Efficiency of cleaning and disinfection of surfaces: correlation between assessment methods

Abstract

Approval: 02-02-2017 ABSTRACT Objective: to assess the correlation among the ATP-bioluminescence assay, visual inspection and microbiological culture in monitoring the efficiency of cleaning and disinfection (C&D) of high-touch clinical surfaces (HTCS) in a walk-in emergency care unit. Method: a prospective and comparative study was carried out from March to June 2015, in which five HTCS were sampled before and after C&D by means of the three methods. The HTCS were considered dirty when dust, waste, humidity and stains were detected in visual inspection; when ≥2.5 colony forming units per cm² were found in culture; when ≥5 relative light units per cm² were found at the ATP-bioluminescence assay. Results: 720 analyses were performed, 240 per method. The overall rates of clean surfaces per visual inspection, culture and ATP-bioluminescence assay were 8.3%, 20.8% and 44.2% before C&D, and 92.5%, 50% and 84.2% after C&D, respectively (p<0.001). There were only occasional statistically significant relationships between methods. Conclusion: the methods did not present a good correlation, neither quantitative nor qualitatively. Descriptors: Equipment Contamination; Housekeeping; Nursing Audit; Health Facility Environment; Infectious Disease Transmission. RESUMO Objetivo: avaliar a correlação do teste de ATP-bioluminescência com inspeção visual e cultura microbiológica na monitorização da eficiência da limpeza e desinfecção (L&D) de superfícies clínicas altamente tocadas (SCAT) em unidade de pronto atendimento. Métodos: estudo comparativo, prospectivo, conduzido de março a junho de 2015, de forma que cinco SCAT foram amostradas antes e depois da L&D de rotina pelos três métodos. As SCAT foram consideradas sujas quando apresentaram: na inspeção visual, poeira, dejetos, umidade e manchas; na cultura, ≥2,5 unidades formadoras de colônias por cm 2 e; no ATP-bioluminescência, ≥5 Unidades Relativas de Luz por cm 2 . Resultados: foram realizadas 720 avaliações, sendo 240 por método. A taxa global de superfícies limpas por inspeção visual, cultura e ATP-bioluminescência foi, respectivamente, de 8,3%, 20,8% e 44,2% antes da L&D e de 92,5%, 50% e 84,2% após (p<0,001). Houve apenas associações pontuais estatisticamente significativas entre os métodos. Conclusão: os métodos nem apresentaram boa correlação quantitativa, nem, qualitativa. Efficiency of cleaning and disinfection of surfaces: correlation between assessment methods Frota OP, et al.

Correlação entre métodos de monitoramento de limpeza e desinfecção de superfícies ambulatoriais

“…(24) The authors stressed that ATP quantification is the most suitable method to be used as a parameter when microbial count is considered the gold standard of surface analysis (p<0.001, sensibility of 67%), suggesting 48 RLUs as a cutoff for surfaces to be considered non-approved. (24) A similar examination of five surfaces at a Brazilian emergency care unit did not show a correlation between the level of dirt before and after cleaning and disinfection in any surface evaluated using the ATP bioluminescence and ACC methods, (18) with the best cutoff equal to 79 RLUs. This value is lower than the ideal cutoff estimated in a study carried out in Taiwan, equal to 55.7 RLUs.…”

“…The product used to clean the surfaces was made up of 12.4% glucoprotamin and 15% alkyl-dimethyl-benzyl-ammonium chloride (Ecolab Deutschland GmbH, Düsseldorf, Germany). (18) This product has detergent and disinfectant functions, and therefore cleans and disinfects in a single step.…”

“…Five environmental surfaces with a higher frequency of touch and that were closer to patients and professionals were selected for the sample, according to the directions of the literature. (18) By using purposive non-probability sampling, surfaces at the dressing room (dressing trolley and stretcher), reception (reception desk), and outpatient surgery room (support table and operating table) were chosen. The surfaces were selected based on systematic observation and indication of the nurses that provide care to patients at the facility.…”

“…Surfaces were considered clean if they had a count lower than 2.5 CFU/cm 2 , that is, less than 60 colony-forming units in a 24 cm 2 plate. (18)…”

Monitoramento da limpeza de produtos para saúde com teste adenosina trifosfato

“…Canulados* ou superficial, a sujidade não é totalmente removida e pode criar barreiras que protejam os microrganismos [6][7][8][9][10] . Segundo o Artigo 65 da Resolução da Diretoria Colegiada (RDC) nº 15, de 15 de março de 2012, os PPS passíveis de processamento, independente da sua classificação de risco, devem ser submetidos ao processo de limpeza dentro do próprio CME do serviço de saúde.…”