Maria Fernandez cleans and disinfects a room at Providence St. Mary Medical Center as she undergoes an extensive regimen to combat the risk of patients getting a health care-associated infection.

Maria Fernandez disinfects cables of patient monitoring devices in a room at Providence St. Mary Medical Center.

Maria Fernandez cleans and disinfects a room at Providence St. Mary Medical Center as she undergoes an extensive regimen to combat the risk of patients getting a health care-associated infection.

Maria Fernandez disinfects cables of patient monitoring devices in a room at Providence St. Mary Medical Center.

Patients coming to a hospital for a stay — planned or not — will encounter a care team almost immediately.

Nurses, physicians and an array of nutrition, respiratory and other therapists typically surround them with all manner of expertise and care.

Before that happens, however, perhaps the most important moment of a hospital stay has already taken place: Bacteria that can cause hospital-acquired infections have been decimated through the wiping, rubbing and scrubbing of the housekeeping staff.

Maria Fernandez is one such warrior.

At 52, she has worked at Providence St. Mary Medical Center for nearly nine years as part of Environmental Services, the hospital’s housekeeping department. Each workday, she commands a large cart that is a mobile headquarters for an arsenal of cleansers and equipment.

When Fernandez enters a room, she’s well prepared to battle the unseen enemy.

Her realm is the Intensive Care Unit, and she rules when it comes to germ warfare, said her supervisor, Phil Smith.

“Marie is good at it, she has a whole system so she doesn’t miss anything,” Smith said.

It’s hugely important work, noted Elizabeth Bowen, infection preventionist for St. Mary.

Bowen, a nurse, among other titles, spends her days working to keep the hospital clear of preventable, health care-associated infection.

According to the Centers for Disease Control and Prevention, in 2011 there were an estimated 722,000 such infections in acute-care hospitals in the United States, and about 75,000 of the victims died while hospitalized.

Not only does that cost an estimated $20 billion per year, but the federal government monetarily penalizes hospitals with high rates of such infections.

In early 2015, St. Mary was one of 17 Washington state hospitals that saw Medicare reimbursement reduced by 1 percent for one fiscal year for having too many potentially avoidable patient mistakes, including central-line blood infections, as defined by the federal Centers for Medicare and Medicaid Services.

The data used in that finding was from an assessment period of 2011 to 2013, hospital officials said then.

Among the most effective battle plans for reducing incidences of infection are hand washing and room decontamination, according to the National Institutes of Health, which recommends hospitals use high-quality cleaning products, especially on spots close to patients like bed rails, bedside tables and doorknobs.

Some pathogens can survive a long time in any environment, particularly methicillin-resistant Staphylococcus aureus, or MRSA, plus norovirus and clostridium difficile, known as C. Diff.

Such diseases call for frequent room cleanings from top to bottom and everything in-between, the NIH says.

There is no doubt preventing the infections in the first place is better for the patient and for hospital finances, said Bowen.

Providence Health & Services, St. Mary’s parent company, has been focusing on infection control in all its facilities. In the coming new year, plans call for a “double down” on all sanitation efforts, including using the best products available and more swab and black light testing of the “high touch” surfaces, she said.

Hospitals have an infinite number of places for bacteria to hide, but there are 17 hot spots that need the strongest ammunition, including hospital stairwells.

Besides some obvious sites, such as the nurse call button, sink and toilet seat, there are areas people often don’t think of, like phones and light switches, Bowen said.

Fernandez and other cleaning staff enter the germ-laden sites every day, tackling the bacteria before the next patient arrives or while the room is still occupied.

If the patient has been discharged, it’s time for what the hospital calls a “terminal clean.” Fernandez starts that process on this day in Room 456 in St. Mary’s ICU by deploying a federally registered disinfecting foam around the room and the adjoining bathroom. Every cord and line on each monitor gets likewise coated.

Fernandez works her way around the room clockwise, using dozens of sanitized cleaning cloths. The bed gets stripped and she has her way with the encased mattress, lifting and flipping, wiping hard over every square inch

Before she’s done, she will remove and replace privacy curtains and window treatments, clean every piece of furniture and rid the room of anything that doesn’t belong in it.

Even one piece of paper dropped into the trash can calls for a whole new liner; reaching in and removing what seems a clean item is a no-no, Smith said.

“Because anything not cleaned can be transferred to the next patient,” he explained — exactly what his crew is fighting against.

Recruiting more employees like Fernandez can be difficult.

“It’s very hard work,” said spokeswoman Kathleen Obenland, adding that just like emergency responders, Environmental Services staff must be ready to jump in at a moment’s notice.

“Often people are waiting on these rooms. Every move in a hospital waits upon a clean room,” she said.

Fernandez said she accepts the responsibility that accompanies her work.

“I think I am a very important part of the medical team, even though I am at the bottom,” she said.

Every hospital cleaner is at the top of Bowen’s list, however: “The people in Environmental Services are my best friend.”

Sheila Hagar can be reached at sheilahagar@wwub.com or 526-8322.

Sheila Hagar has written for the Walla Walla Union-Bulletin since 1998. Sheila covers health, social services and city government in Milton-Freewater, Athena and Weston in the Walla Walla Valley.

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