Pathogen Slayers

Mitch: From University of Utah Health and The Scope Presents, this is Clinical

I'm Mitch Sears, producer for The Scope Radio. For the past six months, we've been developing a series that really focuses on looking behind the scenes at everything that makes a hospital, well, a hospital, an institution that is not only able to treat diseases and traumas but really heal and care for the patients that enter through those sliding glass doors every single day, stories that look beyond the life-saving efforts of doctors and nurses to the hidden heroes that work behind-the-scenes to keep the heart of this medical institution beating in time with the needs of its community.

Now, the series itself isn't finished yet. We've been put on hold with the international pandemic of COVID-19. But our very first episode, "Keeper of the Keys," is focused on the efforts of the workers who have been killing germs, viruses, and pathogens for decades before we all found ourselves acutely aware of viruses and their spread in the year 2020.

Co-producer Stephen Dark has been reporting on the world of environmental services and talking to these frontline workers about their experience.

Stephen, what made you think about doing a story about the cleaners?

Stephen: Funnily enough, I have a personal connection. As a young man in England, I needed to earn some money to pay for a plane ticket to the States. I worked in the local hospital for a year cleaning floors. What stood out for me is how you get to know not only the structure and physical layout, but also the emotional rhythm of the hospital intimately. Yet at the same time, you feel invisible. It's as if you're part of the furniture or the wallpaper.

As I've walked the halls of University Hospital and seen people doing work I once did, I've often wondered, "What do they see and how do they feel about what they do?"

Mitch: And I'm sure they have a perspective that no one else has.

Stephen: They surely do, and that's what I wanted to learn about. Some come from conflict-torn countries with stories of trauma and suffering. They have built new lives here doing this work. Unfortunately, it's work that's often taken for granted and not as appreciated as it should be. And now, with COVID-19, we have a new urgency to concerns about cleanliness, sterilization, and keeping up our pathogen defenses at all times.

Mitch: Yeah. I mean, it really does feel like a whole new world in just the past few months. And especially for those workers that are in the hospital every single day potentially exposing themselves to an infection, I can only imagine what it's like to be on the frontlines doing this kind of work.

Stephen: One of the things that struck me as these first weeks ramped up was how vulnerable you must feel in a room where a COVID patient has perhaps died and not having the same background of medical knowledge that the nurses and the doctors around you have. And yet being called upon to essentially sterilize that room and prepare it for the next patient, there's a vulnerability and responsibility that has to weigh on your shoulders. And I wondered, "How do you keep coming in day after day not knowing quite what lies in wait?"

Mitch: And in light of the urgency we find ourselves in right now, we spoke with Jessica Rivera. She's a manager of Environmental Services at University of Utah health clinics. And she gave us a first-hand look and what it's like to be on the frontlines as an Environmental Services worker during the time of COVID-19. We at Clinical feel it's so important to draw attention to and recognize these frontline heroes and what they're doing to help keep us all safe.

Stephen: In the days before the virus, when I walked the corridors of the hospital and saw an EVS employee's cart parked by the restroom, one of those "Beware Slippery Surfaces" signs in front of the open door, I couldn't help but flash back 40 years to when I cleaned floors at a hospital in the county of Kent in Southeast England. I spent a year buffing floors, my 7:00 a.m. to 3:30 p.m. days dedicated to dragging a heavy floor polisher all the way to the left, all the way to the right, and back to the left again.

Hospital cleaning has evolved so much in the last four decades, including the name. Not cleaners, not housekeeping, not janitors. We're talking Healthcare Custodian currently, although Environmental Services Specialist is a new term that's being phased in according to some of the folks that we've talked to.

Currently during the COVID-19 crisis, only essential staff enter the hospital, doctors, nurses of course, while other staff such as pharmacists and food prep workers are on an as-needed basis. EVS staff, however, are needed round-the-clock. They are on the frontline with the providers. They are essential to battling the virus, and they provide so much that never makes it to the balance sheet that we'll tell you about in our series.

For now, I wanted to ask this one question: What's it been like for EVS employees to battle COVID-19? They are the first line of defense against the novel coronavirus in any medical facility. Don't they feel vulnerable? How do they keep coming back to work day after day after day to face this invisible killer for $15.75 an hour and benefits?

Jessica: My name is Jessica Rivera. My title is . . . I'm the Environmental Services Director for Community Clinics. I've been working for the university for about going on 12 years. And I make sure that my employees are well cared for and so is the facility, that it's a safe and clean environment for all of its occupants.

Stephen: Rivera's office is in South Jordan. It's next to the Health Center. Behind her is a floor-to-ceiling window that fills the room with light. It's spotlessly clean but not in the least bit sterile. There's a warmth to it that comes from Rivera herself. She has this big smile under a pixie cut auburn hair with just the tiniest of endearing gaps in her front teeth that somehow make her even more human.

She's the first to acknowledge that compared to my days of floor cleaning and waving a dust cloth at patient's bedside lockers, the healthcare custodian's role has dramatically evolved.

Jessica: We are environmental services technicians. Our employees clean to make the environment a safe and clean place, right? There are a lot of hospital-associated infections, so we want to make sure that when our patients come to our facilities, they come here to get healthy and not leave with something.

Stephen: Rivera's 80-odd employees are part of a 235-strong department that's responsible for cleaning all the used medical facilities from Ogden to Provo. She puts her faith in systems, in tried-and-tested formulas, in chemicals and routines. Every day, she and her staff draw a line between life and death with chemicals, sprays, and wipes.

But it's more than that. There's such a personal element to saving lives. As the media went 24/7 over COVID-19, she tried to explain to her team the task before them. It boiled down to two simple words: slaying pathogens.

Jessica: I know there's all this information coming out. So many webcasts and live feeds for all of these things. And I wanted to talk to the team and somehow reassure them and empower them that during these times of uncertainty, where all this new information is changing every single day, we could really protect ourselves and focus on the fundamentals of our cleaning techniques and our foundations. This is something that you do every day and you do it really well. You slay pathogens all day.

And while COVID-19 is scary, it's still a pathogen, and you still follow the same techniques for cleaning top to bottom, and cleanest to dirtiest, and in a methodical manner, whether that's clockwise or counterclockwise. You still follow those same principles, and you'll make sure that the environment is clean and safe for yourself, and our patients, and anyone who comes in the building really.

Stephen: It's a complex process, cleaning rooms and services, ensuring that no pathogen is left alive.

Jessica: We use a one-step cleaner disinfectant. It is EPA and hospital approved by Infection Prevention Control to say, "This is the chemical that you utilize to clean all environmental surfaces."

And then there are multidrug-resistant organisms that particular chemical won't kill. And so the clinical staff will place signs on the door that alert my employees that they need to wear specific personal protective equipment and, in some cases, use a different chemical, making sure that the chemical is on the surface for the kill time or dwell time to make sure that when that time is over, there are no longer any pathogens on the surface.

So each wipe has a different dwell time or kill time to kill those particular pathogens. So for the bleach wipes, it's four minutes. For the gray-top wipes, it's three minutes. And for the purple wipes, it's two minutes. So knowing that that surface has to remain wet for that long to kill those pathogens.

So with COVID, it's following those same processes that we were doing before to slay this pathogen, right? We are just now increasing the frequency of the different areas. So clean the lobby areas more frequently, clean the doorknobs more frequently, our cell phones. Those things that we use throughout the day get cleaned and disinfected more often throughout the day.

Stephen: But it must be at the back of your mind just how big a risk are you facing. Each room you go into, each surface you have to clean in the era of COVID-19.

Jessica: I guess, in some ways, it feels riskier because it's a new virus and there's a lot that we're still learning about it. And if you were to be exposed, we start assessing that risk, and how could we potentially be exposed at work, and what would happen if I was exposed, or if I was tested positive. Those are the thoughts and things that they go through my own mind, through the minds of our employees and our families.

And the pressure of feeling that those who are closest in your circle, your family, your friends, I think has a lot of impact whether or not you feel safe at work, because if they're watching the news, and watching YouTube, and they're telling you, "It's not safe out there. Don't go outside. Don't go to work," that can definitely shake your core.

Stephen: If there's an irony here for Rivera and her staff, it's that in many ways the clinics, the health centers, and the hospital feel safer than anywhere else. That's because of the protocols and the strict measures that are in place, the temperature checking, the universal masking, are there as barriers to the virus. They have the PPE they need, at least for now, and so, she says, they do feel protected.

Jessica: We're protecting ourselves from anyone who's walking in the building that's asymptomatic, and I think that feels super safe. So it's like a mix of a feeling so good, and confident, and safe, and this is the best place to be, but also managing those fears and that uncertainty that kind of creeps up.

Stephen: But when those risks, when those fears, and that sense of vulnerability start to work away at you, Rivera has to be a good listener, especially when her staff come to her for solace and support. Even when she knows she's needed elsewhere, she can't afford to lose any of her staff, especially now.

Jessica: There's a sense of anguish and sometimes even desperation in that they're coming to you and you can tell that they have thought about this for a long time, and it's just really eating at them. I always feel eager inside just to reach out and hug them or fix it. My first inclination every time is to say, "We're going to figure this out. It'll be okay. How can I help? What can I do?"

But I always have to remember that it's not that time yet. I have to be quiet and listen, because I think first and foremost they just want me to understand where they're coming from. And so I try to listen. And sometimes, that ends up being kind of a long affair for me.

I think it's good to have that conversation with them and kind of present that you can go to work and you can be safe. You can be vulnerable and scared, and also you can be brave and confident at the exact same time.

Stephen: Sometimes, though, even the best listener can't change the way someone sees the threat of the virus to themselves and their family. None of her staff have tested positive for the virus, but two quit weeks after the pandemic began in Utah, even though that meant they are unable to claim unemployment in the face of the COVID lockdown and fears of an economic collapse. And further, five of her team have taken time off leaving her to worry if they'll ever return.

Jessica: I had one employee who was sad to leave us. She sent me an email one night and expressed how proud she is of our team and just how proud she was to be out there fighting this good battle. But it's all for naught if the enemy sneaks in at her door because she feels like . . . She's older. She's in that higher risk category, and so was her husband. And she was really terrified of potentially bringing something home and then not having him around anymore. So for her, she said she would miss us and she was sad to go, but that's what she felt like she needed to do for her. And I totally respect that.

Stephen: The second employee has worked for her for five years, and you can hear in her voice how much his departure has impacted her. She says it was for personal reasons, and though she gave him 24 hours to reconsider, he did not change his mind. Rivera has taken over his post at the clinic.

Jessica: I'll be here every day. I'm not going anywhere, so you'll see me every single day. I'll be in the office. I'll come help you with whatever you need.

Stephen: She hopes her example and her presence will make her staff feel safer and more confident at work. But even Rivera, who comes across as so self-assured in her profession, still has doubts.

Jessica: And I know that's just such a hard task right now, even for myself in a sense sometimes. With all of the uncertainty, how do you feel a sense of confidence and the things that you're doing every day?

Stephen: She can't help but take these departures personally. And there are those moments when she starts to question even her own choices.

Jessica: It's difficult not to take it personally. And I think that's an important part that I'm willing to do, is to say, "Could I have done something differently? Could I have done something better? Can I change things? Can I change my tactic or my communication going forward?" and then just being able to know what I can do. And the things that I can't change, I'm just being able to be okay with that and then moving on, just accepting that and moving on.

Stephen: Everyone who works at the hospital during the COVID-19 crisis knows that daily routines and emotional connections have all been fundamentally altered.

Jessica: It's hard not to hug my dad. I don't hug my dad right now, but I did. Even if I saw him for five minutes, I'd still hug him twice or maybe more, a greeting and a goodbye. So we make sure that we do our little elbow touch every day and that he's safe and that he's protected because he's also in that high-risk group. All my sisters, my siblings, my brother, we go grocery shopping for him, whenever he needs anything. The tables have flipped. Now, we're telling him to stay home instead of him telling us to stay home, like when we were teenagers, and to be safe. And he listens to us.

Stephen: If Rivera is a shoulder to cry on, a sympathetic ear for her employees, there's always going to be those moments when she needs someone to turn to.

Jessica: At the end of Tuesday, which was a day filled with problems and things needing to be done, and just a long, long day, driving home at 8:30 at night, talking to my sister on the phone, I definitely cried. And she said, "Are you okay? What's going on, Jess?" I said, "Nothing really. I'm just shedding my tired tears. I'm exhausted."

Definitely ready for a break, ready for the weekend, but there's nothing more to do other than just release the tears and move on to the next thing. And for me, that's a good release. Definitely, I'm not ashamed to cry or afraid to cry. I think it feels good just to get it out.

Stephen: And then sometimes, there are those happy tears too.

Jessica: So to keep it light and to keep it fun, I still like to joke around with my team. I still smile. That's one compliment I get a lot, especially right now, is that, "Your team is amazing. Your employees are great. What is the magic? I see them walking around and they're still smiling. They're still upbeat. They're still happy." And I think that that makes everything a little bit better, a little bit lighter. For me, it's hard to just focus on what's not working. Call me an optimist, hopeful, whatever, but that's how I live my life.

Stephen: There's a history within EVS of managers expressing their gratitude in small heartfelt ways to their staff. Jessica is always thinking about little ways that she can say thank you. She has given each of her employees a mask made by one of her sisters to wear when they go grocery shopping.

But how can we say thank you to such remarkable people? Through the generous support of the hospital's interpreting team, Mitch and I offer our sincerest gratitude in some of the languages spoken by EVS staff. We say thank you for their work, for their dedication, and their unwavering commitment to keeping us save.

[Thank You Message from Interpreting Services]

Mitch: Thank you to all of the EVS workers and everything they do. When we talk about heroes during this pandemic, let's always remember the frontline workers that are slaying pathogens on our behalf 24/7.

Clinical is part of The Scope Presents network and brought to you by University of Utah Health. The show is produced by me, Mitch Sears, and Stephen Dark. Music by Ian Post and Muted Artist.

A thank you to Alisha Barker and Jessica Rivera for being willing to overcome the difficulties of recording while physical distancing to speak with us.

A very special thank you to Melissa Tingey and Yesi Timoteo with University of Utah Health's Interpreter Services. This episode wouldn't have been the same without their help recording over 20 different languages. A full list of the names of interpreters can be found on our website.

And as always, a thank you to The Scope team, Scot and Chloe. I couldn't do without you.