Table 8.

Implications of study findings

Factors	Main findings	Implications
Unit type	There were variations in percentages of surfaces cleaned across different types of units.	To identify unit-level factors (e.g., acuity of care, safety culture, unit hierarchy, teamwork) that may influence cleaning performance and variations across units To share experience with patient room cleaning (e.g., facilitators and barriers to room cleaning, strategies for improving room cleaning) across units to improve performance of the entire organization
Patient and family presence in room	Lower percentages of surfaces were cleaned with the presence of the patient and family members in the room. High-touch surfaces close to the patient and family members were more likely to be missed. Surfaces used by the patient and family members or occupied by patient belongings is a frequently observed challenge to patient room cleaning.	To educate patients and family members about the importance of EVC work to care quality and safety and how they can facilitate EVC work (e.g., including education materials in patient and family orientation) To train and empower EVC associates to communicate with patients and family members (e.g., greeting patients and family members, explaining EVC work to patients and family members, asking patients and family members for their preference) To identify and share strategies for mitigating the impact of patient and family presence (e.g., cleaning rooms when patient is out for tests and procedures) among EVC associates
Workflow (main room cleaning patterns, bathroom cleaning orders)	EVC associates followed different main room cleaning patterns and different bathroom cleaning orders. Fewer surfaces were cleaned when using the local pattern. Other main room cleaning patterns did not significantly influence the performance of EVC associates. There were variations in selecting main room cleaning patterns and bathroom cleaning orders within and across EVC associates.	To understand contextual factors resulting in variations in patterns/orders for daily patient room cleaning To identify both desired (e.g., clockwise/counter-clockwise) and undesired (e.g., local) patterns/orders for daily patient room cleaning To balance standardization of cleaning patterns/orders (e.g., precluding undesired cleaning patterns/orders) and autonomy of EVC associates (e.g., allowing EVC associates to select cleaning patterns/orders according to the context) To develop innovative tools and technologies to facilitate desired cleaning patterns/orders and hinder undesired cleaning patterns/orders (e.g., combining the checklist of high-touch surfaces with desired cleaning patterns/orders)
Interruptions during cleaning	EVC associates encountered different types of interruptions during daily cleaning (e.g., interruptions by patients and family members, by EVC supervisors or other EVC associates, by other healthcare workers, due to lack of cleaning tools and supplies, and due to other environmental situations). In general, interruptions encountered by EVC associates did not influence the percentages of surfaces cleaned, but prolonged the duration of room cleaning. Interruptions by EVC supervisors or other EVC associates were associated with longer duration of room cleaning and higher percentages of surfaces cleaned. Interruptions due to lack of cleaning tools and supplies were associated with longer duration of room cleaning.	To understand the nature of interruptions encountered by EVC associates and differentiating avoidable (e.g., interruptions that can be delayed) and unavoidable (e.g., interruptions that are necessary and value-adding to the process) interruptions To educate patients, family members, and other healthcare workers to avoid unnecessary interruptions of EVC work (e.g., including education materials in patient admission package, discussing in unit/staff meetings) To identify and share strategies for dealing with interruptions (e.g., engaging, multi-tasking, mediating, blocking) among EVC associates To facilitate teamwork among EVC associates and between EVC associates and supervisors (e.g., EVC supervisors having daily face-to-face communication with EVC associates) To ensure the availability of cleaning tools and supplies (e.g., improving the cart preparation process to help EVC associates allocate sufficient cleaning tools and supplies before shift)