Correlating Cleaning Thoroughness with Effectiveness and Briefly Intervening to Affect Cleaning Outcomes: How Clean Is Cleaned?

Abstract

ObjectivesThe most efficient approach to monitoring and improving cleaning outcomes remains unresolved. We sought to extend the findings of a previous study by determining whether cleaning thoroughness (dye removal) correlates with cleaning efficacy (absence of molecular or cultivable biomaterial) and whether one brief educational intervention improves cleaning outcomes.DesignBefore-after trial.SettingNewly built community hospital.Intervention90 minute training refresher with surface-specific performance results.MethodsDye removal, measured by fluorescence, and biomaterial removal and acquisition, measured with culture and culture-independent PCR-based assays, were clandestinely assessed for eight consecutive months. At this midpoint, results were presented to the cleaning staff (intervention) and assessments continued for another eight consecutive months.Results1273 surfaces were sampled before and after terminal room cleaning. In the short-term, dye removal increased from 40.3% to 50.0% (not significant). For the entire study period, dye removal also improved but not significantly. After the intervention, the number of rooms testing positive for specific pathogenic species by culturing decreased from 55.6% to 36.6% (not significant), and those testing positive by PCR fell from 80.6% to 53.7% (P = 0.016). For nonspecific biomaterial on surfaces: a) removal of cultivable Gram-negatives (GN) trended toward improvement (P = 0.056); b) removal of any cultivable growth was unchanged but acquisition (detection of biomaterial on post-cleaned surfaces that were contaminant-free before cleaning) worsened (P = 0.017); c) removal of PCR-based detection of bacterial DNA improved (P = 0.046), but acquisition worsened (P = 0.003); d) cleaning thoroughness and efficacy were not correlated.ConclusionAt this facility, a minor intervention or minimally more aggressive cleaning may reduce pathogen-specific contamination, but not without unintended consequences.

Environmental contamination by carbapenem-resistant Acinetobacter baumannii: The effects of room type and cleaning methods

“…The high-touch objects and surfaces that were CRAB positive after the refresher training were located farther away from the patient. Clifford et al 20 reported that after refresher training for cleaning staff, cleaning thoroughness improved for some surfaces and decreased for others. We recommend educating cleaning personnel about the role of objects in disseminating pathogens to the environment and to patients.…”

Importation, Mitigation, and Genomic Epidemiology of Candida auris at a Large Teaching Hospital

“…It could have been that a different recliner was sampled; however, once it was determined that the patient harbored CA, all shared equipment and furniture was restricted to that room. Notably, in a feedback-based study involving an intervention to improve cleaning outcomes, the only surface (of 15 high-touch surfaces sampled) with a statistically significant adverse cleaning outcome (less frequently cleaned thoroughly) was the room chair 16 …”

“…As described previously, 2-cm × 2-cm sponge sticks (3M, Maplewood, MN) and premoistened rayon-tipped swabs (Copan Diagnostics, Murietta, CA) were used for environmental sampling in a standardized fashion. 15,16 Samples were immediately plated on selective agar (sabouraud with gentamycin and chloramphenicol) and incubated for 5 days. Identification was performed using a Vitek matrix-assisted laser desorption/ionization time-of-flight mass spectroscopy (MALDI-TOF MS; FDA database), a Bruker MALDI-TOF (RUO database), and sequencing.…”

“…Notably, in a feedback-based study involving an intervention to improve cleaning outcomes, the only surface (of 15 high-touch surfaces sampled) with a statistically significant adverse cleaning outcome (less frequently cleaned thoroughly) was the room chair. 16 Although the US Centers for Disease Control and Prevention (CDC) and the Association for Professionals in Infection Control and Epidemiology (APIC) have provided guidance regarding CA, [19][20][21][22] we could not locate answers to the following unresolved and recurring issues this case raised. (1) When a patient who had healthcare contact at a hospital where CA has been reported is admitted, should they be placed on preemptive contact precautions until surveillance swabs are negative?…”

Room Occupancy-Associated Transmission of MDRO, Clostridium difficile, or Norovirus: Results From a Room Surveillance Project

“…Our study is limited by the low endemic rate of MDRO and the lack of compliance checks of terminal cleaning procedures, 3 , 4 but it reflects realistic daily practice in a large tertiary-care center in Germany. Enhanced cleaning and disinfections strategies 5 may therefore only be necessary if the room is identified as a risk factor for transmission within an institution by surveillance such as ours.…”