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BACKGROUND: Concern over increasing nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection rates in the United Kingdom has led to discussion of routine environmental
surface cleaning in hospitals. Documented cleaning protocols ensure better compliance
and describe in detail the steps needed to clean specific surfaces and may specify
the use of a detergent or disinfectant. Although disinfectants have antimicrobial
activity, concerns have been expressed about antibiotic resistance, risks to human
health from prolonged exposure, and wider environmental issues. Detergents are better
at detaching soil from surfaces. However, if the detached soil is not removed, reattachment
and recolonization can occur. The aim of the investigation was to assess the ability
of cleaning protocols, with and without disinfectants, to reduce microbial counts
on hospital environmental surfaces.
METHODS: A general surgical ward of a 500-bed hospital was selected. After existing
cleaning practices had been completed, surface counts were taken from eight designated
environmental surfaces, using direct contact methods. This was repeated every day
for 14 days to obtain baseline contamination levels. Existing cleaning protocols were
evaluated and modified in accordance with best practice. The 14-day sampling cycle
was repeated using modified protocols with existing non-ionic detergent. This was
followed by another 14-day cycle, using a quaternary ammonium compound (QAC) disinfectant
in place of the existing detergent. Surface counts for each site were compared using
ANOVA with Tukey comparisons (p = 0.05).
RESULTS: Compared to the existing protocol, the modified cleaning significantly reduced
contamination on 7/8 surfaces using the existing detergent and 8/8 using QAC. No significant
difference was seen between modified protocols using detergent and QAC disinfectant
on any surface. The most contaminated site was the patient's toilet sink handle (mean
9.3 cfu/cm2, range 1.8–25 cfu/cm2 using existing protocols), but both modified protocols reduced this figure to >0.5
cfu/cm2. The least contaminated site with existing cleaning protocols was the ward sink handles
(0.9 cfu/cm2, range 0.1–6.5 cfu/cm2). Both modified protocols reduced this figure to >0.5 cfu/cm2.
CONCLUSIONS: Optimizing cleaning methods can significantly reduce surface counts and
may be more important in microbial removal than the requirement to use a disinfectant.
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Article Info
Publication History
Abstract ID 52436Tuesday, June 21
Identification
Copyright
© 2005 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
