Highlights
- •A multitude of factors can affect cleaning efficacy.
- •Some areas within the ward were consistently clean, and others were consistently dirty.
- •Surfaces with lower colony-forming unit counts before cleaning became more contaminated following cleaning, than surfaces with higher initial colony-forming unit counts.
- •Personal perceptions of cleanability and risk to patients, surface material, who was delegated to clean, and staff groups interacting with the surfaces had an impact on cleaning efficacy.
- •Interactions among these factors are complex, and consideration must be given to them when designing cleaning interventions.
- •The findings from this study can be used to inform and improve cleaning training programs.
Background
The objectives of this study were to assess the number of organisms present on different
surfaces within a clinical environment before and after cleaning took place, and to
identify the impact of cleaning. The study involved extensive 2-week microbiological
environmental monitoring of an entire ward before and after cleaning; the ward was
located within a pediatric hematology-oncology ward comprised of a day unit and outpatient
ward.
Methods
Tryptone soya agar contact plates were used to take a total of 1,160 surface samples
before and after cleaning from 55 predetermined sites. Samples were taken from representative
surfaces throughout the ward representing a variety of materials, surface heights,
functions, and distances from patients, as well as both high-touch and infrequently
touched surfaces.
Results
After surface cleaning was undertaken within the ward, there was a significant difference
between the amount of colony-forming units (CFUs) recovered before and after cleaning
(P < .0001). Cleaning produced an average CFU reduction of 68% throughout the ward environment.
The corridor was the most contaminated area within the ward. There were differences
in the CFUs among the various areas within the ward, which were cleaned with varying
efficiency. The surface material, who interacted with the surface, levels of initial
contamination, perceived risk, and perceived cleanability were all found to have a
varying impact on the cleaning effectiveness.
Conclusions
To the authors’ current knowledge, this is the only study to assess cleaning within
a pediatric ward by taking samples directly before and after cleaning. The standard
of cleaning undertaken within the ward is open for discussion, and these data highlight
the need for an improved cleaning intervention and can provide insight into the multitude
of factors that must be considered when designing an effective training protocol.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Infection ControlAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Burden of six healthcare-associated infections on European population health: estimating incidence-based disability-adjusted life years through a population prevalence-based modelling study.PLoS Med. 2016; 13e1002150
- Healthcare associated infections (HAI) perspectives.J Infect Public Health. 2014; 7: 339-344
- Dos and don'ts for hospital cleaning.Curr Opin Infect Dis. 2016; 29: 415-423
- Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination.Clin Microbiol Rev. 2014; 27: 665-690
- Environmental cleaning and disinfection of patient areas.Int J Infect Dis. 2018; 67: 52-57
- The epidemiology of antimicrobial resistance in hospital acquired infections: problems and possible solutions.Brit Med J. 1998; 317: 652-654
- Sequential enhanced cleaning eliminates multidrug-resistant organisms in general intensive care unit of a traditional Chinese medicine hospital.J Crit Care. 2017; 41: 216-221
- Knowledge, attitudes, and practices regarding environmental cleaning among environmental service workers in Chinese hospitals.Am J Infect Control. 2017; 45: 1043-1045
- Variation in hospital cleaning practice and process in Australian hospitals: a structured mapping exercise.Infect Dis Health. 2017; 22: 195-202
- An environmental cleaning bundle and health-care-associated infections in hospitals (REACH): a multicentre, randomised trial.Lancet Infect Dis. 2019; 19: 410-418
- Changes in knowledge and attitudes of hospital environmental services staff: the Researching Effective Approaches to Cleaning in Hospitals (REACH) study.Am J Infect Control. 2018; 46: 980-985
- Improving hospital environmental hygiene with the use of a targeted multi-modal bundle strategy.Infect Dis Health. 2018; 23: 107-113
- Bacterial contamination on surfaces of public areas in hospitals.J Hosp Infect. 2010; 74: 195-196
- Mopping up hospital infection.J Hosp Infect. 1999; 43: 85-100
- Rapid recontamination with MRSA of the environment of an intensive care unit after decontamination with hydrogen peroxide vapour.J Hosp Infect. 2007; 66: 360-368
- Infection control in paediatrics.Lancet Infect Dis. 2008; 8: 19-31
- Examining the association between surface bioburden and frequently touched sites in intensive care.J Hosp Infect. 2017; 95: 76-80
- How clean is clean? Proposed methods for hospital cleaning assessment.J Hosp Infect. 2008; 70: 328-334
- Assessment of the overall and multidrug-resistant organism bioburden on environmental surfaces in healthcare facilities.Infect Control Hosp Epidemiol. 2016; 37: 1426-1432
- Surface microbial contamination in hospitals: a pilot study on methods of sampling and the use of proposed microbiologic standards.Am J Infect Control. 2015; 43: 1000-1002
- Microbial biogeography of public restroom surfaces.PLoS One. 2011; 6: e28132
- Diversity, distribution and sources of bacteria in residential kitchens.Environ Microbiol. 2013; 15: 588-596
- Environmental viral contamination in a pediatric hospital outpatient waiting area: implications for infection control.Am J Infect Control. 2014; 42: 856-860
- How to carry out microbiological sampling of healthcare environment surfaces? A review of current evidence.J Hosp Infect. 2019; 103: 363-374
Article info
Publication history
Published online: December 06, 2019
Footnotes
Conflicts of interest: None to report.
Identification
Copyright
© 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.