Critical Caring

If, like me, you now look askance at every object which enters your home with new-found suspicion, you are getting a small taste of what the health care workers who clean our hospital patient rooms, operating rooms and other clinical spaces experience every day.

Which items and surfaces need to be cleaned? How carefully? For how long? How do you know when you have cleaned and sanitized enough since you can never actually see the viruses or other pathogenic microbes like bacteria, fungi and molds?

At least ants, when they invade our homes, make their presence known. We can see the brazen, dark line of ant marauders marching purposefully to the cupboard to pilfer our favorite snacks and staples.

A typical ant, however, is 20,000 to 50,000 times larger than a coronavirus cell. The virus cell, at about 0.1 or 0.2 microns wide, is invisible to the human eye.

It would be so easy, when cleaning an empty room, to skip a spot or not disinfect it sufficiently. Nobody would ever notice the lapse. It would be only human to ease up near the end of a tiring shift with a long ride ahead, looming between you and home.

Some years ago in an interview, Meryl Streep, in describing her process of preparation for a role, observed, “When you are cleaning a bathroom, there comes a point where you have to decide if you are going to clean the corners.”

She was speaking metaphorically, of course, to convey the thoroughness of her approach to her craft. The metaphor, however, is clear and powerful.

It is worth noting, in the midst of the current epidemic, that the fine actress was also literally right about bathrooms, whether in a home or a hospital. Especially in a hospital.

Sometimes called Environmental Service workers, or simply custodians, the well-trained and dedicated staff who clean, disinfect and sterilize the complex spaces inside a hospital perform a vital service for which they receive little to no recognition from most patients and the general public.

In the hospitals of the UCLA Health System, whose operations I have had the privilege to observe for over two decades, the vital role of these key members of the team is acknowledged and appreciated at the highest levels of the organization.

Leaders emphasize—and environmental service workers understand—the life or death implications of their work. Their mindset is to look suspiciously at that apparently “spotless” bed pole and give it the additional wipe which could affect the safety of the next patient brought into the room.

Hospital environmental service custodians are exposed to the coronavirus—and a vast spectrum of other pathogens—to the same and often to a greater degree than doctors, nurses and techs when they perform their daily jobs. Some are frightened by the extent of their risk, all are sobered by it, yet they continue to show up for work.

A wonderful ritual was practiced across the country, including in Southern California, in which people went out on balconies, porches and yards every evening at 7 p.m. to applaud and cheer the physicians, nurses, respiratory therapists, techs and other frontline workers who have thrown themselves tirelessly and at great personal risk into the fight against the pandemic.

The next time we make use of the health care system—let’s remember to include the environmental service teams in our thanks. They form an invaluable part of this effort, and through their work, they too are unquestionably saving lives.

Seth Freeman