Environmental services teams (EVS) are crucial players in ensuring patient satisfaction and combating health care–associated infections, yet, too many EVS teams are invisible. They deserve recognition, and this article by environmental hygiene experts explains why and how to give appreciation effectively.
Few jobs are as important and often as thankless as environmental services (EVS). These teams are key players in ensuring patient satisfaction and combating health care–associated infections (HAIs), but many of them are virtually invisible, without professional job titles or presence in the hospital organizational chart. Many health care facilities around the world employ (or outsource) relatively untrained cleaners for low wages. They then demand EVS staff work long hours in relatively demanding conditions and often in contact with dangerous chemicals and fail to recognize the importance of these jobs or understand how this work can disrupt the chain of transmission. As a growing body of evidence demonstrates the hygienic health care environment is important for patient safety,1-3 many institutions still do not consider healthcare environmental hygiene (HEH) there needs to be a shift in how facilities view health care environmental hygiene (HEH). The focus of this shift must center on EVS teams.
At the Geneva University Hospitals (HUG) in Switzerland, environmental hygiene holds special importance. Prior to becoming the director of WHO Collaborating Center on Infection Prevention & Control and Antimicrobial Resistance, the Infection Prevention and Control (IPC) Department led by Didier Pittet, MD, restructured the way cleaning was performed at the hospital, including the practice of hand hygiene. These changes were organized into what would become the World Health Organization (WHO) multimodal hand hygiene improvement strategy, which includes 5 elements: system change, training and education, monitoring and feedback, workplace reminders, and institutional safety climate.4 Ultimately, many of these changes directly affected the EVS teams, reducing cost and staff turnover and improving quality. Although this restructuring was radical at the time, its continued success may provide some guidance for improving HEH programs, especially the challenges facing EVS teams. At HUG, EVS staff have living wages and opportunities for career advancement and remain employed at the hospital for an average of 22 years.
To initiate these changes and avoid the increasingly common outsourcing of EVS staff to an external service provider, HUG conducted an analysis of the HEH program. Resources from overcleaned, noncritical areas were reallocated to more important zones. Non–health care areas such as offices and conference rooms were outsourced to an external service provider, and all health care areas were exclusively cleaned by in-house staff. HUG redeveloped the training system, educating staff not only on cleaning procedures but also on the transmission of pathogens and the importance of cleaning itself. Because EVS staff often come from a lower-income demographic, HUG and regional authorities developed national part-time certification programs of 2 to 3 years. Any staff member who desires to improve their knowledge may do so for free. The courses not only cover EVS management but also reading, writing, and other subjects. Individuals participating in the program can attend these courses during their work time; HUG pays for the courses, the hours staff members spend in them, and the cost of additional staffing when individuals are in class. All EVS team managers are hired directly out of the pool of graduates of the certification program. This formula not only motivates the team but also lends legitimacy to the management, as they have first-hand knowledge of what the job entails.
Because HUG is a public institution, EVS teams have job security once they pass their trial period and can be terminated only for a major transgression or instance of misconduct. EVS staff have the option of joining the union, and the union meets regularly with hospital management.
After initial training, staff continue to receive additional training on specific environments and procedures and may receive individualized training if needed. Managers are always onsite, although EVS staff mostly clean alone. They have pretreated flat mops and cloths for every room and a detailed checklist for procedures on their cart. Tasks are clearly divided between the EVS staff and nursing staff so that no areas are unassigned and left uncleaned.
Monitoring of staff performance is conducted twice a year for each individual and consists of visual and adenosine triphosphate (ATP) tests. Both tests are designed to verify the process; the goal is not to trap someone who missed a spot but to ask an individual to clean a surface to be evaluated and examine the process with the manager if the surface does not pass the ATP test. If needed, monitors will reexamine the cleaning procedure in a pedagogic setting, identify and address the issue causing the lapse in quality, and retest the procedure. If performance is consistently good, staff members may train to become increasingly specialized, such as working exclusively in operating theaters.
Employees can be taught to wipe a surface correctly, whether they are directly employed or outsourced by the hospital. The problem does not lie with outsourcing itself but that institutions usually get what they pay for. It is common practice for health care facilities to cut funding for their HEH programs when budgets are tight, and those cuts affect the EVS teams directly. It is easy to see why EVS workers may receive minimum wages; they usually come from a lower-income, relatively uneducated demographic and the skills required of the position rarely lend themselves to specialization. But failure to invest in employees has a detrimental effect on staff morale, retention, and quality of work.
To perform at their best, EVS teams need all 5 components of the WHO multimodal strategy: necessary cleaning products and equipment, continuing training and education, regular monitoring and feedback that is constructive and includes individualized plans for improving performance, reminders that include HEH safety posters and tasks to be performed, and other elements that are more difficult to quantify but build a strong institutional safety climate. This last component is the most difficult to achieve because it requires ownership of the work and mutual respect and benevolence among EVS teams, medical and nursing staff, and management. It is therefore crucial for the HEH program that EVS management work closely with the institution’s IPC department.
All these measures, from decent wages and benefits to onsite management and certification programs, incur a significant cost to the institution. So how can such measures be justified? To do so, one must look at the cost in context. According to the WHO report on HAI, the pooled HAI prevalence in high-income countries was approximately 7.6%.5 The annual estimates of the financial cost of such infections is approximately $6.5 billion for the United States and $7 billion for Europe.5 For improved hand hygiene practices (estimated to cause between 50% to 70% of HAIs), some studies estimate between a 35- and 92-fold return on investment.6 Even if only 15% to 20% of HAIs are spread through the environment, they remain a huge financial burden. The Centers for Disease Control estimates that of the $45 billion cost of HAIs, $25 billion to $31.5 billion could be saved with better IPC programs.6 In short, although limited data exist about HEH on its own, infection prevention has a higher return on investment than nearly any other cost-reducing medical intervention. The issue with HEH is that indirect costs of HAI are often not calculated in the same budget, making the connection more difficult to quantify.
Because HEH practices are generally heterogeneous and not usually based on best practices or evidence, there is much room for improvement. Nevertheless, the HUG model for environmental hygiene is not universally applicable in its current state. Most health care facilities around the world do not have access to the same level of resources or institutional support. The IPC research team at HUG is working on creating a transposable model of its HEH program so elements from their experience can be adapted and adopted to all levels of resources and cultural contexts.
Global improvement will require a major cultural shift in how hospitals see HEH programs as a whole, starting with the realization that EVS teams are an integral part of infection prevention and as deserving of support and respect as any other staff. Simple, low-cost interventions can make a real difference. Better training, clearer instructions, and more respect and communication in the workplace will have a positive effect on the health care facility’s budget, EVS teams, and patients.
1. Peters A, Schmid MN, Parneix P, et al. Impact of environmental hygiene interventions on healthcare-associated infections and patient colonization: a systematic review. Antimicrob Resist Infect Control. 2022;11(1):38. doi:10.1186/s13756-022-01075-1
2. Mitchell BG, Dancer SJ, Anderson M, Dehn E. Risk of organism acquisition from prior room occupants: a systematic review and meta-analysis. J Hosp Infect. 2015;91(3):211-217. doi:10.1016/j.jhin.2015.08.005
3. Dancer SJ. Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination. Clin Microbiol Rev. 2014;27(4):665-690. doi:10.1128/CMR.00020-14
4. A guide to the implementation of the WHO multimodal hand hygiene improvement strategy. World Health Organization. 2011. Accessed August 20, 2022. https://apps.who.int/iris/handle/10665/70030
5. Report on the burden of endemic health care-associated infection worldwide: clean care is safer care. World Health Organization. 2011. Accessed August 20, 2022. https://apps.who.int/iris/bitstream/handle/10665/80135/9789241501507_eng.pdf
6. Townsend J, Greenland K, Curtis V. Costs of diarrhoea and acute respiratory infection attributable to not handwashing: the cases of India and China. Trop Med Int Health. 2017;22(1):74-81. doi:10.1111/tmi.12808
7. Peters A, Schmid MN, de Kraker MEA, Parneix P, Pittet D. Results of an international pilot survey on healthcare environmental hygiene at the facility level. Am J Infect Control. Published online March 6, 2022. doi:10.1016/j.ajic.2022.02.029
Choose Your Investment Guru Wisely – Forbes
If you want to learn how to play tennis, it makes more sense to take the Masterclass from Serena Williams than to watch a random infomercial or a video from your high school coach. If you want to learn about investing you should also seek out the best.
Warren Buffett is verifiably the best investor of all time, with an audited track record going back several decades. Why, then, do so many would-be investors choose other role models, who all too often turn out to be hucksters and hacks—or just plain misguided?
I’ve asked the question many times. I’ve posed it to my NYU finance students each semester for over 20 years. Still, there’s no satisfying answer. I could hardly believe it when Bloomberg reported that Caroline Ellison of Alameda, FTX, and crypto infamy (and the former girlfriend of Sam Bankman-Fried) had supposedly learned investment strategies from Edwin Lefèvre’s Reminiscences of a Stock Operator, a roman à clef based on the life of Jesse Livermore, the stock trader who made a fortune shorting stocks before the 1906 San Francisco earthquake.
I’ve heard other young stock enthusiasts cite the book before. In 2021, Business Insider published a profile of 20 ambitious teen traders. One even mentioned Reminiscences as a favorite book. It’s one thing to read this book as entertainment. It’s another thing entirely to read it as an instruction manual. That’s because the book was published in 1923—long before Jesse Livermore’s last act.
At the age of 14, young Livermore had his first job posting stock quotes at the Boston branch of Paine Webber. His colorful life makes for great artistic inspiration and Lefèvre was probably unable to resist the allure. Livermore made and lost his fortune many times, not a sign of a good investor but rather the clear profile of a gambler and speculator. Livermore was a flamboyant character. He had a railcar, yacht and an extravagant apartment on the Upper West Side. He belonged to exclusive clubs and kept many mistresses. In the panic of 1907, Livermore made a million dollars in a single day. This was real money back then. But by 1915 he had filed for bankruptcy—and not for the first time. In the end, he lost his entire fortune and filed for bankruptcy a third time. This was in 1934, when his assets were listed at $84,000 and his debts at $2.5 million. That was his final business act. His final personal act was to shoot himself to death in the cloakroom of the Sherry-Netherland hotel in Manhattan on Thanksgiving Day, 1940.
In an era where people get their news from TikTok and Instagram, it’s not surprising that they would take the same dumb approach to learning about investing. But if you ever base your investment technique on a novel, be sure you know the ending of the real story first.
Government of Canada announces investment in three Waterloo Region tech businesses – ITBusiness.ca
Today, the Federal Economic Development Agency for Southern Ontario (FedDev Ontario) announced an investment of more than $10 million in three Kitchener-Waterloo tech companies.
Miovision Technologies is a Kitchener-based company that lets cities and towns reduce traffic congestion and vehicle emissions while improving public safety through intelligent transportation solutions. With the $7.4-million repayable investment through the Jobs and Growth Fund, Miovision will develop TrafficLink and Scout, its traffic monitoring hardware and software. It also plans to increase its network by up to 100,000 intersections in North America over the next four years, and will further its transition into “Smart City” technologies, expanding its presence globally and adding 58 jobs,
Advanced Electrophoresis Solutions Ltd. is a Cambridge medical technology manufacturer specializing in the development of testing instruments for pharmaceutical companies to analyze protein structures and interactions. The repayable investment of over $1.7 million, through the Business Scale-up and Productivity stream, will allow the company to increase the production of ready-to-use customized testing instruments, and grow its sales and marketing team. Advanced Electrophoresis Solutions is looking to expand its presence in Asia and Europe while also creating 11 additional jobs within Waterloo.
Huron Digital Pathology is a St. Jacobs-based medical equipment company that develops digital imaging solutions in the pathology field for the clinical, research and education markets. With the $1-million repayable investment through the Business Scale-up and Productivity stream, the company can increase the production of its digital pathology scanners. It hopes to revolutionize disease diagnosis by being the first company to bring to market an Artificial Intelligence (AI) enabled image search engine for use in the pathology field. Huron Digital Pathology is looking to increase its productivity. with the goal of producing over 100 scanners every year and creating 11 skilled jobs.
“Tech companies, like the three highlighted today, are what builds Waterloo region’s growing resumé of research and innovation. Canadian tech companies work tirelessly to bring new products and processes to markets that will benefit our regional economy and Canadians,” said The Honourable Filomena Tassi, Minister responsible for the Federal Economic Development Agency for Southern Ontario. “The Government of Canada is committed to supporting businesses as they adopt new digital solutions, enhance global competitiveness and create local jobs that will contribute to a growing economy that works for everyone.”
After FTX, is crypto as an investment dead?
But following a series of failures in the industry, including the collapse of Bahamas-based FTX Trading Ltd. in November, bitcoin and ether prices are now down by about 75% from their all-time highs a year earlier — and financial advisors and crypto experts are divided as to the industry’s fate.
Many crypto skeptics see the collapse of FTX as confirming their worst suspicions.
“[Cryptocurrency] is highly speculative, highly volatile and it’s something you steer away from until we see signs of maturity in that sector,” said Andrew Pyle, investment advisor with CIBC Wood Gundy in Peterborough, Ont.
While the blockchain technology that underpins cryptocurrency is likely to offer investment opportunities in the future, the sector has no place today in the portfolios of the “vast majority” of clients, said Pyle, who has never recommended crypto investments.
The fallout from FTX’s collapse means “you’re looking at a number of years before you get broader public trust in cryptocurrencies,” said Mark Noble, executive vice-president of ETF strategy with Horizons ETFs Management (Canada) Inc.
“That said, I don’t think the crypto ecosystem goes away,” Noble said, suggesting that blockchain innovations will continue during what could be a long “crypto winter” of little investor interest. Horizons ETFs offers both long and short bitcoin funds.
Institutional investors who believe in the transformative potential of blockchain technology are likely to “double down” on investments, said Michael Zagari, an investment advisor in Montreal with Burlington, Ont.-based Mandeville Private Client Inc.
“Just because one investment [FTX] didn’t work doesn’t mean they’re going to stop there,” said Zagari, who suggests there will be “a lot of deals to be had” but believes the industry will remain volatile for the next 12–18 months.
He recommends allocating no more than 10% of a portfolio to cryptocurrency or crypto-related investments for risk-tolerant clients with at least a 10-year horizon, as part of their equity exposure.
FTX’s bankruptcy has caused other crypto exchanges to suspend withdrawals, with some struggling to continue operating.
And “there are going to be more shoes to drop. We just don’t how many or how big,” said Alex Tapscott, managing director of the digital asset group with Ninepoint Partners LP, during a Nov. 24 webinar.
Characterizing himself as “short-term bearish, long-term bullish” on cryptocurrency, Tapscott suggested that the Ontario Teachers’ Pension Plan Board and the Caisse de dépôt et placement du Québec exposed themselves to “huge concentration risk” by each investing in a single crypto firm rather taking positions in established cryptocurrencies. (See “Highs and lows,” below.)
Brian Mosoff, CEO of Toronto-based Ether Capital Corp., also said bitcoin and ether will endure through this crash, even if some exchanges don’t. “Nothing has changed [in terms of the technology],” Mosoff said. Bitcoin and ether “still do exactly what they set out to do: the fundamentals are the same; the value proposition is the same.”
Retail investors seem to agree. While crypto ETF assets under management dropped by $4.1 billion between Jan. 1 and Nov. 30, only $66 million of the decline was due to outflows, according to data from National Bank Financial Markets (NBFM).
“It seems like the crypto ETF users in Canada are sticking to their allocations,” said Daniel Straus, director of ETF research and financial products research with NBFM, in an email to Investment Executive. “Bitcoin and ether are both extremely risky and speculative, but the anemic outflows from Canadian crypto ETFs suggest their investors may be treating them like ‘moonshot’ long-term bets.”
Mike Tropeano, senior director of wealth consulting with Broadridge Financial Solutions Inc. in Boston, said he expects global regulators to “be much harsher” on the crypto industry after the collapse of FTX. What will follow over the next few years is “a thinning of the herd,” a flight to safety to the most established names, and more innovation.
“The information is still flowing daily, [not only] with regard to FTX but [also] with the overall market,” Tropeano said. “Anyone who is looking to play a role in the market — the [financial] advisor especially — requires a lot of diligence to stay on top of what is happening.”
Mosoff suggested some “advisors are probably relaxing a little bit,” knowing that clients are less likely to be asking about investing in cryptocurrency “until the next cycle starts.” But he said that cycle will come, and advisors should use the crypto winter to educate themselves.
While the fall of FTX and BlockFi Lending LLC have shaken the market, the depth of the crypto winter may depend on how the industry’s established behemoths weather the storm, said Daniel Gonzalez, research analyst and consultant in Toronto with California-based Javelin Strategy & Research: “If a Coinbase, crypto.com or Binance were to go down the drain, I think that would end crypto adoption for retail investors for a while.”
In many ways, the advisor’s role now isn’t different from what it was when cryptocurrencies were trading at their peaks.
“There’s absolutely a role for advisors to play here, and it’s to be the voice of reason [in terms of allocation to cryptocurrency],” Mosoff said. “But I don’t think that’s saying, ‘I’m going to rule out an asset class entirely.’”
That said, cryptocurrency has not proven to be an inflation hedge or a diversifier, said Jason Heath, managing director of Objective Financial Partners Inc. in Markham, Ont. Furthermore, “higher interest rates and a likely recession are sure to hinder speculative investments like cryptocurrency in 2023.”
Pyle said expecting retail investors to understand is unreasonable “if institutional investors, traders, analysts, portfolio managers, hedge fund managers and even regulators can’t understand this space.”
An advisor’s “paramount responsibility is to protect your clients’ wealth,” Pyle added. “Protect it from inflation, protect it from running out and protect it de facto from things that most people don’t understand.”
Highs and lows in the crypto space
Feb. 18: Toronto-based Purpose Investments Inc. launches world’s first bitcoin ETF.
October: Ontario Teachers’ Pension Plan Board (OTPP) invests US$75 million in FTX Trading Ltd. through its Teachers’ Venture Growth platform.
Oct. 12: Caisse de dépôt et placement du Québec invests US$150 million in New Jersey-based Celsius Network LLC, a crypto lender.
Nov. 10: Bitcoin hits its all-time intraday high of US$68,789.63.
Nov. 16: Ether hits its all-time intraday high of US$4,891.70.
January: The OTPP invests another US$20 million in FTX.
Jan. 10: Fidelity Investments Canada ULC announces it will add 1%–3% exposure to bitcoin in its asset-allocation ETFs. (The target allocations remain the same as of press time.)
Feb. 14: New Jersey-based BlockFi Lending LLC agrees to pay the U.S. Securities and Exchange Commission US$100 million in penalties and pursue registration of its crypto lending product.
March 31: Canadian cryptocurrency ETFs amass $6.1 billion in assets under management, according to data from National Bank Financial.
May: TerraUSD stablecoin and Luna, a linked token, crash.
June 18: Bitcoin plunges below US$25,000. It was trading above US$50,000 in early May.
July 6: Voyager Digital Ltd., a New York-based crypto broker, files for Chapter 11 bankruptcy.
July 13: Celsius Network files for Chapter 11 bankruptcy.
Aug. 17: Caisse de dépôt et placement du Québec announces it is writing down its entire investment in Celsius Network.
Nov. 11: FTX files for Chapter 11 bankruptcy.
Nov. 17: OTPP announces it will write down its entire investment in FTX.
Nov. 21: U.S. senators Elizabeth Warren, Dick Durbin and Tina Smith send a letter to FMR LLC (Fidelity Investments) asking the firm to reconsider a decision to allow 401(k) plans to offer access to bitcoin.
Nov. 27: Bitfront, a U.S. crypto exchange, announces it will cease operations in March 2023. The platform stated the decision “is unrelated to recent issues related to certain exchanges that have been accused of misconduct.”
Nov. 28: BlockFi files for Chapter 11 bankruptcy, citing exposure to FTX.
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