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Improving Value Through Evidence-Based Training Insights

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The Association for the Health Care Environment (AHE) created its Certified Healthcare Environmental Services Technician (CHEST) training program using an innovative, cost-effective model, in which facilities select representatives from their staff to be trained through AHE’s CHEST train-the-trainer program. Upon completion, representatives then deliver the CHEST certification program in their facility directly to frontline staff. As of January 2020, more than 1,100 environmental services professionals in 43 states have achieved the designation of Certified Healthcare Environmental Services Technician trainer (T-CHEST). They have trained and certified more than 5,000 frontline technicians.

Survey research conducted by AHE revealed that in 2019, the CHEST program demonstrated improvements in health care-associated infections, relevant Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction scores, frontline staff turnover and communication patterns between frontline staff and other health care team members. Specifically, the CHEST program achieved the following outcomes:

Infection Prevention

Rates of surgical site infections and other health care-associated infections (HAIs) decreased by amounts ranging from 20.6% to 75.9% after CHEST training. The rates of C. diff, MRSA, vancomycin-resistant enterococci, and catheter-associated urinary tract infections each dropped by more than half after the training.


Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores before and after CHEST training reflected improvements in two metrics related to environmental services—cleanliness of patient rooms and environment conducive to sleep.

Frontline Staff Turnover

Staff turnover among frontline environmental services technicians dropped by nearly one-third after CHEST training was implemented. 

Frequency of Interaction

After CHEST training, frontline environmental services staff interacted with their clinical colleagues more frequently on a daily and weekly basis. This includes nurses, operating room managers, infection preventionists and physicians. More frequent interaction allows for issues to be addressed promptly rather than waiting for periodic, scheduled meetings or allowing them to go unaddressed. 

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