Workplace refrigerators around the world are a necessary evil. Employees need facilities for their meals, but no one seems to clean up after themselves when they’re done and no is one assigned to maintain the shared space so it’s no surprise they’re such a universal source of irritation.
After one Registered Nurse (RN), from an Intensive Care Unit, was brutally attacked by imitation bacon bits upon opening a fridge door, I decided to take action.
Kidding! But seriously, there’s no room in the pictured refrigerator and it’s filthy! Take a look at your break room fridge. When was the last time it was cleaned and how old are the contents? To address the issue of dirty fridges with petrified (or putrefied), forgotten contents and a lack of space, I collected a bit of data and conducted a 5S to get things under control in one ICU.
Our ICU has five fridge and freezer units. We measured the total internal surface area of the refrigerator portion of the smallest fridge to get some baseline data . Four fridges have the capacity to hold a total of 75 hospital-issued lunch bags (freezer space not included). On average, our ICU has 34 bedside RN’s assigned along with a number of other nurses (ECMO, PICC and 2 Charge RNs) for a total of 38 RN’s per shift. Four fridges can easily accommodate both day and night shift for one 24 hour period. This seemed a conservative estimate, especially keeping in mind that some staff eat frozen meals, go to the cafeteria, or have food delivered.
Step 1: Sort
Without a set cleaning rotation, mystery mold items as pictured below can remain for an unknown period of time, taking up valuable space and placing employees at risk of contamination. In the Sort phase of 5S – it’s was pretty easy to determine what stayed and what needed to be tossed in this fridge – everything! Based on the expiration date, I found items as old as two years in the fridge. I think this was a lemon.
Step 2: Set In Order
Since there’s really no need to designate whose lunch or food goes where – it was clear that the next step was to go directly to Shine phase of 5S. That was a welcome decision since these refrigerators were begging to be cleaned.
Step 3: Shine
Currently, we have 11 duties assigned to an average of 34 bedside RN’s. In one shift, the probability of a bedside RN being assigned any duty is 32%. Adding the fridge as an assigned duty would increase the probability of a bedside RN being assigned any duty to 35% if that RN is working on the day the fridge is assigned. The chances of being assigned the fridge as a duty on the day it is assigned is only 2.9%. The probability of being assigned the fridge duty was particularly important when confronting resistance from those who adamantly protested additional duties or having to clean up after others.
There was no way to hold individuals accountable for their break room messes. At the time, , there was a 0% probability of the person leaving the mess being assigned to clean the fridge. We needed to propose a process that encouraged others to clean up after themselves. The idea was that if a better process was available, there would be no reason to accept substandard conditions.
We trialed the proposed process from Jan 22nd to April 16th.The night shift volunteer emptied the fridge, and the dayshift volunteer disinfected the fridge and and then moved a signboard to the next fridge. All five fridges were numbered. Staff were given a one week notice of fridge cleaning by email, as well as by a signboard posted on the designated fridge. We also posted a “day-before” reminder in the unit Facebook group prior to cleaning. Due to the condition of the fridges, the initial emptying & cleaning took more time than once the process had been in place for several weeks. Each fridge was cleaned out every five weeks at a rate of one fridge per week.
Items left in the fridge during the cleaning period were placed on a table to be claimed. Any unclaimed items at the end of the day were discarded (pictured below). This was our break room version of “Red-Tagging.”
Last Step: Standardize and Sustain
We did some data collection to find out how long it took the different shifts to handle their assignments. In order to sustain the effort, it was important to address the time factor. Dividing the trial time period in half, the initial time it took a nightshift RN to empty the fridge was 3 minutes & 9 seconds on average. During the last half of the trial period, emptying the fridge dropped to an average time of 2 minutes and 11 seconds.
The initial time it took a day shift RN to disinfect the fridge, change the date on the signboard, and move it to the next fridge was 5 minutes & 53 seconds on average. During the last half of the trial period, disinfecting the fridge dropped to an average time of 4 minutes and 22 seconds.
To address time consumption concerns, we timed all other duties assigned to bedside RN’s for comparison.
Cycle Times of Nursing Tasks:
- Crash Cart on the 1st (estimated): 46 min
- Milk Room: 16 min
- iSTAT/Glucometer: 7 min, 30 sec
- Medication Room: 4 min
- ECMO Room, Cart & iSTAT: 3 min, 21 sec
- Crash Cart every shift: 2 min
We presented the proposed process along with all the collected data to the staff by email for voting:
“The proposed process is as follows:
- Each fridge is numbered.
- Once a week (Friday night into Saturday morning), emptying all contents in the designated fridge will be assigned as a duty to a nightshift RN. Disinfecting the fridge, changing the date on the sign to seven days, and moving it to the next fridge will be assigned as a duty to a day shift RN.
Please vote on the proposed duty by replying to this email:
- Yes, I vote in favor of assigning fridge duty once a week.
- No, go back to the way things were.
- I can’t vote in favor of this process, but this needs to be addressed. I recommend altering the proposed process as follows: ___________________________”
Initially, several RN’s verbally opposed the idea of assigning the employee refrigerator for cleaning as a duty. However, after viewing the data, reading the proposal and enjoying clean refrigerators, the proposed process won by a majority vote. We forwarded it to Management for consideration and review.
This is how one refrigerator looked after being emptied and disinfected. Now this happens once every five weeks to every single break room fridge. Success!