C CLEANING b ehind the scenes
Hospital cleaning crew risks exposure while reducing others’
NEW HAVEN — They enter where others are barred, risk exposure to the coronavirus and fear bringing it home to their families.
If they don’t do their job well, no one else can, either. They are ever present, but little noticed. They are the people who keep Yale New Haven Hospital clean.
Cesar Vazquez and Tara Smith each have been on the hospital’s environmental services team — the cleaning crew — for about two years. But their jobs were never as important, or as nervewracking, as they are now.
Both were on COVID- 19 wards, though Smith’s unit in the East Pavilion has been turned back into a regular medical unit. “For me it was personal. I treated it like it was my home,” Smith said of working in rooms occupied by extremely ill patients. “I made sure I did it as well as possible … and just taking the extra precautions.”
“It’s kind of scary … seeing the amount of people that have been affected,” said Vazquez. “The concern level really rises up, not only for your family but you have to protect the staff and the patients in the hospital as well.”
Vazquez, who lives in Hamden, has an 11- year- old daughter with health issues. “Coming to work and bringing something home, that’s an extra stress level that’s taking a toll on me,” he said. “We all have a job to do and it’s very important that we be here.”
He’s still working on the 12th floor of the Smilow Cancer Hospital, which was turned into a COVID ICU because the floor is set up with negative- pressure rooms, so the air is circulated to the outside. The cleaning team is given N95 respirator masks and face shields when they are in the intensive- care units, along with yellow, neck- to- knee isolation gowns and gloves.
The respirators, which must be kept on whenever someone is in a patient’s room, are the hardest to wear. Taking them off and putting them back on again — medical personnel refer to it as doffing and donning — is a lengthy process in order to avoid contaminating them. “You literally have it all day, so you have to step into the hall to take a deep breath sometimes,” Smith said. That means leaving the intensive- care unit entirely to go into a common area or by the elevator. She lives in West Haven with her 12- year- old daughter and 5- year- old son.
It was more difficult when COVID patients first were admitted, Smith said. “Things were changing every other day, sometimes every hour. The PPE was a big change. … You have to make sure your hands and everything were sanitized before you put on the mask.”
“Sometimes it’s kind of tough to wear those all day because I’ve been noticing I’ve been getting migraine headaches, but you got to think it’s safer than not wearing it,” Vazquez said.
He said not coming to work was never a serious consideration. “All I got to do is keep good faith. … Somehow we’ll get through this,” he said.
The environmental services team’s job is to empty the trash and linens and clean everything that someone might touch, from the bedside table to the TV remote control and phone to everything in the lavatory. “I think, basically, at this point everything,” Vazquez said.
Both said there being so many unknowns with the coronavirus make work more stressful. “Not knowing how to treat it and how to take care of it. We don’t even know what to take to make you feel better … so that’s the scary part for me,” Smith said.
She said in order to minimize entering and leaving patients’ rooms, she made sure she was equipped with everything she needed when she went in. “I would just make sure I was protected and wearing the proper PPE. I’d just make sure I had everything I needed to properly clean and sanitize the room.”
Once a patient is discharged, the room needs another thorough cleaning, including the bed. Vazquez said they are thinking about the nurses and aides who will be entering the room, as well. He said everyone working together, including the managers, are “like a strong family.” His bosses are “really understanding and if we have a problem or a situation they’ll pinpoint it out and take care of it.”
“Everybody’s in cahoots with each other,” Smith added.
Morale lifts when a patient is discharged and Andra Day’s “Rise Up” is played over the loudspeaker. “It gives you hope,” Vazquez said.
Both Smith and Vazquez know they are not the employees who get the most recognition. But they know how vital their job is and take pride in it. “Cleaning is very important,” Smith said. “We get overlooked a lot, and not purposely.”
Dean Caruso, executive director of support services and sustainability, doesn’t overlook them. “I have a deep appreciatin for the work that they do and I wish they got more recognition and appreciation than they often do,” he said. “Now everyone understands that something that looks clean could still be a harbinger of something that makes me sick. … They are truly heroes.”
Caruso said the level of precaution the cleaning crew is taking isn’t new. The isolation gowns and other equipment have been used with patients who have contagious infections such as C. diff. and MRSA.
“The reality is they are performing the same level of cleaning and disinfection that we used before COVID,” he said.
One thing that has been taken to a higher level is the inspection process. Each day a number of rooms are randomly chosen and 17 surfaces, designated by the Centers for Disease Control and Prevention, are marked with a special pen. “We go through and verify with a blacklight … that those 17 touchpoints were cleaned,” Caruso said.
Before, three failures meant the room had to be cleaned again. “Now, if one touchpoint fails, we reclean the room because the staff are that concerned about the efficacy of their work,” he said.
The crew uses Oxivir, which contains hydrogen peroxide.
He said the increased use of protective equipment is “really trying to ensure that they have confidence in the procedures and the materials they are working with. … There’s a heightened awareness in helping the staff understand that if you follow the proper procedures and do it the way you’ve been taught, then you’re in a good place.”
Environmental services manager Christina Peters, who supervises Vazquez and Smith, said the team has become more comfortable working in COVID units as time has passed. “Obviously, when it first started it was a little bit scary but the hospital gave us the tools and materials we needed,” she said. “I can honestly say, we’re in week nine now and the staff is a little more comfortable,” Peters said. “They were very nervous and hearing things on the news about other places not having enough equipment. They’re a lot more comfortable now.”