Background
Methods
Results
Cleaning and disinfection
Environmental Cleaning | ||
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Theme | Examples | Quotes |
Cleaning and Disinfection activities | • Cleaning protocols already in place • Wiping down high-touch surfaces • Cleaning floors and walls • Sweeping and mopping • “Deep-cleaning” by removing furniture from rooms to clean all spaces | • “And so we just utilize our daily TB protocols, which involves, you know, and our habitability areas. We, we wipe down all surfaces in our habitability areas, in our dorms. Uh, in the showers we do regular cleaning, pressure washing of the showers. We mop all the floors and wipe down all the walls daily with, uh, with a bleach combination that we, that we purchase. Um, we wipe down all high touch areas, uh, clean all ventilation, uh, and this is what we do daily as part of our TB protocol that we just, we just rolled over into, uh, COVID, uh, 19 protocol.” |
Person Responsible | • Clients • Volunteers • Maintenance staff • Non-maintenance staff | • “There's always staff. It, it, it's a combination of staff and clients, together.” • “Yes, our clients clean the areas that- the- the community areas, the bathrooms, and then of course their rooms, twice a day. Well, not their rooms twice day, but we also have a cleaning company that comes in once a week.” |
Cleaning Routine | • Cleaning follows standard schedules or routine • Before a new client comes in and after a client leaves • Every two hours • Three times per day (morning, afternoon, evening) • Weekly “deep clean” | • “We clean um, and disinfect three times a day, at 8:30 in the morning, at one in the afternoon, and at six at night. We clean all the highest trafficking areas, which is the main entry way, the atrium, where the ladies hang out at times and the cafeteria where they eat their lunch, uh, aisle chairs, tables, uh, anything that is being touched, or we feel that is being touched by a client or either staff. We make sure that, um, we get in and clean it and disinfect it three times a day, including the restrooms and also our play area outside for the children.” |
Cleaning Products Used | • Disinfecting wipes • Unspecified sanitizing spray • Hospital grade chemicals/cleaner • Specified sanitizing spray (Fabuloso, Lysol, Gammim-14)a • Alcohol • Bleach • Glass cleaner • Lemon or pine cleaner | • “Uh, we use um, bleach. We use um, Lysol. There's some products that we received from one of our partner agencies, I cannot tell you the name of the products, um, but um, mainly disinfectants are products to keep everything clean and sanitized.” • “We use a disinfectant that the hospitals use called um, Neutral Fresh and bleach, and we have some disinfectants spray that we use also.” |
Changes to Cleaning Routine | • Increase in cleaning frequency • Focus on high-touch areas that haven’t been historically prioritized in cleaning (e.g., doorknobs, light switches) | • “I would say disinfecting the, the common areas like the, the light switches, and sanitizers (laughs), and the doorknobs. We weren't doing that before. We were cleaning, you know, you know, with the, had the regular chores but we weren't doing that until the Coronavirus.” |
Cleaning and Disinfection Promotion | ||
Theme | Examples | Quotes |
Education | • Training on how, where, when to clean, use of personal protective equipment, and daily protocols • Talks on how and why there is a need to keep the facility clean • Coach on how to clean • Community classes about hygiene | • “Yes. Well, all of that takes place. And we have o- our, um, staff meeting, um, it was stressed very much then, uh, you know, about how we have to make sure that we, uh, keep everything in order and- and everything disinfected and clean and- and it was, it was, it was just, um, we, and we also had, um, Fulton County department of health come in, they talked to us.” |
Format | • Posters • Flyers • In-person trainings • Discussions during staff meetings • Orientation sessions for clients • Community meetings • Virtual trainings or webinars • One-on-one discussions or trainings • Emails | • “We ha- have sent out emails, pamphlets, um, encouraged them to sit on Webinars about it.” • “Well, during staff meetings we address the cleaning and we've always done that and also when we have new clients, we have orientations, so we orient them on the- the expectations and the procedures and the policies.” |
Cleaning and Disinfection Barriers | ||
Theme | Examples | Quotes |
Individual Barriers | • Severe mental and physical health problems make cleaning hard • Keeping clients focused and understanding of importance of cleaning • Apathy, lack of engagement or motivation • Different ideas of clean • Different cleaning styles • Complaints about smell of cleaning products | • “And so it, sometimes, it's the challenge just to tell gentlemen, "Oh, yeah you know, I'm, I know you're tired of doing the same thing, and yeah, it may be repetitive or whatever, but we have to do it, and it's important that we do it." And just keeping it, keeping them focused is, is, is to me, one of the challenges to uh, to making this a such, you know, a successful operation… “ • “… we can motivate them. I mean, I think a lot of guys don't want to have skin in the game. They just don't want to participate, but that, that's part and parcel to their entire, to their entire life. And so, um, we have to, you know, interact with them and create relationship that, you know, that overcomes some of that apathy. Of course, there's some guys that are just apathetic, you know, and not, not want to participate at all.” |
Access | • Cleaning supplies and chemicals • Preferred supplies not available • Gloves • Gowns for cleaning | • “Availability of products has been, it… I'm sure you hear this from everybody you talk to right now. It's hard to get stuff.” • “No, I think the only other thing would be having more access to, like, Lysol type wipes or disinfectant spray. So like, there's not enough for, so like if staff, so like something we talked about the other day was okay, wait, this is great, the clients are deep cleaning three times a day. Are staff cleaning their areas? Nope. Um, and so it's like, okay, if each staff had a bottle of disinfectant spray. Or had, you know, a container of Lysol wipes, they would probably be more apt to actually, um, clean more.” |
Capacity | • Large number of clients rotating through • Understaffing or lack of volunteers to keep up with increased cleaning frequency • Individuals who can reliably do good cleaning | • “… most of our cleaning is done… by residents. Then, if we don't have the residents to do it then with us trying to social distance with staff, we don't have the amount of staff that we used to and so, people are being pulled into different roles. And so it might be on me certain day to see clients and then also make sure that the lobby has been disinfected. So, it's just, I guess that would be the biggest challenges that um, because we're still trying to, you know, service our clients and then also we have to adhere to the obligations and the requirements for sanitation.” |
Cleaning and Disinfection Facilitators | ||
Theme | Examples | Quotes |
Oversight | • Monitoring by managers or staff • Discussion with clients about why cleaning didn’t occur or wasn’t done according to protocols • More reinforcement of cleaning behaviors • Tracking logs | • “Keeping everybody informed and then going back and checking areas, check, check, check, check. To make sure that we are staying in compliance. And then being brutally honest with ourselves, with um, where we're succeeding, where we're having difficulty and where we uh, may have missed the mark or missed something that we now need to address.” |
Other | • Put positive spin on cleaning activities • Give people ownership • Cleaning built into daily activities and rhythm • Increasing awareness of why cleaning is important • Clients being willing to help with cleaning • Working together as a team, everyone pitching in | • “… depending on the client and depending on the area, we've definitely, um, moved people around as we've noticed their enthusiasm or lack thereof of cleaning to probably less high traffic areas.” |
Access | • Access to supplies needed | • “Um, we also have cleaning products, um, in the kitchen area and in the bathroom area. So if someone went in and took a bath, they know that they have to clean behind themselves as well. So they always have an abundance of products, you know, so they never run out. That's a good thing. I've not seen them run out of toilet tissue, paper towels, bleach solution, um, soap or the dish washing detergent, any of that. They've never ran out.” |
Hand hygiene
Hand Hygiene Practices | ||
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Theme | Examples | Quotes |
Hand hygiene behaviors | • Washing hands with soap and water • Hand sanitizer use • Wearing gloves | • “Washing the hands, uh, and wearing gloves and uh you know, when, wh- when, folks see that, a lot of times you see people follow, follow in step with that.” |
Key moments hand hygiene occurs | • Before handling food • Walking into or out of the facility • Before and after eating • After using the restroom | • “We, we washing our hands at all times, everybody is. You touch something, you know, you know you gotta wash your hands. We don't let the clients use the same utensils. Like when you're being served, we serve them. So we're really the only ones who use that particular utensil.” • “More. Everybody is more, you know… Anybody. We, we wash our hands, you know, like before we eat, after we use the bathroom. We know everybody's more conscious. You wash your hands constantly. If you cough, you're washing your hands. If you touch your face, you're washing your hands. If you touch the counter, you know to hit the hand sanitizer. You know, everybody's doing that more than we would normally have done it due to COVID-19.” |
Changes to hand hygiene | • Changes to HH • Increase of washing hands and using hand sanitizer • Less hand shakings, hugs, or high five | • “Well, I see, uh, I see us washing our hands more frequently as well. And then, uh, then using gloves.” • “… and just no interaction in regards to handling hands, uh, like handshakes and stuff like that. No hugs.” |
Hand Hygiene Promotion | ||
Theme | Examples | Quotes |
Format | • Posters • Flyers • Videos • In-person trainings • Meetings | • “We have posters up, like, at, at the sinks in the bathroom.” • “Well, I mean, we, we do, you know, you put up the posters and you have the training, and you know, we have the little video snippets that we have.” |
Hand sanitizer dispenser locations | • Entrance/exit of the facility • Outside the restrooms • Offices • Dining room entrance • Common areas | • “Yes. Okay. So we have sanitizers at the front door, the backdoor, the dining hall, outside the restroom, inside the rest, uh, restrooms. Um, and then we also have gloves.” • “Yeah, no, we have added, um, more, um, dispensers for hand sanitizer… um, in the building. Um, and, like, we've added them in the, like, in new places that we think would be more helpful. Like, when you come off an elevator, when you go on the elevator, when you right come in the door, whatever door you come in. Um, and more on each floor. So, we add- added access to that.” |
Hand Hygiene Barriers | ||
Theme | Examples | Quotes |
Multiple barriers | • Barriers include: • Remembering to practice hand hygiene • Limited time • Limited access to hand hygiene products • Location of bathrooms • Limited handwashing facilities • Unable to leave hand sanitizer with clients due to high alcohol percentage | • “Just getting up and just accessibility to the bathrooms. I mean it's not [inaudible] per area. It uh, it could be a long walk for some, more so than others. Uh, we have, this was a, this was designed to be an all male facility, but we've, course we've had uh female staff here over the last four or five years. So those combinations had to be created so. It's not easy for everyone just to walk across the hallway, or take a couple of feet here or there to wash their hands. So I guess, again, it's accessibility and just that reminder that something needs to be done more often than usual.” • “Um, just lack of, so like one of the main places that we hang out in the administrative office, there's no sink anywhere close by.” |
Hand Hygiene Facilitators | ||
Theme | Examples | Quotes |
Access | • Access to products | • “Well, I mean, the biggest thing you can do for staff is provide the tools to do the job… and so if I want them to use hand sanitizer, I have to make sure they have abundant amount of hand sanitizer.” |
Motivation | • Positively motivating each other | • “And then we just really, we t- We just kind of make fun of, uh, you know… Make jokes, like, hey did you wash your hands? Don't talk to me, don't touch me until you wash your hands. Stuff like that.” • “But when you, you look at it as, ‘Hey, let's join together to keep us safe and keep your family safe,’ and spin it from a positive perspective, then I notice that most people were compliant, not because you said you had to do it. More because, ‘Hey, I need to, I need to protect myself and my family. You know, I need to take care of myself, you know’." |
Hand sanitizer locations | • Placing hand sanitizer dispensers throughout facility | • “So, we've posted that. Um, and then we just talk about it. We have sanitizer posted e- everywhere so they can always, um, you know, do the sanitizer, uh, pump thing. Um, our, our, uh, CDC director has given us bottles of sanitizer. So, we promote that as well.” |
Guidance communication preferences
Guidance Information Needs | ||
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Theme | Examples | Quotes |
How to clean specific items | • Leather furniture • Toys • Electronics • Donated food • Donated furniture • Donated clothes • Soft surfaces | • “…definitely [more instructions] for [cleaning] leather furniture because I don't see guidance concerning that” |
When to clean items | • Including information on how frequent items should be cleaned | • “I think that the, the electronics surface 'cause you're using them all the time, it's like what is the frequency about what you should do this?” • “Um, so the only question I have, like, which I'm confused about, is when it's talking about like for soft surfaces to clean. Like, is this just like, so I understand how often or when to clean high touch surfaces. As far as the soft surfaces, like, is this just a if you spill something on it? Or is this something that should be done on a regular basis? How frequently?” |
Cleaning products | • Including information on what cleaning and disinfecting products to use • Ideas on how to store products and make it more accessible in large facilities | • “…maybe giving an example of EPA-registered household disinfectants because I don't think … everybody know what EPA, um, registered household disinfectant is.” • “I guess maybe just storage, or how to make it more accessible to use. Um, or maybe ideas about how to do that. Like I said, we keep… all these items in a secure place. But I think that'd be key if there was some creative ways that you could create cleaning stations where it's easy or more accessible. At least have some ideas about if you're a large facility and how to um, get to these items quicker.” |
Personal protective equipment | • Using gloves safely • Disposal process of personal protective equipment | • “Like, um, how long it should be used or like when should you change your gloves. We've been, I've had clients ask me that and we change our clients relatively often, but, um, someone just washing their gloves and reusing, for me, that's like I don't think so, but I don't, that may be something to include.” |
Suggestions for future guidance | ||
Theme | Examples | Quotes |
Communication Material Formats | Format suggestions: • Poster • Flyer • Video • Email blasts • Physical copies • One-pager summarizing guidance | • “It's just not a crisis, or even if they're in a crisis, there's some people that just aren't going to read, you know, materials. But if you put it in the form of video and then we facilitate through the video, it kind of makes it easier. I mean, that, that'd be my suggestion.” |
Low literacy | Developing materials with low literacy in mind • Use methods like adding pictures in future guidance to convey message for people with different reading levels | • “… [the guidance should be] at a medium range of- of comprehension” • “You know, we try to make it, you know, put more pictures in there, you know, of how to do things so that it catches everyone. It, it's for everyone at every, you know, level of, uh, intellect, level of understanding.” |
Communication Materials Dissemination Partners | Disseminate to existing partnerships and directly to the facility including: • Leaders of facilities • Local health department • Organizations already working with PEH • Hotels and motels PEH may access • Mercy Care • City of Atlanta | • “I think every, every group that has an interaction with individuals in a community. I mean, you go from faith based, uh, groups, because, you know, faith-based group, they don't get this type of information, and in schools. Uh, anyone that's volunteering in a volunteer capacity, that's working with, in any area where they, where they come into contact with a lot of people, but specifically when they're working in environments where individuals are homeless or individuals are marginalized in the community or, um, you know, working in areas of severe poverty.” • “Um, so some things would be helpful is connecting where people already have those connections. So like, the city of Atlanta, their continuum of care partners of home with [name] and [name], there's a phone call every week.” |
Trainings | • Web-based training on information presented in the guidance • Q&A sessions with experts to ask for clarification | • “I guess if we had a canned, uh, or like a canned training program that, you know, had a video or something with it that came from let's say the Department of Health or whoever that talked to us and give us a tool to train individuals, a standardized kind of training protocols. Especially in a video kind of, um, a media that we could, you know, sit guys in front of and show 'em, "Hey, these are the recommendations on how to clean, and this is actually how the job should get done." |