Towards Total Worker Health Among Environmental Service Workers
This project was designed to examine how some of the most frequently dismissed members of healthcare teams can be empowered—and how that empowerment might not only create better health for them but also help save the lives of patients. These healthcare staff are not physicians or nurses or technicians, but environmental service workers (ESWs) who clean patient spaces, dispose of waste, and ensure that infectious contaminants are not carried from room to room. These tasks may sound simple, but consider that ESWs handle bodily fluids such as blood, dangerous medical equipment like needles, and even tissue and bones. Consider also that fully disinfecting a vital signs cart, for example, requires careful attention to protect patients against healthcare-associated infections.
Many ESWs lack power in the form of adequate wages, sufficient equipment, training, and career development; in addition, ESWs are often subcontractors who have high workloads that leave them unable to clean to the best of their ability. Towards TWH for ESWs seeks to study ESWs who work at a specific type of care facility: long-term care facilities, which include nursing homes and assisted living communities. Some of the patients most vulnerable to healthcare-associated infections reside in long-term care facilities, but failing to institute effective infection control procedures doesn’t only impact them—it also can lead to increases in hospital outbreaks, especially when patient transfers take place.
In the first year of this project, members of the research team at Clemson University in South Carolina have been conducting work to better understand what environmental sanitation practices are used in long-term care facilities and what sorts of structures are in place through a survey that is being distributed to such facilities: is there an infection control committee, and, if so, who is in charge? What kinds of rooms, equipment, and other items are ESWs responsible for cleaning? Are there factors like wall-to-wall carpet, upholstered furniture, and curtains? The survey also asks questions like how many ESW workers are employed, if ESW workers are employed by a third-party company or by the facility directly, how many rooms ESWs are responsible for, and what sorts of training they receive.
Along the way, work is also being conducted at University of California Los Angeles (UCLA) to better characterize how ESWs may experience power disparities and how power is exercised over them. Research has increasingly shown that worker well-being is affected by the power they are allowed to exercise at work, like being able to operate autonomously or have control over what order tasks are completed. In addition, lack of ESW power is exacerbated by structural problems like outsourcing, time pressures, and unsupportive team structures. Members of the UCLA research team have been examining theories of power, how power is perceived by those who do—or don’t—possess it, and the sources of power and how they may influence working conditions. The long-term aims of this research include characterizing disparities in work and health experienced by ESWs, but also to outline how ESWs may be empowered. If the working conditions that ESWs experience are improved, and ESWs are valued and invested in as members of the healthcare team, it seems likely that cleaning practices will improve as well. The research also plans to examine existing training interventions to see how they account for power in order to lay the groundwork for future training developments.