Infection prevention education in French

FigureHEALTHCARE-ASSOCIATED INFECTIONS (HAIs) are a quality indicator of patient care and safety that cost US hospitals approximately $28.4 billion a year.1,2 Practices to prevent HAIs focus on interrupting pathogen transmission through contaminated surface cleaning and handwashing. The US CDC has developed specific guidelines for healthcare facilities to address infection prevention and control (IPC).3 These guidelines include providing job-specific IPC education for environmental services (EVS) employees.3 Frequently, these employees don't speak English as their primary language. For nurse managers and hospital EVS leaders, designing an educational intervention for these employees can be a challenge. BACKGROUND EVS staff are an essential resource for hospital facilities as they sanitize patient-care areas and equipment.4 According to research, EVS employees are often undervalued, unappreciated, and lack recognition from nurse managers.5 This situation can lead to feelings of division, discontent, and eventually staff turnover.5 Nurse managers should understand the barriers and challenges associated with EVS attrition. For example, EVS employees often aren't included in discharge huddles or planning meetings, which can be an associated challenge.5 Nurse managers can address EVS employees' specific needs by supporting, protecting, and recognizing their vital contributions to patient satisfaction, care, and safety.5 EVS staff are the first line of defense in preventing the transmission of infectious pathogens.6 Providing EVS employees with infection prevention education is essential for their own protection, as well as the protection of patients and other staff members. Because of the critical nature of IPC, it may be beneficial for EVS staff to receive detailed education in their primary language. These individuals need to have knowledge of appropriate hand hygiene, personal protective equipment, and cleaning methods based on isolation precautions. Surveyors and IPC nurses conduct their rounds in English, and they tend to assume that employees are fluent in the language. Therefore, EVS staff whose primary language isn't English may have difficulty communicating with accreditation surveyors and nurses during IPC rounds.7 EVS staff are expected to respond quickly to questions and be as articulate during conversations as their English-speaking colleagues. At this community hospital, the largest population of EVS staff for whom English is a secondary language speak French as their first language. Although the ability to communicate in basic English at an understandable level is a requirement for employment at this facility, staff may feel most comfortable receiving essential information in their primary language.8 In order to assist these staff members with their role requirements, a pilot study was conducted to examine the effects of presenting an IPC educational intervention in French on French-speaking EVS workers' IPC knowledge. The Baptist Health Foundation provided funding for this pilot study. METHODS Sample and setting The pilot study was approved by the hospital's institutional review board and conducted at a 434-bed Magnet® redesignated hospital in the Southeastern US. English isn't the primary language of 35% of EVS staff at this hospital. Participants were included if they worked in EVS and spoke French as their first language. Class participation was mandatory, but participation in the study was voluntary. Design This intervention was conducted as a pilot study, which is a study implemented on a smaller scale to determine the needs, potential problems, or feasibility of a larger study.9 The investigators assumed that the participants would learn better when taught in their native language.10 A quasi-experimental design was selected to assess the effects of an educational intervention in French on participants' knowledge related to their role requirements. Necessary resources, design of the intervention, and time required to complete the study were addressed. Procedure Potential participants were identified by posting a flyer on the EVS huddle board inviting them to attend an educational session. In addition, an announcement was made about the class during the EVS daily huddles. Of the 25 EVS staff invited, 23 attended. The primary investigator invited attendees to participate in the study at the beginning of the class. An interpreter repeated the invitation in French. Completing the paper-and-pencil questionnaire pre- and postintervention implied consent to participate in the study. Intervention: educational session The IPC team consisted of two nurses with a combined 23 years of IPC experience, and the director of EVS. This team developed a one-time, 1-hour, in-person educational session for EVS staff members whose primary language was French. The principal investigator, an IPC nurse, working alongside a French interpreter, presented the class, which was titled Environmental Services Education Infection Prevention and Control 2024. - Research box Purpose The purpose of this funded pilot study was to examine the effect of an educational intervention presented in French on knowledge of infection prevention and control among French-speaking environmental services workers. Location and description 434-bed Magnet®-redesignated hospital in the Southeastern US Time frame One-time educational intervention Population French-speaking environmental services employees Collection tool (questionnaire) An investigator-designed questionnaire translated to French was used to assess knowledge of infection prevention and control procedures pre- and postintervention. Sample size N = 10 The IPC team identified the most important information to be included in this education session (see Table 1). Class attendees had previously received this information in English. A PowerPoint presentation of this information was developed in English and translated into French by a translation service. During the class, the primary investigator presented key points in English. Following each point, the interpreter expressed the same information in French. Active participation in the class was encouraged. For example, attendees participated in a hand hygiene demonstration, using Glo Germ®—a product used as a visual aid when teaching proper handwashing and infection control practices—and a black light. Instructors provided verbal feedback on what participants did well and what they could have done better. The principal investigator and a second IPC nurse were available for guidance and questions. TABLE 1: - Education session content Infection prevention and control team members Importance of hand hygiene Detailed process of proper handwashing, with demonstration Hand hygiene considerations when wearing gloves When to perform hand hygiene Hospital practice of observing staff for hand hygiene compliance Specifics of various precaution level considerations such as: – Standard precautions – Contact precautions – Contact spore precautions – Droplet precautions – Airborne precautions What cleaning products to use for each level of precaution, with disinfectant contact time What surfaces must be sanitized when cleaning a patient room Survival time of various pathogens on environmental surfaces Considerations for high-touch surfaces Additionally, class attendees received handouts written in French. For example, one handout included pictures of the contact times for the disinfectants that EVS staff use. The handout was laminated so it could be kept on the EVS cart as a reminder of the contact time needed for each disinfectant. Measurement The investigators developed an 11-item questionnaire to assess knowledge of IPC requirements. The questionnaire, which was created in English and translated into French, took approximately 5 minutes to complete. The following two demographic questions were included. 1) How long have you worked at the facility? 2) How long have you worked in the cleaning industry? RESULTS This study was conducted to assess participants' knowledge regarding role requirements and to determine the feasibility of a larger study related to necessary resources, intervention design, and time required.11 Ten participants completed the two demographic items on the questionnaire. Eight participants had worked at this facility for 0 to 3 years, and two participants had worked at the facility for 4 to 8 years. Within the cleaning industry, five participants had worked for 0 to 3 years, five participants for 4 to 8 years, and one participant for 9 to 15 years. Eight participants completed both pre- and postquestionnaires regarding knowledge. Table 2 contains preintervention responses to the nine knowledge items. It appears that participants were more knowledgeable preintervention than expected. Postintervention questionnaires revealed little change in participants' knowledge following the education session. TABLE 2: - Correct responses, preintervention (N = 8) Item assessed (correct response) Correct (n) Total (n) % Correct Hand hygiene is the best way to prevent the spread of infection (true) 7 7 100 I need to perform hand hygiene even if I'm wearing gloves (true) 5 6 83 Match the disinfectant with the correct contact time – Oxivir wipes (1 minute) 6 6 100 Match the disinfectant with the correct contact time – Bleach wipes (3 minutes) 4 5 80 Match the disinfectant with the correct contact time – Virex Plus (5 minutes) 6 6 100 Match the disinfectant with the correct contact time – Sani-Wipes (2 minutes) 4 5 80 For a terminal clean in an airborne isolation room, how long should the door remain closed before Environmental Services enters to clean? (70 minutes) 6 8 75 I should perform hand hygiene for (20 seconds) 6 8 75 How long can C. diff live on surfaces? (>5 months) 6 6 100 Key: C. diff, Clostridioides difficileNote: The last three items assessed were multiple-choice questions. DISCUSSION Given concerns among infection control staff regarding the education of EVS staff, participants' responses were unexpected. Their knowledge was at a high level preintervention; therefore, postintervention results were similar. It's possible that the language barrier, rather than a lack of knowledge, is the challenge that needs to be addressed. These employees may not have fully understood accreditation surveyors' or IPC nurses' questions or processed information relayed in English quickly enough to provide a correct answer. In addition, the small group of participants who responded to the questionnaire may have been confident in their ability to perform expected duties. Another possible explanation for the unexpected level of knowledge preintervention may have been that the areas assessed didn't reflect participants' knowledge gaps. Although the outcome of this intervention didn't align with the researchers' expectations, it was a successful pilot study because the results can inform future educational initiatives or research studies. These findings could guide future research to: 1) identify specific areas to include in an educational intervention, and 2) develop strategies to understand the barriers preventing individuals from participating in a study. Limitations Because this was a pilot study, the sample size was small, which limits the generalizability of the findings to the broader population of EVS staff. Participants' high level of IPC knowledge preintervention may have contributed to the minimal change observed postintervention. Furthermore, the measurement tool used was brief, which might have limited its ability to assess the full scope of participants' understanding. The intervention consisted of a one-time, 1-hour educational session. Perhaps a longer or repeated intervention is necessary to observe a significant increase in knowledge. Additionally, those who volunteered to participate in the study may differ from those who received the education but didn't complete the questionnaire, in ways that could impact the study results. IMPLICATIONS FOR NURSE LEADERS Nurse leaders should recognize the importance of effective communication with EVS staff, especially those for whom English is a second language. The challenge related to educating these employees may be to assist them with feeling confident that they can interact in English with colleagues and surveyors in a timely fashion. Increased informal interaction among individuals who speak English fluently and those who don't may increase confidence. Further research in this area is recommended. Nurse leaders should consider conducting needs assessments to identify specific knowledge gaps among EVS staff. Tailoring educational interventions to address these gaps may enhance the efficacy of training programs. Understanding and addressing cultural factors that influence learning and communication can improve the effectiveness of educational interventions. Nurse leaders should strive to create a culturally competent work environment. UNDERSTANDING EVS WORKERS' NEEDS EVS staff play a critical role in maintaining hospital hygiene and infection prevention. Despite the high level of preexisting knowledge among participants, language barriers might present challenges to effectively communicating with and educating these workers. The study highlights the importance of inclusive practices, targeted education, and cultural competence. By recognizing and addressing the unique needs of EVS staff, nurse leaders can foster a more supportive and collaborative work environment. This approach could boost morale, reduce turnover, and strengthen the hospital's infection prevention efforts, ultimately contributing to better patient outcomes.