained (Phase 5)	58 min avg / 45–50 min peak	Held steady post-implementation

Riverside’s model rested on four pillars: staffing aligned to a mapped discharge curve rather than shift tradition; a dedicated dispatcher assigning rooms within two minutes and enforcing priority sequencing; a standardized workflow with a room-readiness checklist and supervisor validation before any room is released; and real-time communication, including EVS representation in bed-management huddles and a live, floor-visible dashboard rather than a static report.

The system-level effects extended beyond EVS’s own metrics, according to the case study: reduced emergency department boarding as beds returned to service faster, more throughput cycles per day without adding physical beds, improved surgical-schedule integrity as OR cases and direct admissions were no longer held waiting on rooms, and — notably — charge nurses reporting greater confidence in EVS’s reliability.

Tools Departments Can Apply Now

The session closed with a set of practical mechanisms any EVS department can adopt without significant capital investment.

The Daily Throughput Huddle

A five-minute, every-shift, no-exceptions huddle involving the EVS supervisor (who leads it), the dispatcher (who owns the day’s sequencing), a charge nurse or designee (who brings the discharge picture), and a bed management representative when available. The huddle works through five questions: What does today’s discharge volume look like? Do we have the right coverage? What are today’s priority rooms? What barriers need to be cleared? And what is our turnaround target for today?

A Reimagined Supervisor Role

The presenters described active throughput management as incompatible with a desk-bound supervisor. Instead, supervisors round hourly to catch rooms falling behind before they become a backlog, visually validate every completed clean before it’s released to bed management, take over dispatching directly when no dedicated dispatcher exists, coach in real time rather than waiting for a monthly review, and review turnaround data daily, sharing results transparently rather than holding them back.

A Four-Metric Dashboard

Rather than tracking everything, the session recommended narrowing to four measures: discharge-to-clean time (Riverside’s peak-hour target was 45–50 minutes); idle time between assignments (five minutes or less, since longer gaps signal a dispatch failure rather than a cleaning problem); room-readiness accuracy (95 percent or higher, meaning rooms are accepted on first inspection without re-cleans); and volume-versus-staffing ratio, tracked hourly to catch coverage gaps before they compound into a backlog. As Sipp put it: “If the dashboard isn’t visible to the floor, it isn’t a dashboard — it’s a report.”

Predictable Failure Modes — and How to Head Them Off

The presenters were candid that these models fail in recognizable, avoidable ways. Dispatch responsibilities added on top of a supervisor’s existing duties tend to lose out during peak hours, since dispatching is effectively a full-time cognitive task when volume is high. Supervisors under pressure often revert to old habits unless leadership visibly reinforces the new model at exactly the moments it’s hardest to maintain. Nursing notification has to be a two-way commitment — a dispatcher has nothing to sequence if EVS isn’t told about discharges in real time. And accountability reviewed monthly rather than daily, the presenters argued, represents roughly 30 missed coaching opportunities every month, allowing performance drift to become normalized before anyone notices it.

A 30-Day Starting Point

For departments looking to begin, the session laid out a three-phase, 30-day framework. In week one, departments should honestly measure their current discharge-to-clean time, map their discharge curve by hour and day, and determine whether dispatch ownership already exists on any shift. In weeks two and three, departments should designate dispatch ownership for each shift, align at least one shift’s staffing to the mapped discharge curve, and standardize the cleaning and readiness workflow in coordination with charge nurses. In week four, departments should launch the daily huddle using the five-question structure, make real-time room-status updates non-negotiable, and begin tracking discharge-to-clean time daily with a 30-day check-in scheduled from the start.

The Bottom Line

The session’s closing message was pointed: EVS does not own hospital throughput outright, but it controls one of its most consequential levers — how fast a bed returns to service. Riverside Health’s experience suggests that improvement doesn’t require new technology or additional headcount so much as a redistribution of existing labor, a named owner for real-time dispatch, and a discipline of daily — not monthly — accountability. As the presenters told attendees: “Start today. One shift. One week. Assign dispatch. Measure daily. The beds will move.”

Healthcare leaders have made the case that a clean room is only half the job — the other half is the human connection made while cleaning it.

What does “clean” actually mean to a patient? That question opened a session at this year’s AHE Exchange26 summit in New Orleans, presented by Veronica Gutierrez, director of environmental services for hospitality healthcare services at Onvida Health, and Heather Armour, Onvida’s administrative director of support services. Their answer, backed by several years of patient-experience and quality data from their Arizona-based health system, was that cleanliness is necessary but not sufficient — patients’ perception of their environment is shaped as much by whether they felt seen and cared for as by whether a surface was disinfected.

Gutierrez and Armour set out to show how environmental services staff, often the most frequent visitors to a patient’s room during a hospital stay, can become a deliberate part of the patient experience strategy rather than an invisible operational function.

The Gap Between Compliance and Perception

The session opened with a striking contrast drawn from Onvida’s own quality data. On paper, the department’s operational compliance metrics were strong throughout fiscal year 2026 — blacklight inspections, quality assurance audits, and director rounding scores consistently landed in the mid-to-high 90th percentile across categories ranging from operating rooms and patient rooms to equipment storage and stairwells.

Yet patient perception, tracked through the HCAHPS-linked “room kept clean during stay” measure, told a more volatile story: scores fluctuated between roughly 71 and 80 over an 18-month period, consistently above the presenters’ internal benchmark of 70.3 but far short of ceiling performance, and prone to unexplained dips even in months when audit compliance held steady. The presenters used this gap to make their central argument: inspection scores measure whether the work got done, but they don’t capture whether the patient felt it.

A clean room and a room a patient perceives as clean are not automatically the same thing.

From Compliance Culture to a Behavior Framework

To close that gap, Onvida built its approach around a system-wide behavioral framework the presenters referred to as “HWways Behaviors” — five expected behaviors applied consistently across every department and every patient interaction: a friendly greeting, purposeful communication, follow-through, championing others, and an attitude of gratitude. Layered onto that foundation is AIDET, a widely used five-step patient-communication framework — Acknowledge, Introduce, Duration, Explanation, Thank You — that gives EVS staff, like every other patient-facing role in the system, a consistent script for a room encounter: greet the patient by name, introduce themselves and their role, give an honest sense of how long the cleaning will take, explain what they’re doing, and thank the patient and any family present.

Layered on top of these system-wide frameworks, the presenters introduced a narrower, EVS-specific concept they called “moments that matter”: brief, intentional connections with patients, families, or visitors that help someone feel seen, heard, and cared for — interactions built on empathy, trust, and reassurance rather than task completion alone.

Three Operating Principles

Gutierrez and Armour organized their department’s approach to these moments around three operating principles: be visible, be intentional, and take action. In practice, that translated into four specific behavioral commitments built into daily EVS operations.

1. Be Present

Room assignments and scheduling are deliberately structured to allow time for genuine connection during a cleaning visit, rather than treating each room as a task to complete as quickly as possible.

2. Stay Connected

EVS staff perform intentional refresh visits in the emergency department and conduct deliberate rounding on hospital day two and again for any patient whose length of stay exceeds ten days — recognizing that a patient’s relationship with their environment changes the longer they remain in the hospital.

3. Make the Invisible Visible

Much of EVS’s work happens when patients aren’t watching. To surface that effort, Onvida uses simple tools like a bedside card identifying the staff member who cleaned the room by name, along with a direct extension patients can call with concerns — turning an anonymous service into a personal one and giving patients a low-friction way to raise an issue before it becomes a complaint.

4. Listen Before Discharge

Rather than waiting for a post-discharge survey to learn how a patient felt about their environment, Onvida built a nine-question verbal patient survey tool — covering both environment (room and bathroom cleanliness, public-area upkeep, working equipment) and service (staff appearance, courtesy, responsiveness, linen quality, overall satisfaction) — administered face-to-face on day two and day ten of a stay. The presenters were explicit about the intent behind the tool: it’s meant to open a bedside conversation, not simply collect a score, and any concern it surfaces is meant to trigger service recovery and, where warranted, staff recognition, while the patient is still in-house and something can still be done about it.

What Moved — and What the Data Still Shows

The presenters shared several data views suggesting the framework has had a measurable, if not perfectly linear, effect. Their HCAHPS “room kept clean” trend showed a substantial early climb — from a 73.5 baseline average to roughly 78–79 through the mid-period of the tracking window — before settling into a narrower band in the high-70s. A separate view comparing inpatient discharge-to-clean turnaround time against the same HCAHPS measure suggested the two move somewhat independently: turnaround times drifted upward into the 70-minute range in the most recent months shown even as perception scores held relatively steady, a reminder that speed and perceived quality are related but distinct levers.

Longer-term CMS Care Compare star-rating data presented in the session showed the hospital’s overall quality score climbing from two stars in 2017 to a sustained four-star rating in recent years, with the presenters noting that this broader quality trajectory has occurred alongside — and could not be attributed to any single cause, including — the environmental services team’s cleanliness-related work over the same period.

Metric	What It Tracks	Recent Trend Shown
Blacklight & QA Inspections	Objective compliance with cleaning standards	Consistently in the mid-to-high 90s across most categories, FY2026
HCAHPS: Room Kept Clean	Patient-reported perception of cleanliness	Volatile, mid-70s to low-80s; above internal benchmark of 70.3
Inpatient Turnaround Time	Time from room marked dirty to marked clean	Fluctuating in the 55–70 minute range over the tracked period
CMS Care Compare Star Rating	Overall hospital quality, one of several inputs	Risen from 2 stars (2017) to a sustained 4 stars in recent years

Recognition as Part of the System

The presenters closed with an example meant to illustrate the culture they were describing rather than a metric on a dashboard: an EVS staff member, identified as Maria Avila, found a gold wedding ring while cleaning a pre-operative room and immediately turned it in, allowing it to be returned to a patient who had worn it for sixty years of marriage. The presenters used the story, along with several handwritten thank-you notes shared from patients and families praising specific housekeeping staff by name, to argue that recognizing this kind of behavior publicly — through internal channels like a recurring “Weekly Dose” recognition feature — reinforces the same behavior across the department rather than treating it as an isolated act of individual character.

The through-line of the session, as the presenters framed it, was that environmental services staff are often the most frequent, and sometimes the most trusted, presence in a patient’s room over the course of a stay — more so than physicians, and often more than nursing, simply by volume of visits. Treating those visits purely as a cleaning task, they argued, wastes an opportunity that is otherwise built into the job by default.

The Takeaway

Onvida’s session offered a relatively low-cost model for other EVS departments: it did not rely on new technology, additional headcount, or capital investment, but on a defined behavioral framework, a handful of specific rounding and communication practices tied to length of stay, a short in-person survey tool timed to allow for service recovery before discharge, and a consistent practice of surfacing and recognizing the moments staff already create. As the session’s closing slide put it, distilling the argument to a single line: every interaction is an opportunity to create a moment that matters.

Session: “Beyond Clean: Moments that Matter,” presented by Veronica Gutierrez, T-CHEST, T-CSCT, CMIP, CMEL (Hospitality Healthcare Services | Onvida Health) and Heather Armour, MSN, RN, CPHQ (Onvida Health), at AHE Exchange26, the AHE Education & Solution Summit, New Orleans, August 16–19, 2026.

A recurring line ran through a technical session at this year’s AHE Exchange26 summit in New Orleans: buying an EPA-registered disinfectant is the easy part. Getting that product to perform as registered, once it’s diluted, applied, and wiped across a real patient room, is where things quietly go wrong. The session, presented from three angles — Ron Sample, an EVS-side technical support specialist and T-CHEST credential holder; Dr. Mark Wiencek, a principal microbiologist; and Dr. Keri Lestage, a technical service manager and certified infection preventionist (CIC) — worked through the regulatory, chemical, and practical failure points that separate a correctly labeled product from an effective one.

Cleaning, Sanitizing, and Disinfecting Are Not the Same Regulatory Category

The session opened by re-establishing a distinction the presenters said is frequently blurred in practice. Cleaning — the physical removal of dirt and organic matter with soap or detergent — is not regulated by the EPA for efficacy claims at all. Sanitizing and disinfecting, by contrast, are regulated as pesticides under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA), meaning every claim on the label has been tested and verified. A sanitizer is generally expected to achieve a 99.9 percent (3-log) reduction in bacteria and is not intended to address fungi or viruses; a disinfectant is expected to achieve a 99.99 to 99.9999 percent (4- to 6-log) reduction against bacteria, fungi, and viruses. The practical implication, the presenters stressed, is that a product’s category is not cosmetic — it determines what claims can legally be made about what the product actually kills.

Eight Things to Find on Every Label

Because the label is the legal instrument governing use, the session walked through eight specific elements every EVS worker, infection preventionist, and microbiologist should be able to locate on any disinfectant container: the product name and EPA registration number; the active ingredient or ingredients and their concentrations; whether the product is ready-to-use or a concentrate requiring dilution; whether it’s a one-step or two-step product; the approved use sites and surfaces; the organisms covered and their associated contact times (which can vary significantly by pathogen); the precautionary statements covering hazards, personal protective equipment, first aid, and disposal; and the expiration or lot date — found on the original container or looked up via a certificate of analysis by lot number if unlisted, in which case the default is one year from manufacture.

The Centers for Disease Control’s Project Firstline initiative maintains a widely used infographic walking through this exact checklist, which the presenters pointed attendees toward as a shareable staff reference.

The Math Behind the Percentage on the Bottle

One of the session’s more granular technical points concerned the difference between the percentage printed on a concentrate’s label and the percentage of active ingredient actually present once that concentrate is diluted for use — a distinction the presenters said is a frequent source of confusion on the floor.

The conversion is straightforward once stated plainly: multiplying a percentage by 10,000 yields its equivalent in parts per million, so a 0.1 percent concentration equals 1,000 ppm, a typical use-dilution strength for many quaternary ammonium (“quat”) products. But that percentage on the label refers to the concentrate, not the diluted solution used on a surface. In a worked example from the session, a hypothetical product called “Germicide Plus” listed four separate quaternary ammonium active ingredients totaling 22.24 percent of the concentrate. Diluted at a common 1:256 ratio (roughly half an ounce per gallon), that 22.24 percent becomes approximately 0.087 percent, or about 870 ppm of total active quat in the working solution — within the effective disinfection range for bacteria, but a very different number from what’s printed on the jug.

More is not necessarily better: over-concentrating a disinfectant increases the risk of surface damage, skin irritation, and wasted product, without a corresponding gain in efficacy once the labeled effective range has been reached.

One Product, Many Different Rules

Using the same “Germicide Plus” example, the session illustrated a point that trips up many facilities: a single EPA master label can specify different dilution ratios and different contact times depending on which organism is being targeted. In the label reviewed during the session, the same product required a 1:256 dilution and a 15-second contact time to function as a general-use sanitizer, a 1:256 dilution with a 1-minute contact time against enveloped viruses like influenza and SARS-CoV-2, a 1:256 dilution with a 3-minute contact time for general disinfection against most bacteria, a 1:128 dilution (double the concentration) with a 5-minute contact time against norovirus and other non-enveloped viruses, and a 1:64 dilution (quadruple the concentration) with a full 10-minute contact time against adenovirus and Legionella pneumophila.

The presenters’ point: using one product correctly against C. difficile spores or Candida auris does not mean it’s being used correctly against a norovirus outbreak in the same building, if staff default to a single familiar dilution and contact time regardless of the pathogen in question.

One-Step vs. Two-Step: The Pre-Cleaning Question

A one-step disinfectant has been tested and validated in the presence of a 5 percent organic soil load, meaning it can clean and disinfect in a single application on a visibly clean surface without a separate pre-cleaning step. A two-step product requires cleaning with a detergent first to remove all visible and non-visible soil, followed by a separate disinfection step on the now-clean surface. The session noted that some hypochlorous acid formulations and diluted bleach solutions without a surfactant fall into the two-step category, and are the appropriate choice for heavy soil, known outbreaks, or C. difficile isolation rooms — while emphasizing that using a two-step product as though it were one-step, by skipping the pre-clean, undermines the product’s tested efficacy regardless of how the label reads elsewhere.

Wet Contact Time: The Clock Only Runs While the Surface Is Wet

Perhaps the most operationally significant point in the session concerned contact time — sometimes called dwell time or kill time. The core rule: the surface must remain visibly wet for the entire labeled contact time, and if it dries before that time elapses, the surface must be re-wetted; wiping a surface dry immediately after application does not count toward contact time, regardless of how long the product technically sat on the surface beforehand. EPA-registered products generally cap contact times at ten minutes.

The session illustrated the stakes numerically, starting from a hypothetical surface carrying one million microorganisms: meeting the full wet contact time reduces that population by 99.9999 percent, leaving roughly one organism behind; wiping the surface dry immediately, before the labeled time elapses, leaves an estimated 50 to 90 percent of the original population intact — over 100,000 organisms; and applying no product at all obviously leaves the full population untouched. The presenters’ practical takeaways: drier rooms mean shorter effective wet time and require closer attention; “wet” means visibly wet, not merely undisturbed; visible dirt should be cleaned before disinfecting; and staff should know their specific product’s contact time requirements rather than assuming a single standard time applies across products.

Three Different Expiration Clocks

The session identified three distinct “clocks” governing disinfectant potency, each requiring separate tracking: shelf life, which applies to an unopened container and typically runs one to three years, with staff instructed to check and prominently mark the expiration date and never use an expired product; use-dilution life, which begins once a concentrate is mixed and can range from 24 hours to 90 days depending on the product, requiring the mixed bottle to be labeled with the date and discarded on schedule unless the label specifies otherwise; and use life, which applies once a solution is added to a working container such as a bucket or spray bottle, generally lasting only a single shift or 24 hours, with the open date and time written on the container and old solution never topped off with fresh product rather than fully replaced. The presenters were explicit that a product’s printed expiration date governs only the original, unopened container — it does not extend to diluted solution sitting in a bucket or spray bottle, where a new clock starts the moment the product is mixed or opened.

Clock	Applies To	Typical Duration
Shelf Life	Unopened original container	1–3 years
Use-Dilution Life	Concentrate after mixing	24 hours – 90 days
Use Life	Solution once added to a working container	1 shift / 24 hours

How Wipes, Mops, and Buckets Quietly Sabotage Disinfection

The session’s most sobering data point came from a citation to Cadnum and colleagues, published in Infection Control & Hospital Epidemiology (ICHE 45.11, 2024), which tested 80 in-use disinfectant solutions found in mop buckets and wiper containers actually deployed in healthcare facilities. Only 61 percent were found to be the correct product at the correct concentration. Sixteen percent were diluted too far to be effective; 18 percent were essentially water, with no measurable disinfectant activity; and 5 percent turned out to be an entirely different chemical than intended. In total, the study found that 39 percent of real-world samples — nearly four in ten cleaning events — were not performing as intended.

The session connected this finding to a specific chemistry problem: quaternary ammonium compounds carry a positive charge, which is precisely what allows them to disrupt the negatively charged membranes of target microorganisms. But that same positive charge is attracted to any negatively charged surface, including cotton and rayon fibers, dirt, and organic soil. If a quat-based disinfectant contacts a cotton or rayon wiper — or a dirty mop bucket — before it ever reaches the target surface, the active ingredient can bind to the fabric or debris instead, becoming chemically trapped and unable to kill anything, even though the surface may look and feel adequately treated. Dirty mop buckets compound the problem over the course of a shift, as accumulating residue and biofilm compete with target organisms for a shrinking pool of active disinfectant — meaning, as the presenters noted, that the last room mopped in a bucket often receives the weakest solution of the day. Separately, leftover anionic (negatively charged) laundry detergent residue on microfiber towels and mops can chemically neutralize quat activity outright. Hypochlorous acid solutions carry a different vulnerability: the chemistry is highly reactive and begins degrading relatively quickly once generated by an electrolytic on-site generator, making shelf-stable storage assumptions risky for that product category specifically.

Verifying Concentration on the Floor

The session offered three practical methods for confirming a working solution is at the correct strength. The simplest is a look-and-smell check — an off odor, unexpected color, or unusual sudsing is reason enough not to use a solution. The more rigorous method is test-strip verification: dipping a strip into the solution as expressed from the actual applicator (not from the source container) for the time specified on the strip’s own label, typically one to ten seconds, removing it immediately, and comparing the wet pad to a reference color chart within about five seconds, since strips can also expire and should be checked against their own lot dates. The presenters also recommended a “trust but verify” posture toward automated dispensing equipment — even a properly functioning dispensing system merits a periodic, at minimum weekly, spot-check with a test strip.

The session added that a wiper’s own behavior can itself be diagnostic: a wipe that dries out too quickly suggests insufficient product; one that’s dripping wet suggests an overly concentrated or wasteful application; an unusual odor can signal an over-concentrated, incorrect, or contaminated product; and a wipe that wets out and stays evenly damp is the target behavior, consistent with proper contact time.

Case Study: Two Outbreaks, One EVS Team

The session closed with a discussion scenario built to force the three perspectives into direct conversation. An acute care facility identifies three cases of carbapenem-resistant Enterobacteriaceae (CRE) within the same medical unit over ten days; infection prevention places affected patients on contact precautions and asks EVS to intensify cleaning. Simultaneously, an adjacent rehabilitation facility is managing a recurring C. difficile outbreak. EVS at both sites relies on quaternary ammonium and bleach-based products.

From the EVS perspective, the presenters noted the team was already cleaning to protocol and had recently switched to a five-minute bleach contact time at the rehab facility for C. difficile — raising the question of whether the same switch was warranted for the CRE unit. A review of solutions actually squeezed from in-use microfiber towels, however, found both the quat and bleach solutions running at only half their target concentration — echoing the Cadnum findings directly — prompting a shift from a soak-and-wipe method to a dip-and-wipe method and a trial of disposable wipes and mop heads borrowed from the operating room.

The microbiology perspective clarified that CRE, a gram-negative bacterium, is resistant to antibiotics but not inherently resistant to properly used disinfectants, meaning the existing quat and its labeled contact time should be adequate against it if actually delivered at full strength; that properly diluted, stored, and applied bleach should be effective against C. difficile spores on surfaces; that both organisms can persist in water, warranting attention to sinks and sink drains in affected units; and that C. difficile spores transfer easily via hands and shoes, making hand hygiene, proper doffing sequence, and cleaning from cleanest to dirtiest areas relevant alongside any product change.

The infection prevention perspective raised a different set of questions: whether the underlying problem was actually a disinfectant limitation or a protocol and technique issue, given that the in-use quat product already carried a CRE claim on its label; whether increasing concentration and contact time made sense as a first response; a preference to avoid switching to bleach for the CRE unit specifically if avoidable, citing odor and material corrosion concerns; and a suggestion to extend the operating room’s disposable wipe and mop-pad practice into the affected units, with reevaluation once the outbreaks resolved.

The scenario was left open-ended for audience discussion rather than resolved with a single correct answer — reflecting, the presenters noted, how outbreak response typically unfolds in practice: as a negotiation between microbiological fact, product chemistry, and the practical realities of what a cleaning team can consistently execute on the floor.

Resources Cited

• EPA Product Performance Labels (PPLS) database, for looking up master labels by registration number: ordspub.epa.gov/ords/pesticides/f?p=PPLS:1
• CDC Project Firstline, “How to Read a Disinfectant Label” infographic
• EPA List K: products registered as effective against Clostridioides difficile spores
• EPA List P: products registered as effective against Candida auris
• APIC Text, Environmental Hygiene & Infection Prevention chapters
• Cadnum, J.L., et al., Infection Control & Hospital Epidemiology 45.11 (2024) — in-use disinfectant concentration testing

The Bottom Line

The session’s throughline was that disinfectant efficacy is not a property of the product alone — it is the product interacting correctly with dilution, contact time, surface soil, and the physical applicator carrying it. A correctly registered, correctly labeled disinfectant can still fail in practice if it’s diluted incorrectly, wiped dry before its contact time elapses, delivered through a wiper that binds its active ingredient, or left in a bucket well past its use life. As the session’s closing message put it: clean counts most — but only when everything upstream of the wipe actually happened as the label assumes it did.

Session: “What YOU Can Do to Ensure Your Disinfectants Are Effective,” presented by Ron Sample, T-CHEST (EVS Perspective, Executive Technical Support); Dr. Mark Wiencek, PhD (Microbiology Perspective, Principal Microbiologist); and Dr. Keri Lestage, CIC (Infection Prevention Perspective, Technical Service Manager), at AHE Exchange26, the AHE Education & Solution Summit, New Orleans, Tuesday, August 18, 2026.

Most conversations about integrating EVS into facility design rely on anecdote and instinct. A session at AHE’s Exchange26 Education & Solution Summit in New Orleans offered something harder to dismiss: data. Calvin Clawson, interior design program manager for the Veterans Health Administration, and Gary McCarthy, VHA’s healthcare sanitation program manager, presented findings from 16 completed Environmental Programs Service (EPS) site reviews conducted across fiscal years 2024 and 2025 — a structured look at how the exclusion of EVS from planning and design decisions plays out, concretely, across one of the largest integrated health systems in the world.

EVS as a Design Stakeholder, Not a Downstream Service

The session’s organizing argument was direct: Environmental Services is not a downstream service that shows up after a building is finished — it is an operational stakeholder in planning, design, construction, activation, and long-term facility sustainment. Decisions made during project development, the presenters argued, directly influence cleanability, maintainability, workflow efficiency, staffing needs, and operational readiness. Operational insight is most valuable when it shapes decisions before they harden into permanent constraints — a fact that is easy to state and, as the data showed, consistently difficult to operationalize.

That influence runs across four domains. Materials and finishes determine chemical compatibility, cleaning frequency, and long-term maintenance requirements. Space and infrastructure planning determine whether support rooms, storage, and utilities can actually support the service model. Workflow and adjacency decisions determine circulation and the separation of clean and soiled processes. And staffing and activation readiness determine whether training, workload assumptions, and equipment are aligned with what the finished space will actually require.

What Happens When EVS Is Left Out

When EVS is excluded, the presenters noted, the resulting problems rarely show up as isolated incidents — they surface later as a recognizable pattern: materials selected without review of chemical compatibility or maintenance demands; housekeeping closets, linen areas, and equipment rooms omitted, undersized, or poorly located; workflow barriers built directly into room layout and circulation; and staffing, training, and equipment needs addressed too late, creating readiness gaps right at occupancy.

The Data: 16 Site Reviews, 10 Recurring Categories

To move past anecdote, VHA’s Environmental Programs Service analyzed 16 completed site and program review reports across healthcare sanitation, Central Equipment/Occupied Cleaning (CEOC), integrated pest management, textile care, waste and recycling, and interior design. The analysis focused on material and finish degradation, chemical compatibility, infrastructure and storage design, standard operating procedures, training, and product procurement.

The results were striking in their consistency. Across ten major finding categories, the percentage of facilities found non-compliant ranged from 56% to 88%:

– Program collaboration and communication: 42 findings, affecting 14 of 16 facilities (88% non-compliant)

– Chemical compatibility and finish integrity: 39 findings, 13 facilities (81%)

– Training and competency deficiencies: 33 findings, 13 facilities (81%)

– Space and infrastructure deficiencies: 28 findings, 12 facilities (75%)

– Policy and SOP gaps: 27 findings, 12 facilities (75%)

– CEOC deficiencies: 23 findings, 11 facilities (69%)

– Equipment and supply limitations: 21 findings, 10 facilities (63%)

– Failure to use required chemicals: 19 findings, 10 facilities (63%)

– Procurement and contract oversight: 16 findings, 9 facilities (56%)

– Missing instructions for use: 14 findings, 9 facilities (56%)

Communication and collaboration gaps between EVS and planning, design, and facilities teams topped the list, appearing in nearly nine of every ten facilities reviewed — a signal that the other nine categories are, in large part, downstream consequences of that first one.

Recurring Themes: Where the Failures Actually Show Up

Chemical utilization and application: Incorrect chemical selection combined with material incompatibility was shown to lead to surface delamination, flooring degradation, and discoloration, with chemical buildup making routine cleaning progressively harder and less effective. Mandatory-chemical non-compliance was found to introduce residential-grade, highly caustic products into inventories that are often ineffective against the pathogens they’re meant to control. In a detail that speaks directly to design decisions made without EVS input, the application of wax or surface finish coatings to flooring that doesn’t require them was found to increase labor costs, complicate routine cleaning, and jeopardize manufacturer warranties — a maintenance burden built into the building before it ever opens.

Supply and equipment gaps: Reviews found a recurring lack of proper floor-care equipment — carpet extractors, stripping and buffing pads, microfiber systems — that made proper floor maintenance impossible regardless of staff diligence. Absent preventive maintenance and lifecycle management programs contributed to increased equipment downtime and accelerated failure, while improper use of supplies and equipment created cross-contamination risks that undermined sanitation and infection prevention protocols directly.

Space and infrastructure deficiencies: This is where the design connection is most visible. Housekeeping closets were found to be missing, undersized, or poorly located relative to the areas they serve, and in some cases, not planned with the plumbing infrastructure required for chemical mixing and dispensing at all. Linen storage rooms often lacked adequate storage units and transport carts, and undersized linen rooms were tied directly to shortages in critical clinical areas. Clean and soiled storage spaces were sometimes inadequately signed or identified, creating confusion about intended use and raising the risk of occupational exposure, while unsecured linen distribution rooms compromised the integrity of clean linen through unauthorized access.

Communication gaps: The reviews traced a clear causal chain: when EVS is excluded from space planning, insufficient space and inadequate storage directly affect service delivery. When EVS isn’t consulted on material and finish selection, the result is inappropriate care requirements and premature finish failure, occurring both during initial project design and later, when replacement products are introduced without EVS review. Interior designers and planning teams, in turn, are often not informed of EVS product types or equipment limitations, leading to specification of materials that EVS staff cannot properly maintain. The pattern extends to staffing: adjustments to EVS staffing needs are often not considered during design, construction, or space realignment, producing shortages in newly activated spaces from day one. And facility-level EVS training programs were found to sometimes misalign with VHA standards of practice entirely, leaving technicians working from incomplete or inaccurate guidance.

Why the Failures Are Preventable

The presenters framed these outcomes as preventable, not inevitable, tracing four system-level root causes: EVS excluded from governance and decision-making, with input either not formally required or requested too late to matter; no formal EVS design criteria or review standard, leaving projects to rely on ad hoc feedback instead of defined requirements; operational readiness starting too late, with SOPs, staffing impacts, training, and equipment planning discovered near occupancy rather than built into the plan; and no post-occupancy feedback loop, meaning lessons from activation and early operations are never captured, so the same planning and design problems recur across projects.

A Governance Model for EVS Integration

To correct that pattern, the session proposed a four-stage governance model mapped to the project lifecycle. In the plan phase, EVS defines operational requirements, support-space needs, and staffing assumptions. In design, EVS reviews finishes, cleanability, chemical compatibility, space allocations, and plumbing and electrical requirements. In construction, EVS participates in mock-ups, punch walks, activation planning, and turnover training. And once the space is occupied, EVS validates SOPs, training, competencies, par levels, and ongoing quality monitoring.

The engagement framework behind that model is specific: establish EVS as a required stakeholder at every project kickoff; create a formal EVS design criteria document defining requirements for materials, cleanability, chemicals, equipment, and support spaces before design decisions are finalized; require EVS review at schematic design, design development, and 100% construction documents; use mock-ups and field validation to test cleanability under real-world conditions rather than only in plan view; link activation planning to SOP updates, staff training, and stocking plans so a space opens with genuine operational readiness rather than mere construction completion; and perform a post-occupancy review at 30 to 90 days to capture design gaps and workflow barriers before they get built into the next project.

A Working Checklist

The session closed with a detailed checklist organized around the same four domains, offered as a practical tool for project teams. On materials and finishes: are they compatible with approved cleaners, disinfectants, and required dwell times; has EVS reviewed manufacturer care instructions before specification is approved; will the finish tolerate the routine, scheduled, and terminal cleaning frequencies the space actually requires; and has unnecessary variation in finish types been minimized to reduce chemical complexity and misuse risk? On space and infrastructure: are housekeeping closets sized and located correctly, with the plumbing needed for chemical mixing and dispensing; is there adequate space for carts, equipment, and safe segregation of clean and soiled items; and are support rooms positioned to reduce travel time and improve response? On workflow: can staff access high- and low-touch surfaces without moving excessive furniture; are clean and soiled flows separated to reduce cross-contamination; and are service areas adjacent to what they support? And on staffing: has EVS evaluated staffing impact using room type, risk level, and task frequency; do project assumptions account for occupied cleaning, discharge and terminal cleaning, and specialty space demands; and has activation planning included SOP updates, training, and competency validation before occupancy begins?

The Bottom Line

The presenters closed by reframing EVS’s role in blunt terms: it is not a downstream service, but an operational stakeholder whose input influences safety, maintainability, staffing, and long-term facility performance. When that stakeholder is excluded from planning and design, the VHA data suggests the resulting risks aren’t occasional; they’re close to the norm, showing up in the large majority of facilities reviewed, across materials, infrastructure, training, and readiness alike. Early, structured, and formally required EVS engagement, not simply an invitation to the conversation, but governance built into every phase from plan through occupancy, was presented as the difference between a healthcare environment that can be sustained as designed and one that starts accumulating avoidable risk and cost from the day it opens.

This article is based on the AHE Exchange26 Education & Solution Summit session “Building Smarter Together: The Role of Environmental Services in Facility Planning, Design, and Environmental Sustainment,” presented August 18, 2026, in New Orleans by Calvin Clawson (Interior Design Program Manager, Veterans Health Administration) and Gary McCarthy (Healthcare Sanitation Program Manager, Veterans Health Administration). The views expressed in the original presentation are those of the presenters and do not necessarily reflect the official policy or position of the U.S. Department of Veterans Affairs or the Veterans Health Administration.

Antimicrobial resistance (AMR) is no longer a looming threat that infection preventionists whisper about at conferences — it has arrived, and it is reshaping how healthcare facilities must think about environmental hygiene. That was the central message of a session delivered at this year’s AHE Education & Solution Summit (Exchange26) by Doe Kley, RN, MPH, T-CHEST, LTC-CIP, CIC, an infection prevention fellow in Clinical and Scientific Affairs at Clorox. Kley, a dual-board certified infection preventionist with 25 years of acute-care experience at systems including Intermountain Healthcare and Kaiser Permanente, used the session to make a case that environmental services (EVS) professionals are not bystanders in the fight against resistant organisms — they are one of the last, most reliable lines of defense.

A Crisis That Has Already Arrived

Kley opened with a blunt framing borrowed from the CDC: the post-antimicrobial era isn’t coming, it’s here. The evidence backs up the alarm. Globally, AMR increased more than 40 percent between 2018 and 2023, and roughly one in six infections worldwide is now resistant to treatment. In the United States, AMR rose an average of 38 percent during the pandemic years, one in seven infections is resistant, and the toll is measured in both lives and dollars — an estimated 48,000 deaths and $5.7 billion in costs annually.

Compounding the problem is a stagnant drug pipeline. Only 22 new antibiotics have reached market in the past decade, far too few to keep pace with evolving resistance. As Kley put it, that scarcity is precisely why protecting the antibiotics already in use — largely by preventing infections in the first place — matters so much.

The math behind resistance is sobering on its own. Bacteria can replicate roughly every 20 minutes, giving resistance traits an extraordinarily fast track to spread through a population. Kley pointed to methicillin-resistant Staphylococcus aureus (MRSA) as the textbook example: methicillin became widely available in 1959, and resistant strains were already documented within a year.

How Resistance Actually Happens

Kley walked attendees through the underlying biology in plain terms. Every infection involves billions of bacteria, and a small number are naturally resistant to a given drug. When antibiotics wipe out the susceptible majority, those resistant survivors are free to multiply — and they don’t keep their advantage to themselves. Resistance genes can move between entirely unrelated bacterial species through three mechanisms: transduction (carried by viruses called phages), conjugation (direct transfer via plasmids), and transformation (uptake of genetic material released by dead or nearby cells).

Bacteria have several biological strategies for defeating antibiotics once exposed, Kley explained: producing enzymes that break the drug down (such as extended-spectrum beta-lactamases, or ESBLs), altering the molecular “lock” the antibiotic is designed to fit, or deploying efflux pumps that eject the drug from the cell — functioning, as Kley described it, much like a sump pump clearing water from a basement.

Healthcare settings, Kley noted, are uniquely suited to accelerate all of this. Four factors converge inside hospitals and long-term care facilities: heavy antibiotic use, a vulnerable patient population, frequent use of invasive devices, and abundant opportunities for transmission via hands, equipment, and surfaces. On any given day, half of hospitalized patients receive at least one antibiotic, and by some estimates at least 28 percent of that use is unnecessary or inappropriate. Healthcare-associated infections (HAIs) — which affect roughly 1 in 38 hospitalized patients — add another layer to the problem, since they are themselves typically treated with antimicrobials.

The result is a growing roster of multidrug-resistant organisms (MDROs) that the CDC has designated “urgent threats,” the highest alert category: carbapenem-resistant Acinetobacter (CRAB), Candida auris, Clostridioides difficile, carbapenem-resistant Enterobacteriaceae (CRE/CPOs), and drug-resistant Neisseria gonorrhoeae. Compared with susceptible infections, AMR infections are associated with substantially higher morbidity and mortality, longer hospital stays, and higher costs.

Clearing Up a Critical Misconception

One of the session’s most important points was also its simplest: antimicrobial resistance is not the same thing as disinfectant resistance, and confusing the two can lead EVS teams to doubt tools that still work perfectly well. Kley was emphatic that AMR is a property of the pathogen, not a reflection on the person or the product.

Antibiotics work by targeting a single, specific mechanism inside a cell, which is exactly why bacteria can evolve around them. Disinfectants operate differently, attacking microorganisms through multiple, non-specific mechanisms at once — destroying cell membranes, denaturing proteins, and inducing oxidative stress. A disinfectant with a validated kill claim against a susceptible strain of an organism will, in virtually all cases, kill the resistant strain just as effectively. True resistance to disinfectants remains uncommon. When disinfection fails in practice, the far more likely culprits are incorrect dilution, disinfectants left on surfaces for less than the labeled contact time, or inconsistent cleaning technique — not the germs outsmarting the chemistry.

Kley cited a multi-hospital evaluation of automated dilution-dispenser systems that underscored this point: none of the facilities studied reported routine monitoring of their dispensers, 9 of 10 hospitals had at least one system delivering lower-than-expected disinfectant concentrations, and roughly a quarter of all dispensers tested were under-dosing product. Her takeaway for EVS leaders was direct — dispensing equipment needs active oversight, and ready-to-use products can remove that variable altogether.

The Environment as a Transmission Pathway

Kley grounded the abstract science in data about what actually happens on hospital surfaces. In a study of five long-term care facilities, roughly 65 percent of resident rooms and 50 percent of common areas tested positive for at least one MDRO, with MRSA the most frequently detected. Separate research on rooms housing colonized patients found that surfaces can become recontaminated within just four hours of disinfection — with Candida auris detected on 20 percent of surfaces and other MDROs on up to 24 percent — raising the question of whether once-daily disinfection is sufficient in higher-risk areas.

Sinks and drains deserve particular attention, Kley said, because biofilms readily form in these moist environments, harbor communities of often drug-resistant bacteria, and can splash contaminated droplets several feet from the basin. One 2025 study found that 30 percent of sink drains tested positive for carbapenemase-producing organisms (CPOs). Her recommended safeguards: never dispose of liquid waste in handwashing sinks, keep supplies at least three feet from the splash zone, consider installing splash guards, and disinfect sinks and countertops at least daily.

Shared equipment is another weak point. Citing research on cleaning compliance for mobile and portable medical devices, Kley noted that only about 16 percent of such equipment was cleaned between patients, and 36 percent of the time it moved directly from one patient’s room into another’s. Her recurring message to clinical and EVS staff alike was a simple mantra: if you use it, you clean it.

The stakes of leaving any of this unaddressed are measurable. Research on room turnover has found that a patient admitted to a room previously occupied by someone colonized or infected with an MDRO — including CRE, VRE, MRSA, Acinetobacter, or Pseudomonas — faces 1.5 to 3.5 times the risk of acquiring that organism themselves.

Putting It Into Practice: A Scenario

To make the stakes concrete, Kley presented attendees with a discharge-cleaning scenario. A patient with a post-operative surgical site infection was found, on the day of discharge, to have a wound culture growing NDM-1 Klebsiella pneumoniae — a carbapenem-resistant organism. The patient had been in a private room but had not been placed on Contact Precautions. EVS staff were given two disinfectant options for the terminal clean: a dilutable quaternary ammonium compound with label claims covering 38 organisms and a five-minute contact time, or a ready-to-use disposable bleach wipe with claims covering 60 organisms — including Klebsiella pneumoniae specifically — and a 30-second contact time.

The quaternary ammonium option, Kley explained, carried no kill claim for the target pathogen, required a longer contact time, introduced the risk of dilution error, and relied on reusable cloths that could themselves become a transmission vector. The sporicidal, ready-to-use bleach wipe, by contrast, offered a broader spectrum of coverage, a documented claim against the specific organism in question, a much shorter contact time, no dilution risk, and disposable cloths requiring no reprocessing. In the scenario, choosing the sporicidal option meant the next patient admitted to that room was discharged three days later with no complications or HAIs; choosing the quaternary ammonium product resulted in that next patient acquiring the same resistant infection.

The lesson, Kley emphasized, isn’t that quaternary ammonium products are inherently inadequate — it’s that kill claims matter, and for a critical pathogen like CRE, the safest choice is the product validated against that specific organism, deployed correctly.

A Multimodal Defense, With EVS at the Center

Kley situated environmental cleaning and disinfection within the CDC’s broader multimodal framework for MDRO prevention, which also includes active surveillance, antimicrobial stewardship, standard and contact precautions, hand hygiene, staff education, and communication. She adapted the WHO’s “Five Moments for Hand Hygiene” specifically for EVS teams: clean hands upon entering a resident room and before donning gloves, upon leaving a room and after removing gloves, before touching clean items on a cleaning cart, between cleaning different resident rooms or bedspaces, and between dirty and clean tasks.

For known or suspected outbreaks involving urgent-threat organisms, Kley described an escalated response: dedicating cleaning personnel, increasing the frequency of high-touch surface cleaning, focusing attention on the patient zone, adding observation and auditing, reinforcing staff training, switching to a sporicidal product, replacing cloths more frequently, supervising cleaning directly, and, in severe cases, closing an affected unit for deep cleaning. She illustrated the potential impact with a real-world example: an ICU battling endemic carbapenem-resistant Acinetobacter baumannii (CRAB) that closed for three days for intensive cleaning with diluted sodium hypochlorite, disposable cloths, and ATP verification testing, reopening only once environmental cultures came back negative. New CRAB cases in that unit fell 96.5 percent in the following year.

Kley also pointed to published evidence that broad adoption of bleach-based disinfectants for all discharge cleans — not just those involving known C. difficile cases — reduced C. difficile contamination on surfaces in non-C. difficile rooms from 24 percent down to 5 percent. And she reminded attendees that the responsibility doesn’t stop at the patient room door: laboratory services, radiology, endoscopy, respiratory therapy, physical therapy, dialysis, and cardiology diagnostics are all ancillary departments where the same principles apply.

Key Takeaways

Kley closed the session with three points she asked attendees to carry back to their facilities:

1. The post-antimicrobial era is not a future scenario — it is the current reality, and healthcare settings actively amplify AMR.
2. Contaminated surfaces and inadequately cleaned shared equipment are active vehicles for spreading resistant organisms between patients.
3. Antimicrobial resistance is not the same thing as disinfectant resistance — properly selected and correctly used disinfectants continue to work.

For EVS professionals, the message was one of empowerment as much as urgency: the same surfaces that can silently transmit some of the most dangerous pathogens in modern medicine can also be the point where that transmission is stopped — provided the right product, the right technique, and the right level of institutional support are all in place.

Based on “UV Devices in the Healthcare Environment: Considerations EVS Professionals Should Know,” Part 2, presented August 18, 2026, at the AHE Exchange26 Education & Solution Summit in New Orleans by Julie E. Mangino, MD, FSHEA, FIDSA (Professor Emeritus, The Ohio State University); Sade Rolon, MBA, CHESP, CMIP, T-CHEST, T-CSCT (Regional Director of Operations, Sodexo); James E. Odom Jr., MBA, CHESP, CMIP, T-CHEST (Facilities Development & Operations, UConn Health); Liz Claverie, MS (VP of Strategic Regulatory Liaison); and Christopher Dugard, MS (FDA Division Director).

Ultraviolet-C disinfection has moved from a novelty adjunct to a mainstream conversation in environmental services departments across the country. But adopting the technology successfully — and understanding what the evidence actually says it can and cannot do — requires more than purchasing a device and adding it to the terminal cleaning checklist. The second installment of this AHE Exchange26 session paired a practical change-management framework for implementation with a rigorous tour of the clinical literature on UV-C and pulsed-xenon systems, offering EVS leaders a grounded picture of where this technology delivers value and where the evidence remains mixed.

Building the Case for Adoption: Kotter’s Eight Steps

Rather than treating UV-C adoption as a procurement decision, the presenters framed it as an organizational change initiative, applying John Kotter’s well-established eight-step model for leading change.

The first step is creating a sense of urgency — highlighting gaps in current infection control practice, emphasizing the patient safety risks of environmental contamination, and using an organization’s own healthcare-associated infection (HAI) data to build the business case internally. From there, successful programs build a guiding coalition that includes C-suite sponsorship, infection prevention leadership, IT, nursing, facilities, and AHE members, with clearly assigned roles across that cross-functional group.

A strategic vision needs to answer whether the initiative promotes a culture of safety that is consistent, reliable, and operationally sound, and whether it aligns with the organization’s compliance and quality goals — with defined success metrics established up front. Enlisting a “volunteer army” means engaging frontline staff early to help vet the technology, providing education on its benefits, and addressing concerns transparently to reduce resistance before it takes root.

Implementation itself requires removing barriers: training staff on device use, anticipating workflow disruption, and ensuring technical support is available when problems arise. Programs should generate short-term wins by piloting in select units chosen based on multidrug-resistant organism (MDRO) data, tracking infection incidence, establishing a regular review cadence with infection prevention partners, and celebrating early successes with stakeholders. Sustaining momentum means expanding to additional units strategically, continuously refining workflows, and monitoring performance data over time. Finally, making the change stick requires embedding UV disinfection into standard protocol, updating training and development plans, and ensuring the practice survives staff turnover and leadership changes.

Why the Room Matters: Acquisition Risk From Prior Occupants

The clinical rationale for investing in enhanced terminal disinfection rests on a body of evidence showing that the room itself — not just the patient — carries infection risk. An updated systematic review by Mitchell, McDonagh, and Dancer, published in Infection, Disease and Health in 2023, pooled data from eleven studies spanning cohort designs and one randomized controlled trial across VRE, MRSA, ESBL-producing gram-negative organisms, A. baumannii, C. difficile, and norovirus. The pooled odds ratio for pathogen acquisition from a prior room occupant across all organisms was 2.45 (95% CI, 1.53–3.93) — and the presenters noted this represents an increase in likelihood compared with the risk estimated in a similar review conducted in 2015. That trend, they argued, supports continued investment and research into cleaning services within healthcare facilities.

The Foundational UV-C Studies

Several landmark studies anchored the session’s review of the evidence.

Anderson et al., ICHE, May 2013 assessed a Tru-D UV-C device’s effectiveness at reducing environmental contamination with VRE, C. difficile, and Acinetobacter across 39 rooms in two tertiary care hospitals, sampling surfaces before standard cleaning and again after UV-C treatment. The device produced greater than 90% reductions in colony-forming units for all three organisms, with over a 1-log reduction at each site — cutting VRE counts from 712 to 15 CFU, C. difficile from 724 to 51, and Acinetobacter from 52 to 1. The device performed effectively in both direct and indirect line of sight, supporting its use as an adjunct to standard cleaning, particularly in rooms vacated by patients with known infections.

Boyce and Donskey’s 2019 primer in ICHE examined how UV-C dose actually reaches surfaces in real patient rooms, using radiometer measurements alongside log10 reductions in MRSA and C. difficile spores during five-minute cycles from a mobile device placed in various room locations. The results illustrated a dramatic drop-off in delivered dose with distance, surface orientation, and shading: a vertical surface in direct line of the device at 1.3 meters (about 4 feet) received a dose of 1000 mW·sec/cm², while a horizontal surface in a shaded area at 3.3 meters (about 10 feet) received only 3–10 mW/cm². C. difficile spores proved particularly resistant to UV-C, especially in shaded, distant, or poorly oriented locations — a finding with direct implications for how devices should be positioned and how many cycles a room may need. The presenters noted several practical mitigations: running two cycles and repositioning the device, using systems with three vertical towers positioned in different locations to reduce shadowing, running longer cycles for shadowed areas, and applying UV-reflective paint to increase delivered dose.

The same 2019 paper catalogued just how much methodological variability exists across the underlying dose-response literature — inoculum preparation, inoculum size, dispersal method, exposure conditions, carrier material, organic load, pathogen strain, spore formation, humidity, temperature, and recovery method all differ substantially from study to study, complicating any simple answer to “how much UV-C is enough.” As a general benchmark, since high-touch surfaces in patient rooms are typically contaminated with fewer than 100 CFU per sample, the presenters suggested UV-C doses should aim for at least a 3-log10 reduction.

The Multicenter Trials: Mixed and Nuanced Results

The BETR Disinfection study (Anderson et al., Lancet Infectious Diseases, 2017) remains the largest and most rigorously designed trial in this space — a cluster-randomized, multicenter crossover trial conducted across nine hospitals in the southeastern United States (tertiary, community, and VA settings) between April 2012 and July 2014. Each hospital rotated through four disinfection strategies over four seven-month periods: standard quaternary ammonium cleaning, bleach for C. difficile rooms, standard cleaning plus UV-C, and bleach plus UV-C. Rooms targeted were those vacated by patients with MRSA, VRE, multidrug-resistant Acinetobacter, or C. difficile, with more than 31,000 patients exposed to rooms vacated by colonized or infected patients.

Adding UV-C to standard disinfection significantly reduced surface contamination and the incidence of target organisms by roughly 30% — including VRE and MRSA — along with a reduction in patient-level infection. Notably, adding UV-C to bleach produced no additional benefit over bleach alone, a finding the presenters flagged as unresolved: possible explanations include UV-C’s known limitations with shadowing and spore resistance, incomplete (about 90%) EVS adherence to protocol, or the positioning of devices relative to the bathroom. EVS staff in the trial cleaned high-touch surfaces thoroughly, and while room cleaning times increased slightly with UV-C, the added burden — roughly 10 to 20 extra minutes per room — did not disrupt hospital operations or patient flow.

A secondary analysis of the same trial (Anderson et al., Lancet Infectious Diseases, 2018) examined hospital-wide, not just room-level, effects across roughly 272,000 patients. The decrease in risk during UV-C study periods was driven primarily by reductions in hospital-wide C. difficile incidence (from 9 to 8 hospital-acquired cases per 10,000 patient-days) and VRE. Interestingly, EVS used UV-C 21,844 times during the study, but only 30% of those uses were in the “seed rooms” that technically qualified under the protocol — the remainder were applied to other contact-isolation rooms, remote infections, or other organisms. The authors concluded that enhanced UV disinfection can have both a direct protective effect on the next patient admitted to a treated room and an indirect benefit — via reduced C. difficile and VRE transmission — for other patients throughout the hospital.

Not every study found a benefit. A quasi-experimental study by Steele et al. (American Journal of Infection Control, 2021) compared a pediatric hematology/oncology unit, where UV-C was added to post-discharge cleaning, against a PICU control unit over 42 months (January 2015–June 2018 pre-intervention; August 2018–January 2020 post-intervention). Of 2,857 eligible heme/onc discharge rooms, UV-C was performed in 73% (2,080); in the control PICU, only 6% of discharges incidentally received UV-C. The intervention unit showed a decrease in hospital-onset C. difficile incidence density that approached but did not reach conventional statistical significance (p=0.06). The authors cautioned that this was a small, single-center sample, and that a cluster of other infection-prevention interventions — visitor restrictions and C. difficile diagnostic stewardship changes made around 2013 — remained in place without change throughout the study period, alongside a six-month expansion of the heme/onc unit itself.

A study by Rock et al. (Clinical Infectious Diseases, 2022) at Johns Hopkins Hospital found no significant reduction in HAIs from VRE or C. difficile when UV-C was added to both daily and post-discharge cleaning across four cancer units and one solid-organ transplant unit between December 2015 and February 2018, using a crossover design in which unit assignments switched after the first study year. Notably, four of five units showed lower fluorescent-gel-marker removal rates — a proxy for high-touch surface cleaning thoroughness — in the UV-C arm (p=0.07), suggesting a possible unintended consequence: staff may have relied on the technology in ways that reduced manual cleaning diligence. The authors also noted that UV-C was used during routine work hours only, with no weekend or night coverage, and rooms were vacated during treatment — all factors that could have limited the intervention’s real-world effect size.

Pulsed Xenon and the Broader Evidence Landscape

Two recent systematic reviews rounded out the evidence discussion. Ma et al. (Journal of Infection and Chemotherapy, 2025) conducted an updated systematic review and meta-analysis of pulsed-xenon UV across 14 studies (mostly pre/post designs, with two controlled trials), evaluating outcomes for C. difficile, MRSA, VRE, and A. baumannii. The meta-analysis found a statistically significant reduction in C. difficile infection with pulsed xenon (RR 0.76, 95% CI 0.59–0.97) — but that significance held only for pre/post studies, not for controlled trials. MRSA showed a non-significant trend toward reduction, and pooled analysis showed no significant impact on VRE infection in either study design. The authors concluded that current evidence, drawn from variable study designs, suggests pulsed xenon may have limited efficacy in reducing HAIs overall, and called for high-quality randomized controlled trials to resolve the uncertainty.

A broader systematic review by Maugeri et al. (Journal of Hospital Infection, 2025) examined 25 studies spanning UV-C, pulsed-xenon, and unspecified UV technologies across a wide range of healthcare settings — ICUs, oncology and transplant units, long-term care facilities, and operating rooms. Several pulsed-xenon studies showed HAI reductions, particularly for C. difficile in high-risk areas like ICUs, though results varied considerably by setting, with some studies showing no improvement at all. The review’s overall conclusion was that UV disinfection has demonstrated potential to reduce HAIs — especially when integrated into a comprehensive infection control strategy rather than deployed as a standalone intervention — but that effectiveness varies meaningfully by UV application type, target pathogen, and healthcare setting.

A Practical Question for the Operating Room: Is the Dose Actually Landing?

A 2026 study in Cureus by Gibbons, Dexter, Loftus, Seering, and Charnin addressed a question with direct operational relevance: when UV-C or pulsed-xenon devices are run according to manufacturer instructions in a real operating room, does the anesthesia workspace actually receive an adequate disinfecting dose? Prior research established 27 mJ/cm² as the minimally effective dose to attenuate Staph aureus. This multicenter simulation study, conducted across ten operating rooms at the University of Iowa and at Mayo Clinic, compared a triangular three-emitter UV-C configuration against single-emitter UV-C and pulsed-xenon devices, using calibrated radiometers positioned horizontally on the anesthesia machine and medication cart to capture realistic shadowing effects.

The results were striking. A single pulsed-xenon emitter run for a five-minute cycle met the target dose at the anesthesia machine in only 1 of 16 trials, and never at the anesthesia cart. A single UV-C emitter run for up to 30 minutes met the dose reliably at the anesthesia machine (16 of 16 trials) but never at the cart, even after 30 minutes. Only the triangular three-emitter UV-C configuration — with one emitter at the head of the surgical bed and one on each side — reliably delivered adequate dose to both locations, achieving it at both the machine and the cart in 8 of 8 trials once cycle time was extended to 16 minutes. The researchers concluded that device geometry and emitter placement, not just cycle duration, determine whether a disinfection cycle is actually achieving a biologically meaningful dose in real-world equipment layouts — a finding with clear implications for procurement decisions and standard operating procedures in perioperative environments.

The Takeaway for EVS Leadership

Taken together, the evidence presented in this session resists a simple verdict. UV-C and pulsed-xenon technologies can meaningfully reduce environmental bioburden and, in some well-designed trials, hospital-acquired infection rates — particularly for C. difficile and VRE. But device type, emitter configuration, cycle duration, room geometry, shadowing, surface orientation, and the pathogen in question all shape whether a given deployment actually delivers a biologically effective dose. Several studies also raise the possibility that reliance on UV-C technology can inadvertently reduce the rigor of manual high-touch surface cleaning — a reminder that these devices are best understood, and best implemented, as an adjunct to a comprehensive infection prevention program rather than a replacement for disciplined manual cleaning practice. For EVS departments considering adoption, the evidence argues for pairing any technology decision with the organizational groundwork Kotter’s model describes: a genuine coalition across infection prevention, facilities, and frontline EVS staff, clear success metrics, and an honest, ongoing look at whether the dose delivered in your own building’s rooms actually matches what the literature says is needed.

Based on a session presented at AHE Exchange26, the AHE Education & Solution Summit, Aug. 16–19, New Orleans, by Kathryn Munck, MPH, T-CHEST, manager of support services, Northside Hospital Cherokee, and Valentin Sturza, CMIP, CHESP, T-CHEST, EVS general manager, Northside Hospital Forsyth.

When patients rate their hospital stay, cleanliness is one of the few dimensions they can evaluate with confidence — they can see it, smell it, and feel it every time a housekeeper walks through the door. At Northside Hospital’s Cherokee and Forsyth campuses, that visible standard has translated into measurable results: both facilities have earned recognition among the cleanest hospitals in the country, validated by Becker’s List rankings and CMS HCAHPS data. At Exchange26, EVS leaders Kathryn Munck and Valentin Sturza walked attendees through the operational playbook behind those numbers, and the throughline was simple — consistency, communication, and engaged people.

Standardization as the Foundation

The Northside approach starts with clearly defined, non-negotiable cleaning protocols that apply the same way in every patient area, from rooms to restrooms. Rather than leaving cleaning quality to individual interpretation, the program is built on four pillars: standardization, visible cleaning routines, evidence-based methods, and regular auditing. Each patient room is cleaned against a detailed checklist covering high-touch surfaces, floors, restrooms, bed rails, and call buttons — areas patients and families notice immediately. Common areas, including waiting rooms, corridors, elevators, and public restrooms, are cleaned and disinfected multiple times per shift, reinforcing a sense of ongoing, visible care rather than a one-time pass.

Documentation closes the loop. Recording task completion isn’t just a compliance exercise — it creates accountability and traceability that leadership can audit and that staff can be recognized for.

Communication as a Clinical Skill

One of the more distinctive elements of the Northside model is how deliberately it treats EVS-patient interaction as a skill to be trained, not an afterthought. Frontline staff are expected to greet patients, explain what they’re doing, and ask whether additional cleaning is needed before leaving a room. That small script does double duty: it reassures patients that their space is being actively cared for, and it surfaces problems in real time rather than after a survey has already gone out.

That same communication discipline extends upward. EVS leaders maintain an established cadence of conversations with nursing leadership, arriving with an organized agenda rather than an open-ended check-in. The goal is collaborative problem-solving that keeps EVS aligned with the clinical teams responsible for the overall patient experience, rather than operating as a separate, siloed function.

Rounding: From Anecdote to Data

Patient rounding gives the program its feedback loop. Northside’s approach includes establishing a formal rounding tool, setting quantified daily goals, and identifying which patient populations to prioritize. Rounding isn’t treated as a soft-touch courtesy visit — it’s a mechanism for collecting real-time data and addressing service opportunities before they become complaints. Accountability runs in both directions, with leaders and frontline staff sharing responsibility for follow-through.

Investing in the People Who Do the Work

None of this holds together without a stable, engaged workforce, and the presenters spent significant time on how Northside builds that engagement. Recognition and connection take several forms: daily huddles, department meetings, newsletters, employee rounding, and formal awards — including an internal Excellence Award for Highest HCAHPS in Cleanliness. These aren’t symbolic gestures; they’re part of a deliberate cadence that keeps frontline staff connected to how their work shows up in the hospital’s outcomes.

Growth and development pathways include the EVS STEP program, AHE certifications, vendor in-service training, participation in multidisciplinary committees, and role-play exercises that let staff practice difficult interactions — including the patient-rounding scenarios attendees themselves worked through during the session’s group activity.

Recruitment gets the same structured treatment as cleaning protocols: a close working relationship with the department recruiter, active use of job fairs and hiring events, and a standardized interview template designed to identify candidates who will thrive in a role built around both technical skill and interpersonal contact.

The Numbers Behind the Story

The results are documented in each hospital’s HCAHPS trend data. Northside Hospital Cherokee’s EVS patient satisfaction score climbed from 88 in FY22 to 95 in both FY25 and FY26 (Press Ganey and CMS percentile rank data). Northside Hospital Forsyth showed an even steeper trajectory, rising from 79 in FY22 to 91 in FY25 and FY26. Both hospitals have sustained scores above the 90th percentile mark for the past two fiscal years — a level that both presenters credited to the compounding effect of standardized cleaning, structured rounding, and workforce investment operating together rather than as isolated initiatives.

The Takeaway

Munck and Sturza’s central message was that EVS excellence is what moves a hospital from merely “clean” to “comforting and healing” in the eyes of patients. That shift doesn’t happen through a single policy change — it comes from a consistent process, strong communication with nursing and patients alike, and a workforce that feels supported enough to bring genuine attentiveness to every room they enter. For EVS leaders looking to replicate the Northside results, the session offered a clear structural template: standardize the work, measure it, talk about it constantly, and invest visibly in the people doing it.

A new detect-inspect-correct-educate model pairs forensic-grade inspection with mechanical cleaning to target one of infection prevention’s most persistent — and least visible — threats.

Biofilms sit at an uncomfortable intersection in infection prevention: they are everywhere, they are almost impossible to see, and standard cleaning and disinfection protocols often fail to remove them. At the AHE Exchange26 Education & Solution Summit in New Orleans, David W. Koenig, PhD, and Aaron Jett of the Environmental Services Optimization Project (EvSOP) presented a session, “Controlling Biofilms with the DICE™ Program,” that laid out both the scope of the problem and a structured framework hospitals can use to address it.

Surface-Associated Life

A biofilm, as Koenig and Jett defined it, is a community of surface-associated microbial cells — bacteria, fungi, viruses, protozoa, and algae — encased in a protective extracellular polymeric substance (EPS) matrix. These communities form on living tissue, medical devices, water piping, and hospital surfaces, and the cells within them grow more slowly and behave differently than free-floating, or planktonic, microbes.

That difference in behavior is what makes biofilms so difficult to eliminate. The EPS matrix shields cells from disinfectants and desiccation, and biofilm-embedded organisms can be up to 1,000 times more resistant to antibiotics than their planktonic counterparts. Slower growth and altered gene expression further increase tolerance, and biofilms can form on virtually any surface — tissue, devices, and piping alike.

The economic stakes are considerable. Citing research published in npj Biofilms and Microbiomes, the presenters noted that biofilms carry an estimated global cost of roughly $3.9 trillion annually when corrosion is included, and about $1.3 trillion when it is excluded — spanning medical, food, water, and energy sectors. Medical and human health are among the largest sectors affected, and biofilm-linked healthcare-associated infections (HAIs) drive longer stays, readmissions, and excess mortality.

How Biofilms Form and Spread

Biofilm development follows a five-stage process: reversible attachment to a surface, irreversible attachment, cell-to-cell communication known as quorum sensing, maturation into a three-dimensional architecture, and finally detachment and dispersal to new surfaces. Several conditions accelerate that process, including rough surface texture, hydrophobic materials such as plastics, low flow velocity, and favorable pH, nutrient, and temperature conditions.

Quorum sensing plays a particularly important role. Cells release small signaling molecules to sense population density, and once a critical number of cells is reached, coordinated gene expression is triggered — in Gram-negative bacteria, often through N-acyl homoserine lactones. That coordinated response drives biofilm maturation, virulence, and matrix production.

The presenters distinguished between wet and dry biofilms, both of which resist standard disinfection and are difficult to see. Wet biofilms form in sinks, drains, and P-traps, serving as reservoirs for organisms such as Pseudomonas and Acinetobacter and spreading via splash and aerosol. Dry surface biofilms form on bed rails, tray tables, and equipment, and can survive desiccation for days to months. Together, drain biofilms, dry surface biofilms, and medical device biofilms inside catheters, scopes, and implants represent three high-risk reservoirs that infection preventionists must manage — and roughly 80% of microbial infections are believed to involve biofilms in some form.

The DICE™ Framework: Detect, Inspect, Correct, Educate

The core of the session was the DICE framework, a four-part sequence designed to make biofilm contamination visible and actionable rather than assumed away by a “visually clean” standard.

Detect. A forensic torch emitting blue light in the 437–458 nanometer range excites organic residues, which become visible through yellow-lensed glasses. This step identifies critical control points before cleaning begins and provides real-time, targeted feedback to EVS staff — effectively making the invisible visible.

Inspect. ATP bioluminescence testing offers a rapid, indirect measure of viable microbes, while protein residue testing captures both live and dead microbial material along with biofilm matrix. The presenters flagged a particularly useful diagnostic pattern: low ATP paired with high protein can indicate possible biofilm-associated residue even after disinfection appears to have worked, since disinfectant may kill organisms while leaving the protein-rich matrix behind. Genomic swabbing rounds out the inspection step, feeding into cloud-based data capture and AI-generated recommendations.

Correct. The framework calls for a strict two-step sequence: mechanical cleaning first, using Healthcare Grade UltraMicrofiber (HGUM) wipes and mops, followed by a hospital-approved disinfectant. This ordering matters because disinfectant alone has limited penetration through the EPS matrix, allowing persister cells to survive. HGUM wipes physically dislodge and trap soil, microbes, and biofilm through mechanical action, disrupting and thinning the biofilm matrix so that disinfectant can penetrate more effectively and achieve a higher kill rate. Non-HGUM wipes, by contrast, tend to redistribute rather than remove microbes, while paper towels and sponges can leave residue behind or harbor microbes themselves. Among disinfectant chemistries, the presenters noted that oxidizing agents — bleach, hypochlorous acid, peroxide, ozone, dichloroisocyanurate, and peracids — penetrate biofilm more effectively than non-oxidizing options such as metals, quaternary ammonium compounds, or alcohol; several oxidizing and mixed chemistries carry EPA biofilm claims.

Educate. Technology alone doesn’t solve the biofilm problem, the presenters emphasized — staff need to understand both the how and the why. That means building knowledge of active ingredients, contact times, and safety; mastering HGUM technique, drain protocols, and torch/ATP/protein swabbing methods; providing data-driven validation and real-time coaching; and cultivating a culture of accountability and pride in hygiene work.

Managing Drain Biofilms

Sinks and drains received specific attention as critical reservoirs. The presenters recommended daily scrubbing of basins, faucets, and handles with a hospital-approved disinfectant, plus periodic drain and P-trap treatment using foaming disinfectants such as hydrogen peroxide combined with peracetic acid, which cling to surfaces and penetrate more effectively; they suggested applying these every three to five days in high-risk areas. Heat or steam flushing and approved chemical dwell times were offered as alternatives, alongside preventive measures like splash guards and sink redesign to reduce aerosol generation.

Preliminary Evidence from CHI Immanuel Hospital

The session’s most concrete data came from two surface-cleaning assessments conducted at CHI Immanuel Hospital in Omaha, Nebraska, on March 12 and April 20, 2026. The first study collected 98 samples of roughly 25 square centimeters each, primarily from patient rooms and one operating room; the second collected 59 samples from operating rooms and a patient room. Both measured ATP and protein levels before and after cleaning.

Metric	Study 1 (Mar. 12) Pre → Post	Study 2 (Apr. 20) Pre → Post	Observation
ATP (RLU/swab)	28 → 14.5	14 → 7	Consistent post-clean reduction
BCA Protein (µg/swab)	10.2 → 3.8	4.4 → 0.7	Greater improvement in Study 2
Samples collected	58 → 40	48 → 11	Patient rooms/ORs/EVS equipment

Certain surfaces emerged as recurrent high-risk sites for protein residue: toilet seats measured up to 95 micrograms of protein per swab, grab bars measured 54 micrograms, sharps containers measured 45 micrograms, and bedside rails also registered elevated levels. Cart wheels emerged as an unexpected contamination reservoir. Taken together, the presenters argued, the data suggest protein may be a more sensitive biofilm indicator than ATP alone — disinfectant reliably lowers viable bioburden as measured by ATP, but wiping can leave a protein-rich matrix behind that ATP testing alone would miss.

Koenig and Jett described the findings as preliminary, and their stated next steps include continued protein surveillance and the addition of targeted 16S rRNA sequencing on high-risk surfaces to better characterize the microbial communities involved.

Choosing a Biofilm Control Strategy

For facilities weighing which combination of tools and products to adopt, the session offered a value-analysis approach: score candidate strategies — mechanical cleaning, cleaning solutions, disinfectant solutions, or a bundled program — against weighted criteria including biofilm removal efficacy, safety and material compatibility, strength of clinical evidence, workflow integration, total cost of ownership, and regulatory and compliance fit. The highest weighted score identifies the best-value option for a given facility’s needs and constraints.

Key Takeaways

Biofilms, and dry surface biofilms in particular, are persistent reservoirs driving HAIs. Standard cleaning fails without mechanical disruption paired with oxidizing chemistry. The DICE framework — Detect, Inspect, Correct, Educate — offers a practical, technology-enabled structure for addressing the problem, and pairing protein testing with ATP testing provides an actionable biofilm signal that either metric alone may miss. The preliminary data from CHI Immanuel Hospital suggest that focused, verified cleaning can produce measurable improvement, though facilities should weigh efficacy, operational fit, safety, cost, and regulatory alignment carefully when selecting a strategy.

Disclosure: EvSOP is a nonprofit educational initiative and does not sell or recommend any specific product discussed in this session.

This article is based on “Controlling Biofilms with the DICE™ Program,” presented by David W. Koenig, PhD, and Aaron Jett of EvSOP at the AHE Exchange26 Education & Solution Summit,

A tale of two facilities shows how staffing model and workflow design — not just products — determine whether between-case cleaning in the OR succeeds or fails.

Few environments in a hospital combine time pressure, complexity, and infection risk quite like the operating room. At the AHE Exchange26 Education & Solution Summit in New Orleans, Bruce D. Osborne, BA, MDiv, CHESP, of Carle Foundation Hospital, and Marc-Oliver Wright, MT(ASCP), MS, CIC, FAPIC, presented “Elevating the Profession in the Operating Room: Dedicated EVS Teams,” a session built around a real-world contrast between a facility where between-case cleaning had quietly broken down and one where a multi-year effort to build a dedicated EVS presence in the OR produced measurable gains in turnaround time, cleaning quality, and staff satisfaction.

Why the Environment Matters

The presenters framed their session around a well-established transmission model: contaminated environmental surfaces and the hands of healthcare providers form a two-way loop that can ultimately reach a susceptible patient, broken only by consistent environmental hygiene on one side and hand hygiene on the other. Surgical site infection (SSI), they noted, is arguably the most multi-factorial HAI for prevention efforts, shaped by patient factors (age, obesity, immunosuppression, diabetes), preoperative factors (skin and nasal decontamination), operative factors (procedure length and complexity, blood loss), and postoperative factors — alongside facility-specific risk factors across the preoperative, intraoperative, and postoperative phases. Against that backdrop, the presenters kept a set of reference numbers in mind throughout the session: roughly 300,000 to 500,000 SSIs annually, a 17% relative frequency among HAIs, 2-4% absolute incidence, and a 5% benchmark figure often cited in the literature.

Who Cleans the OR? It Depends

The session’s central observation was that operating room cleaning responsibility varies widely by facility and by task. Terminal, or end-of-day, cleaning is handled almost universally by EVS — compliance approaches 100% in most facilities. Between-case cleaning is a different story. Depending on the organization, that work may fall to a dedicated EVS presence, to clinical procedure staff juggling cleaning alongside case prep, or to OR technicians who may or may not have been trained by EVS.

Each staffing model carries trade-offs. Dedicated EVS teams bring specialized training, knowledge, and competency along with a dedicated resource that has backup coverage, but staff turnover remains a disadvantage. Clinical procedure staff bring specialty equipment knowledge — since anesthesia workstations and other specialized equipment are often handled by their operators or designees — but face disadvantages around training, cost and time commitment, and redundancy. OR technicians offer some specialty equipment knowledge as well, but similarly face training, cost, and redundancy challenges. In practice, the presenters noted, between-case cleans are the most variable scenario of the three phases, and time is always of the essence.

The Perils of “All Hands on Deck”

Time-sensitive, complex, critical tasks carry a natural appeal for shared responsibility — but the presenters warned that division of labor in complex settings, without clear and ingrained delineation of who does what, leads to chaos and failure. They illustrated the point with Charles R. Swindoll’s well-known parable about Everybody, Somebody, Anybody, and Nobody: an important job that Everybody assumed Somebody would do, that Anybody could have done, but that Nobody ultimately did — with Everybody blaming Somebody when Nobody did what Anybody could have done. The parable captured, in miniature, what can happen to between-case cleaning when responsibility is left ambiguous across EVS, clinical procedure staff, and OR technicians.

A Tale of Two Facilities

The session’s most striking material came from a direct comparison of two facilities — one left unnamed, evaluated in the summer of 2025, and the other Carle Foundation Hospital, a 525-bed academic facility in Urbana, Illinois, affiliated with the University of Illinois, with a Level 1 trauma center, 25 operating rooms, and roughly 35,000 procedures a year.

The unnamed facility — a 600-plus-bed Level 1 trauma center with more than 30 ORs and over 50,000 annual procedures, using a contracted EVS service — showed the risks of an unstructured approach. Terminal cleans occurred only once weekly per room, with limited wall coverage and a supplemental UV target that went unmet. End-of-day cleaning left out items and surfaces including the anesthesia cart, Draeger and Omnicell units, the DaVinci and other procedural robots, and wall-mounted medical gas valves; there was a disconnect between EVS and OR techs over “clean side/dirty side” methodology, and despite training not to encounter blood or body fluids, staff reported doing so 40-60% of the time, with limited to no handoff communication with the day shift.

Between-case cleans at that facility were, in the presenters’ words, the worst of times. Cleaning was sometimes started by OR staff while the patient was still in the room. Roughly 25% of rooms had one or more items disinfected more than once, while about 10% had one or more items or surfaces missed entirely. Technicians alternated between perimeter and interior cleaning without a systematic approach; lead vests were observed touching the floor; visible dust appeared in 20% of rooms, including those terminally cleaned the night before; cleaning logs inside rooms were incomplete (“I don’t go off that,” one worker said); and door handles were disinfected less than 10% of the time. Anesthesia drugs were sometimes left behind after procedures and after the last case of the day. Perioperative staff at times began setting up supplies for the next case before the floor was mopped or the anesthesia cart trash was removed. In one instance, technicians responding to an overhead call were told by OR staff that the room “just needed mopping” — and had not, in fact, been told what OR staff had specifically cleaned. As one technician told interviewers, “They tend to miss the little things.” In another observed lapse, a technician used a microfiber mop — after using it on the floor — to clean the base of the bed.

Human Factors Engineering: Working Backward from Outcomes

To address these gaps, the presenters turned to a human factors engineering (HFE) framework — specifically the SEIPS (Systems Engineering Initiative for Patient Safety) model, in which a work system encompassing technology and tools, organization, the person, tasks, and the physical environment produces a process, which in turn produces outcomes. The approach, they argued, works best applied backwards: start by defining the outcomes you want, then design the process and work system to reliably produce them.

For OR cleaning, the target outcomes were threefold: a perioperative environment that is consistently as pathogen-free as possible from the first case of the day to the last, measured through observation and fluorescent marking; between-case turnaround times as brief as possible without sacrificing quality, in order to maximize case volume and organizational revenue, measured through automated and consistent turnaround time (TAT) tracking against an aspirational goal; and avoidance of equipment damage alongside perioperative and technician staff satisfaction, measured through biomedical engineering tracking, surveys, and staff feedback. The process, in this model, is simply a high-reliability system maximizing each of those measurements.

On the work-system side, the physical environment is arguably the least controllable or modifiable element, best optimized to workflow only when remodeling or new construction presents the opportunity. Organizational alignment matters at two levels: C-suite and senior leadership need to align on goals, measurements, resources, and visibility, and should diversify representation to include EVS, perioperative, and infection prevention leaders; an operations-level “working group” needs the same alignment plus front-line representation and a discipline of hyper-communicating and sharing successes. On the technology and tools side, cleaners and disinfectants should be optimized for end users — with quick wet, contact, and kill times effective against organisms of concern, along with safety and material compatibility — supplemented as needed by technologies like UV or aerosolized hydrogen peroxide, typically reserved for terminal cleans, and with product placement and stocking optimized so the right tool is where it’s needed, when it’s needed, at or near the point of use, on optimized work carts. Tasks should be sequenced top to bottom, inside to outside, in zones that are clearly understood by everyone performing them.

How Carle Got There

Osborne traced the origin of Carle’s dedicated OR team back to 2023, when he was meeting with OR leadership about a recurring problem: EVS technicians were being asked to “hold feet” or assist with moving patients in preparation for surgical procedures. The reason, he learned, was that the OR was short on OR assistants — and those assistants were busy cleaning between cases. At the time, EVS was staffing the OR with only two full-time-equivalent staff. The realization that followed was straightforward: why ask OR assistants to clean when EVS technicians are the trained professionals?

Osborne, who reported directly to the hospital president at the time, proposed a plan for three teams of two EVS technicians to take over all between-case cleans in the ORs, Monday through Friday. The president was supportive; so was the vice president of perioperative services; so was the CFO. “I was shocked,” Osborne said of the reception the proposal received at every level.

The rollout that followed was iterative rather than immediate. In January 2025, all six EVS employees selected for the OR team were trained for two weeks by a combination of EVS trainers, EVS leadership, and OR leadership, and split into three teams of two to clean all ORs between cases — importantly including traditionally more sensitive areas and equipment such as the anesthesia workstation and stand. Workflow diagrams from this early period, mapping the movement of OR assistants and surgical techs around the room, showed tangled, overlapping, and inefficient paths.

By April 2025, roughly three months in, OR/EVS leadership meetings surfaced a problem: OR assistants were still being asked to help with cleaning so the process could move faster. The team structure was adjusted to two teams of three, organized into three zones — lights and bed, anesthesia, and perimeter and tables — with floor and trash handled by whichever team member was first available, working inside to outside. Cleaning times and quality both improved.

By November 2025, a different kind of problem emerged: some of the original team members were, in Osborne’s framing, the right people in the wrong position, with work ethic issues, personality conflicts, and disciplinary concerns requiring change. Between December 2024 and January 2025, all six original EVS technicians assigned to the OR were reassigned to other areas, and the team hand-picked a new group of technicians for the role — a change that the presenters credited with driving substantial subsequent improvement.

Measuring What Matters

The session leaned heavily on data to demonstrate that the redesigned model was working. An ISO audit conducted between May 18 and June 22, 2026 interviewed and observed all six EVS technicians assigned to the OR. Interview-based compliance — covering questions on damp-dusting protocols, correct disinfectant use, trash bag color coding, sharps container handling, timing of surface disinfection, linen bag procedures, disposal of contaminated liquids, and storage of supplies — came in at 95%. Direct observation compliance — covering disinfection of the warming device, OR bed control, Omnicell keypad, patient transfer device, door handle, and anesthesia machine — came in at 96%.

Longitudinal quality scores told an even more dramatic story of improvement: 66.1% from September 2023 through February 2024, rising to 98.53% from January through June 2025, and 99.47% from January through June 2026. Biomedical engineering reported no significant equipment issues attributable to the cleaning process since it began in 2025.

Turnaround times improved as well, though more modestly and against a backdrop of rising case volume. Average turnaround time — measured, in the EMR-defined sense, as the time Patient #2 enters minus the time Patient #1 exits — was 23 minutes and 2 seconds from January through October 2024, improving to 22 minutes and 51 seconds over the same months in 2025, an 11-second reduction. During that period, total case volume rose 6.3%. Comparing 2024 to 2026 overall, the facility saw a 14% increase in total cases, and turnaround time for January through May 2026 improved further to 22 minutes and 40 seconds — another 11-second decrease. The presenters also highlighted a more precise alternative metric: the time a room is ready for Patient #2 minus the time Patient #1 exited, which strips out setup and perioperative flow variables to isolate EVS’s specific contribution.

What Staff Said

Staff survey results, gathered from EVS technicians, perioperative clinical staff, and anesthesia staff, pointed toward broad buy-in for the dedicated-team model. EVS technicians strongly agreed that their role in the OR is important to patient safety and reported feeling valued for their work, with somewhat more mixed views on whether non-EVS OR staff appreciate the work they do and on how their workload compares to other EVS assignments. One technician commented, “I love working in the OR. The staff here make me feel like they appreciate the work I do. I never had a job that I like to wake up and come to until I started work in the OR.” Another said simply, “Team work in OR department is so good.”

Perioperative clinical staff, surveyed after EVS technicians assumed full responsibility for between-case cleans, largely agreed or strongly agreed that having a dedicated EVS team improved room turnover, that rooms were sufficiently clean and ready for the next patient, and that they liked having a dedicated EVS team perform the cleans. Open-ended comments were largely positive, with several respondents calling the current team a marked improvement over a previous group (“10x better than the previous group,” one wrote), while noting occasional friction points — one comment noted that aggressive wiping of keyboards sometimes opened random windows or altered computer desktop backgrounds, and another suggested the team could use additional day and later-shift staffing.

Anesthesia staff, asked specifically about EVS technicians wiping down anesthesia carts and workstations during between-case cleans — a task traditionally reserved for anesthesia personnel at many facilities — were largely comfortable with the practice and had not observed equipment damage as a result of the workflow change.

An Outside Auditor’s View

Wright, speaking as an infection preventionist, described being asked in the summer of 2025 to audit OR cleaning practices at an unnamed facility, drawing on his most recent hands-on experience from more than five years earlier and a “phone a friend” call to Osborne. What he found was cohesion, hyper-communication, and a team that stayed at the ready. Using the stricter “room ready for Patient #2 minus Patient #1 out” measure rather than the standard EMR-defined turnaround time, he calculated an average of five minutes — including one six-hour CABG case that turned around in seven minutes. Against a 22-minute overall turnaround time, that left roughly 17 minutes attributable to the rest of the perioperative team’s setup and workflow, not to EVS.

Quality, in Wright’s assessment, was practically perfect, with a single notable exception: anesthesia cords that had been wiped thoroughly, wrapped, and hung, but subsequently fell to the floor and were re-hung without being re-cleaned. Staff were re-educated on the point.

A Worksheet for Getting Started

For facilities considering a similar path, the presenters offered a three-part starting framework.

Assess the current state. Observe current practice — ideally with an outside pair of eyes — to understand who does what, what’s working, and what needs improvement. Collect turnaround time data and compare it to comparable facilities, and assess the more precise “room ready” measure to understand how much EVS specifically contributes to turnaround.

Assemble the troops. Build a working team first, including front-line representation, and develop shared goals and objective measurements. Build a business case: how many minutes would need to be shaved off turnaround time to gain one additional case per day, and does that offset the cost of a dedicated team? Determine senior leadership sponsors and approach the effort in a united fashion.

Redesign the work system. Use a failure mode and effects analysis (FMEA) approach, actively seek out naysayers, and listen to end users. Pilot the new approach, assess results, and be willing to “fail up” — treating early stumbles as information rather than a verdict. Deploy at scale, keep measuring, hyper-communicate throughout the organization, and share successes visibly.

Summary

Outcomes, the presenters concluded, are driven by processes, which are in turn derived from work systems — and OR cleaning practices are highly complex work systems, with staffing methods and practices that vary considerably from one facility to the next. Done well, dedicated EVS teams for between-case cleans can be highly efficient, contributing to greater throughput and revenue at potentially cost-neutral or even favorable terms; beneficial to patients through improved cleaning quality; engaging work for EVS technicians; and satisfying to perioperative staff who depend on a clean, ready room for every case.

Disclosures: Marc-Oliver Wright is an employee of the clinical team of PDI Healthcare; the content of the presentation does not represent the views of PDI or its ownership. Bruce Osborne received limited expense reimbursement from PDI to attend the conference. No commercial products, including PDI products or solutions, were discussed in the session, in accordance with continuing education requirements.

This article is based on “Elevating the Profession in the Operating Room: Dedicated EVS Teams,” presented by Bruce D. Osborne, BA, MDiv, CHESP, of Carle Foundation Hospital, and Marc-Oliver Wright, MT(ASCP), MS, CIC, FAPIC, at the AHE Exchange26 Education & Solution Summit, August 16–19, 2026, in New Orleans.

Based on the AHE Exchange26 session “The Remarkable Health Care Paradox: Environmental Services Hospitality Integration,” presented by Nasar Masry, CHESP, VP of Operations at Job Options Inc.; Tasha Acevedo, MBA, T-CHEST, T-CSCT, CMIP, Director of Environmental Services at Phelps Hospital; and Thomas J. Mattice, CHESP, T-CHEST, CMIP, Senior Director of Support Services at Montefiore Nyack Hospital.

Ask any environmental services (EVS) leader whether their frontline technicians are compassionate, and the answer is almost always yes. Ask whether that compassion consistently translates into the kind of polished, memorable experience patients associate with a five-star hotel, and the answer gets murkier. That gap — between genuine caring and consistent hospitality — was the focus of a session at this year’s AHE Exchange26 summit, where three EVS and support services leaders argued that healthcare doesn’t have a compassion problem. It has an execution problem.

The Paradox

The session’s premise is captured in its title: healthcare workers are, by nearly every measure, more caring and more compassionate than the average frontline hospitality worker. Nurses, technicians, and support staff choose the field because they want to help people. And yet patients routinely rate their experience lower than they would rate a hotel stay, even when the clinical care they received was excellent.

The presenters framed this as a paradox worth naming directly: the raw material for outstanding hospitality already exists in healthcare’s workforce. What’s often missing is the structure — the vision, the training, the accountability — that turns individual compassion into a consistent, systemized experience.

Why the industries diverge

One exercise the panel walked attendees through was comparing healthcare’s approach to service against the stated missions of major hospitality brands. Marriott’s mission speaks to enabling “unsurpassed” experiences. Hilton’s talks about filling the world with “the light and warmth of hospitality.” Ritz-Carlton’s motto — “we are ladies and gentlemen serving ladies and gentlemen” — treats staff and guests as equals deserving the same respect.

Few hospitals, the presenters noted, have anything comparable that’s specific to the patient and family experience of environmental services, dietary, or support services teams. Without that kind of explicit, values-driven language, hospitality in healthcare tends to happen inconsistently, driven by individual personality rather than institutional design.

The panel also pointed to a familiar source of friction: siloed departments that don’t understand each other’s priorities, challenges, or workload. EVS teams frequently feel that other departments don’t grasp what the job actually requires — the competing demands, the turnaround pressure, the technical knowledge behind infection prevention protocols. The presenters’ point wasn’t that this frustration is unfounded; it’s that airing it productively, and “managing up” by highlighting EVS’s contributions rather than only its constraints, does more to build cross-departmental trust than staying siloed does.

Borrowing frontline ownership from hospitality

A central example in the session was the Ritz-Carlton’s well-known “$2,000 rule,” which empowers any employee — without manager approval — to spend up to that amount per guest to resolve a problem or create a standout moment. The number itself isn’t the point for a hospital setting; the underlying principle is. The panel asked attendees directly: how do you inspire that kind of ownership on your own team? Are frontline EVS staff actually empowered to solve problems in the moment, or does every exception have to travel up a chain of approval?

The presenters framed sustainable hospitality culture as something built deliberately, through several concrete levers:

• Creating moments that feel personal rather than transactional
• Turning champions into owners — giving staff who already embody the culture visible responsibility for spreading it
• Being intentional about language, since the words staff use shape how patients perceive an interaction
• Establishing scripting guidelines so consistency doesn’t depend on which technician is on shift
• Distinguishing service from hospitality — the panel’s framing was that service is necessary but “ordinary,” while hospitality is what stands out and gets remembered
• Building in ongoing measurement and adjustment, treating culture as something that has to be monitored and refined, not launched once and left alone

Personal service, made tangible

The session translated these principles into a checklist of specific, replicable practices EVS and support services teams can implement, including:

• Greeting patients by name
• Recognizing birthdays and anniversaries during a stay
• Toilet bands, room seals, and bed covers that visibly signal a room has been freshly cleaned
• Tent cards and towel designs that add a personal touch
• Scheduling cleaning assignments around times that work best for the patient and family, rather than purely around departmental efficiency
• Enhanced in-room cleaning and disinfection protocols for joint replacement rooms while the patient is in surgery

These are small, operationally manageable interventions — the kind that don’t require new headcount or capital investment, but do require training, consistency, and leadership follow-through.

A case study in incremental gains

To ground the discussion in data, Mattice shared results from a pilot program at Montefiore Nyack Hospital. Support services leadership dedicated focused resources to a single inpatient unit that had a high volume of patient surveys and a high return rate, aiming to better understand where the experience was breaking down and to measure whether targeted attention could move the needle.

Over three months, the unit’s patient experience scores moved consistently upward:

Metric	August	September	October
Cleanliness	63.42	73.48	83.32
Meal Overall	32.69	37.97	47.62
Food Temperature	38.46	41.77	50.00
Food Quality	26.92	34.18	45.45

Every tracked metric improved month over month, with cleanliness scores climbing nearly 20 points and food-related scores nearly doubling over the pilot period. The presenters were careful to characterize the results as incremental rather than transformational — but the trajectory itself was the point. Concentrated attention, applied consistently, produced measurable movement in a relatively short window.

The takeaway for EVS leaders

The session’s closing message was less about adopting hospitality’s tactics wholesale and more about adopting its discipline: define what hospitality means for your organization, put it in language your team can act on, give frontline staff real authority to act on it, and then measure whether it’s working. Healthcare doesn’t need to import a $2,000 rule. It needs its own version of the thinking behind it — a deliberate answer to the question the panel put to the room: are your frontline staff truly empowered to deliver the experience your patients deserve?

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Based on a presentation by Colleen Bennett, EVS System Development & Compliance Specialist, WellSpan Health, delivered at the Association for the Health Care Environment’s Exchange26 Education & Solution Summit, August 17, 2026, in New Orleans.

For environmental services leaders overseeing more than one facility, a familiar assumption often goes unexamined: that hazardous waste processes are standardized across the system. At WellSpan Health, that assumption didn’t survive a closer look.

“So did we,” Colleen Bennett, EVS System Development & Compliance Specialist at WellSpan Health, told attendees at AHE’s Exchange26 summit, describing the moment her team realized their hazardous waste program wasn’t nearly as uniform as they’d believed. “Until we looked closer.”

Eight Hospitals, Eight Different Answers

WellSpan’s environmental services program spans eight hospitals and more than 240 off-site locations. On paper, that scale suggests efficiency of scale. In practice, Bennett said, it produced the opposite: eight different approaches to the same regulatory obligation, and more than 240 sites where handling practices could — and did — vary from one building to the next.

That variability came with real consequences. Inconsistent handling of hazardous waste elevated regulatory risk and, notably, drove an increase in vendor rejections — shipments or containers refused by waste haulers because they didn’t meet specification. Behind the inconsistency, Bennett’s team identified three root causes: education that differed from site to site instead of following a single curriculum, no clearly designated owner for the process system-wide, and competing operational priorities that pushed hazardous waste compliance down the list at the department level.

A Deliberate Structural Fix

Rather than layering on more policy memos or one-off retraining sessions, WellSpan made a structural decision: it repurposed an existing FTE into a dedicated EVS Compliance Specialist role, built specifically to own hazardous waste compliance across the system and establish accountability at the system level rather than leaving it to individual facilities to interpret independently.

That role operates on what Bennett described as a five-step Compliance Specialist Model: assess current practice, educate staff, validate competency, report findings, and reinforce what’s been learned — a cycle rather than a one-time fix.

Solving for Space, Not Just for Sharps

One of the presentation’s more concrete case studies involved a common EVS dilemma: limited storage space colliding with compliance requirements. In practice, that tension often shows up as clean and full sharps containers stored together in shared departmental space — a setup that’s understandable given real estate constraints, but one that increases the odds of confusion and mishandling.

WellSpan’s mitigation strategy was to zone the room itself. Zone A was designated for clean containers, empty sharps containers, and designated shelving. Zone B was designated for full containers, vendor pickup staging, and locked cart storage. Before-and-after photos Bennett shared showed the visual difference clearly: a single utility room that once mixed combined clean and dirty storage was reorganized into distinct clean and dirty areas, with containers flowing in a consistent direction from use to pickup.

It’s a modest physical change, but one that removes ambiguity from a task that previously depended on individual judgment call by call.

Education Over Enforcement

Underlying the entire initiative was a philosophical choice Bennett was explicit about: education over enforcement. In practice, that meant hands-on training rather than passive instruction, taking the time to explain the “why” behind a requirement rather than simply issuing the rule, validating competency rather than assuming it, and correcting and reinforcing on-site, in the moment, rather than relying solely on after-the-fact citations.

That approach depended on cross-functional partnership. Bennett described active collaboration among EVS, infection prevention, nursing, safety, and facilities — five functions that each touch hazardous waste handling from a different angle, and that needed to be aligned rather than operating from separate playbooks.

Measuring What Matters

To know whether the new model was working, WellSpan’s team tracks a defined set of metrics: vendor rejections, S1 safety events, hazardous waste incidents, staff competency scores, and regulatory readiness. Tracking these together — rather than treating compliance as a pass/fail audit outcome — allows the compliance specialist role to spot drift before it becomes a citation.

Bennett framed the resulting shift in cultural terms as much as operational ones. Before the change, the system’s posture was largely reactive: problems were corrected after they surfaced. After implementing the compliance specialist model, the posture shifted toward proactive education, continuous oversight, and shared accountability across departments — a change in orientation, not just in paperwork.

Knowing When to Push Back

Not every session on regulatory compliance addresses this directly, but Bennett devoted specific attention to it: not every survey finding should automatically become a system-wide process change. She encouraged EVS leaders navigating regulatory pushback to ask for the specific standard, Element of Performance, or regulation that supports a finding; to distinguish between a surveyor’s stated “best practice” and an actual cited requirement; and to verify state-specific regulations before rolling out changes across an entire system, since requirements that apply in one state may not apply uniformly elsewhere.

That distinction matters practically. A system-wide process change carries real cost in training time, materials, and disruption — reserving that response for confirmed requirements, rather than every observation, keeps the compliance program credible and sustainable.

A Framework Other Systems Can Replicate

Bennett distilled WellSpan’s experience into a six-step framework intended to be transferable to other health systems grappling with the same multi-facility variability: identify variability, assign ownership, standardize assessment, implement education, validate competency, and track outcomes.

She paired that framework with a set of concrete starting tools: a hazardous waste assessment checklist, a staff education module, a workflow map template, a metrics dashboard, and a competency validation tool. Her closing advice to attendees was pointedly modest in scope: start small, standardize one process, and build from there — rather than attempting to overhaul an entire system’s hazardous waste program at once.

To that end, Bennett offered attendees a practical self-assessment — a Hazardous Waste Program Health Check — that EVS leaders can bring back to their own organizations as a first, low-stakes step toward identifying where their own variability lives.

The Takeaway

WellSpan’s experience is a reminder that hazardous waste compliance gaps in multi-facility systems often aren’t the product of any one department’s failure. They’re the product of scale itself — of processes that were never actually unified in the first place, even when everyone assumed they were. Bennett’s presentation offered a template for closing that gap: assign clear ownership, standardize assessment and education, validate rather than assume competency, and measure the results over time. As she told attendees in closing, “Your questions, challenges, and ideas help us all continue improving healthcare together.”

Based on a presentation by Flash Fiegel, CHESP, CMIP, CMPS, CMEL, delivered at the Association for the Health Care Environment’s Exchange26 Education & Solution Summit, August 17, 2026, in New Orleans.

Hospitals lose billions of dollars every year to preventable infections, and many of those losses trace directly back to environmental hygiene failures. Framed that way, the problem sounds like a cost issue. Flash Fiegel, CHESP, CMIP, CMPS, CMEL, told attendees at AHE’s Exchange26 summit that it’s something else entirely: an opportunity, and one that EVS leaders have to learn to argue for out loud.

His session, “Professional Persuasion: Elevating EVS Through Strategic Dialogue,” made the case that technical competence alone doesn’t secure resources, staffing, or a seat in the rooms where decisions get made. Persuasion does — and it’s a skill EVS leaders can build deliberately, the same way they’d build any other competency.

Knowledge Is Potential; Action Is Power

Fiegel opened by acknowledging the discomfort many EVS professionals feel with the idea of “selling” their department’s value. “No one expects an EVS leader to be a professional B2B salesperson,” he said. But he argued that leadership requires something adjacent to sales skill: the knowledge of a subject matter expert paired with the mental fortitude to act on what that expertise reveals. He framed the distinction with a line borrowed from motivational speaker Tony Robbins — that knowledge is only potential, and action is what converts it into power.

To gauge where the room actually stood, Fiegel opened with a live poll asking attendees how confident they felt walking into a Director or C-suite meeting to advocate for their EVS team. That gut-check set up the session’s central premise: most EVS leaders have the operational knowledge to make their case. What they often lack is a structured way to deliver it.

The Strategic Dialogue Framework

Fiegel offered attendees a three-step framework for conversations with leadership, built around three verbs: anchor, bridge, and close.

Anchor means establishing credibility before anything else — leading with data the audience already cares about, such as patient outcomes, cost avoidance, or compliance risk, and connecting EVS metrics to organizational goals rather than departmental ones.

Bridge means translating EVS work into executive language. Fiegel offered direct equivalencies: beds cleaned translates to patient throughput, staff retention translates to cost savings, and infection prevention translates to liability reduction. The underlying skill isn’t spin — it’s fluency in the vocabulary the audience is already listening for.

Close means never leaving a conversation without a specific, named ask. Whether it’s additional resources, headcount, formal recognition, or a seat at the planning table, Fiegel emphasized naming it clearly and confidently rather than letting a productive conversation end without a concrete outcome.

Six Skills for the Moments That Matter Most

Beyond the three-step framework, Fiegel walked through six supporting skills he described as the tools that “change rooms”: active listening (understanding an objection before countering it), data storytelling (recognizing that numbers alone rarely persuade, but stories built on numbers do), objection anticipation (walking in already knowing the top three pushbacks and having answers ready), reframing (changing the lens without changing the facts — positioning EVS as patient safety infrastructure rather than a janitorial line item), alliance building (identifying which C-suite members already respect EVS and starting conversations there), and timing and access (recognizing that even the best argument fails if delivered at the wrong moment).

Stepping Into the Arena

The session’s centerpiece was a live debate simulation built around a deliberately uncomfortable scenario: a hospital implementing a 5% budget cut across all non-clinical departments, with five minutes to make the case to the CFO for a full EVS staffing model.

Attendees split into two roles. The Advocate defended full staffing, armed with arguments tying understaffing to rising HAI rates, patient satisfaction and HCAHPS scores, the cost math showing agency and temp labor exceeding FTE savings within 90 days, Joint Commission compliance risk, and the institutional knowledge lost to turnover. The Skeptic pushed for the cuts, arguing that every department should share the burden of austerity equally, that technology such as UV disinfection and robotics could offset reduced headcount, that productivity benchmarking might reveal not every position is equally critical, and that cross-training could reduce dependency on specialized roles.

Each side got three minutes to make its case and two minutes to rebut, with the room voting afterward — not on who was factually right, but on who was more persuasive. Fiegel’s framing for the exercise was pointed: “Your job is not to win the argument. Your job is to change the mind.”

What the Room Actually Learned

The debrief surfaced the session’s real thesis. Across the debate rounds, Fiegel observed that the most persuasive participants weren’t necessarily the ones with the strongest facts — they were the ones who sounded like they genuinely believed the facts they were presenting. Conviction, not just content, moved the room.

That distinction reframes what persuasion training is actually for. As Fiegel put it, “Persuasion is not a presentation. It is a conversation with a clear destination.” The goal isn’t to deliver a polished pitch and hope it lands — it’s to walk into a conversation already knowing where it needs to end up, and to communicate with a level of belief that makes the destination feel inevitable to the other person in the room.

Five Moves to Make This Week

Fiegel closed with five concrete, near-term actions EVS leaders could take without waiting for a formal training program or a scheduled review cycle:

• Reframe your language by translating your next department report from EVS metrics into patient outcome metrics.
• Know your numbers by identifying the top three data points that connect EVS performance to hospital-wide goals — and practicing saying them out loud.
• Build one alliance by identifying a C-suite champion who already respects EVS and scheduling a short conversation with them this month.
• Use anchor-bridge-close in the next email sent to leadership, writing it out deliberately before hitting send.
• Bring someone with you by identifying one frontline EVS team member to develop as a future advocate, investing in their voice alongside your own.

The Takeaway

Fiegel’s closing message to the room was direct: no one is going to hand environmental services a seat at the table. “You have to walk in, pull up a chair, and start talking about what matters most,” he said. For a discipline that has spent years building the operational and infection-prevention case for its own importance, the missing piece, in Fiegel’s framing, isn’t more data — it’s the willingness to advocate for that data with the same conviction leaders bring to any other high-stakes case. As he told attendees in closing, “Now go advocate for your team like their careers depend on it — because your patients’ lives do.”

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Based on a presentation by Keith H. St. John, MS, MLS(ASCP), CIC, FAPIC, infection prevention and control specialist, Facilities Management, VW International Contractor, Walter Reed National Military Medical Center, delivered at the Association for the Health Care Environment’s Exchange26 Education & Solution Summit, August 17, 2026, in New Orleans.

Roughly 5,000 deaths occur every year in the United States due to construction- and renovation-related infections in healthcare facilities. Keith H. St. John, MS, MLS(ASCP), CIC, FAPIC, an infection prevention and control specialist at Walter Reed National Military Medical Center, opened his AHE Exchange26 session with that figure and a pointed follow-up: these deaths are preventable, not inevitable. His presentation, “Legos and Erector Sets: The Role of EVS in Construction Projects,” made the case that environmental services isn’t a peripheral player in construction infection control — it’s the final and often decisive link in the chain.

Where the Pathogens Come From

St. John walked attendees through the environmental sources of pathogens tied to healthcare construction: soil and dust disturbed by excavation, standing water collected in poor drainage or equipment, construction materials like wood, insulation, and drywall that can support microbial growth, contaminated HVAC ductwork and cooling systems, foot traffic tracking contamination on footwear, construction equipment surfaces, and disturbed vegetation. He illustrated the scale of the risk with a photograph he called “ground zero” — a complete demolition of a patient floor, framed as a starting point for imagining just how much material and dust a single project can generate.

Fungi, and Aspergillus in particular, were a central focus. St. John explained that fungal spores function like microscopic plant seeds, capable of dispersing through air, water, or contact and germinating into new colonies wherever they land in warm, moist conditions. He outlined four categories of fungal infection that pose real risk to patients: respiratory infections common in transplant recipients, invasive Aspergillus infection that can spread from the lungs to the brain, kidney, and liver — with a mortality rate for Aspergillus-related pneumonia in bone marrow transplant patients estimated at a staggering 85% — surgical site infections traced to mold exposure in the OR or recovery environment, and cutaneous infections from contact with open skin.

The Chain of Infection and the ICRA Tool

St. John grounded the clinical logic in the classic chain of infection model: pathogen, reservoir, portal of exit, means of transmission, portal of entry, and new host. Each link, he emphasized, can be interrupted — and the mere presence of microbes doesn’t equal infection. The tool healthcare facilities use to systematically break that chain during construction is the Infection Control Risk Assessment, or ICRA, developed in the late 1990s specifically to help contractors and facilities staff prevent the spread of infection during building projects.

St. John walked through the four-step ICRA 2.0 process now in wide use: identifying the construction activity type (from Type A, minor inspection work, through Type D, major demolition and construction); identifying the patient risk group that will be affected, from low-risk non-patient areas to the highest-risk procedural and transplant units; cross-referencing those two factors in a matrix to determine the required Class of Precautions, ranging from Class I through Class V; and finally, assessing the risk to surrounding areas above, below, and adjacent to the project — since noise, vibration, dust, and pressurization changes rarely respect a construction barrier’s physical footprint.

The precautions scale sharply with class. Class I requires simply avoiding dust and not blocking patient care. Class V — reserved for the highest-risk combinations, such as major demolition adjacent to transplant or oncology units — requires full critical barriers meeting NFPA 241 fire-rating standards, dedicated anterooms for equipment staging and cart cleaning, disposable coveralls for all personnel, continuously monitored negative air pressure directed through HEPA-filtered exhaust, and routine collection of particulate data to verify containment is actually working.

What Went Wrong at Dallas Children’s

St. John used a documented case to make the stakes concrete: a published study examining hospital construction and the development of healthcare-associated environmental mold infections in pediatric leukemia patients at Children’s Medical Center of Dallas. During an excavation project adjacent to the hospital, researchers found that exposure to the campus during the excavation period was significantly associated with mold infection risk. Of 50 total invasive fungal disease cases identified over the study period, 31 were healthcare-associated environmental mold infections — and the outbreak was linked to 10 deaths.

The hospital’s infection control department had implemented real precautions: resealing windows in adjacent buildings before excavation began, instructing crews to keep the excavation site moist to reduce spore aerosolization, optimizing HEPA-filtered air handling with redundant units, routing staff through an enclosed sky-bridge, and providing N-95 respirators to arriving families. St. John pointed out something notable about that list, though: it made no mention of EVS’s role at all.

His analysis of what went wrong pointed to several contributing factors: ineffective infection prevention recommendations that couldn’t be validated, sub-optimal ICRA barriers, a failure to monitor ongoing compliance with ICRA precautions once they were put in place, and changes in building pressurization that may have introduced contaminated air into the oncology ward. The published recommendations that followed called for future studies on how to achieve better adherence to preventive measures and for developing and validating new environmental prevention strategies — an implicit acknowledgment that having a plan on paper isn’t the same as having one that holds up under real construction conditions.

## Construction Clean vs. Terminal Clean

A recurring theme of St. John’s talk was the distinction between construction clean and terminal clean — a distinction he argued EVS professionals need to understand precisely, because confusing the two is where compliance quietly breaks down. Construction clean is the process of removing gross dirt, debris, and trash from a work site, along with properly cleaning and disinfecting any reusable tools or equipment. Terminal clean goes further: it means going inside the ICRA barrier itself and thoroughly cleaning and disinfecting the entire environment — walls, ceiling, surfaces — using an EPA-approved disinfectant according to facility protocol. Construction clean gets a space ready; terminal clean is what actually makes it safe for occupancy. St. John was direct that both steps are essential and neither substitutes for the other, including disinfecting the ICRA barrier materials themselves — the plastic sheeting, zipper doors, support poles, base plates, seams, and tape — before they come down.

He also reviewed the tradeoffs among common disinfectant classes for this work: quaternary ammonium disinfectants, effective against bacteria, viruses, and fungi with low odor and non-corrosive properties, though requiring 3 to 10 minutes of wet contact time; accelerated hydrogen peroxide disinfectants, safe and non-irritating with just a one-minute contact time and no harmful residue; and sodium hypochlorite (bleach), highly efficient at killing bacterial spores and economical, but with a distinct odor and a residue left behind on drying.

What Good Looks Like — and What Doesn’t

St. John shared a series of real photographs from the field illustrating both problems and fixes: torn and soiled shoe covers, a heavily soiled containment mat that should have been changed, and — in a section he titled “Debris cart challenges” — a side-by-side comparison of a new cart, a semi-clean cart, and a visibly dirty cart with an open lid being wheeled through a patient hallway, its wheel tracks depositing grout dirt behind it. His message throughout this section doubled as a call to action for frontline EVS staff: “See something, say something.” An EVS technician who notices new construction or renovation activity — particularly if no ICRA permit is posted — should alert their supervisor immediately, who can then escalate to the infection prevention specialist to confirm mitigation measures are actually in place.

St. John was emphatic that EVS’s role extends well beyond the visible work zone. EVS surveillance should also track facilities management work orders and outage or access requests, since those frequently signal repair activity in or adjacent to patient care areas. EVS should request to be copied on ICRA permits as they’re issued. And EVS has a role in facility water management as well: post-construction discharge cleaning should include flushing plumbing fixtures to support dynamic water flow, and EVS should have a seat on the water management committee, given that Legionella species require longer disinfectant contact times than most bacteria and that construction frequently involves work on water supply and sanitary sewer lines. EVS may also be called on to clean and disinfect HVAC systems before renovation, particularly units that have sat inoperable for months or years.

A Compliance Checklist Built for EVS

To operationalize all of this, St. John shared a Compliance Monitor Checklist — adapted from an American Society for Healthcare Engineering template and revised for this presentation — that explicitly flags which line items fall under EVS engagement. Those items include verifying that walk-off mats are clean and adequate to contain construction dust, confirming patient care equipment and items have been removed from the construction area, checking that construction entry points and adjacent areas are free of dust and debris, and confirming that the area is cleaned daily with an approved disinfectant. Making EVS’s specific responsibilities explicit on a shared compliance document, rather than leaving them implied, was St. John’s practical answer to the exact gap that appeared to contribute to the Dallas Children’s outbreak.

The Takeaway

St. John’s closing framing positioned the EVS professional as nothing less than the guardian of the healthcare environment — the person with eyes and ears on what’s actually happening in a facility every single day, often before anyone in infection prevention or facilities leadership is aware a risk exists. His conclusions were unambiguous: infections resulting from construction pose real hazards to patients, staff, contractors, and visitors alike; roughly 5,000 associated deaths occur annually, and none of them are inevitable; hospitals and contractors alike need to comply with infection control procedures; and preventing these infections is, in the end, everyone’s responsibility. As he put it in closing, EVS’s contribution to that shared responsibility comes down to three things: teamwork, clean spaces, safer care.