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Evaluating hygienic cleaning in health care settings: What you do not know can harm your patients

  • Philip C. Carling
    Correspondence
    Address correspondence to Philip C. Carling, MD, director of Hospital Epidemiology, Carney Hospital, 2100 Dorchester Ave, Boston, MA 02124.
    Affiliations
    Infectious Diseases Section, Department of Medicine, Boston University School of Medicine, Boston, MA; and VP Epidemiology Consulting Services, Inc (ECSI), Detroit, MI
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  • Judene M. Bartley
    Affiliations
    Infectious Diseases Section, Department of Medicine, Boston University School of Medicine, Boston, MA; and VP Epidemiology Consulting Services, Inc (ECSI), Detroit, MI
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      Recent studies using direct covert observation or a fluorescent targeting method have consistently confirmed that most near patient surfaces are not being cleaned in accordance with existing hospital policies while other studies have confirmed that patients admitted to rooms previously occupied by patients with hospital pathogens have a substantially greater risk of acquiring the same pathogen than patients not occupying such rooms. These findings, in the context recent studies that have shown disinfection cleaning can be improved on average more than 100% over baseline, and that such improvement has been associated with a decrease in environmental contamination of high touch surfaces, support the benefit of decreasing environmental contamination of such surfaces. This review clarifies the differences between measuring cleanliness versus cleaning practices; describes and analyzes conventional and enhanced monitoring programs; addresses the critical aspects of evaluating disinfection hygiene in light of guidelines and standards; analyzes current hygienic practice monitoring tools; and recommends elements that should be included in an enhanced monitoring program.

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