Environmental cleaning is a fundamental principle in prevention and control of hospital
acquired infections (HAIs) and reducing the microbial burden on the surfaces. Pathogens
like vancomycin-Resistant Enterococci (VRE), Methicillin-Resistant Staphylococcus
Aureus (MRSA), Multi Drug Resistant Organisms (MDROs), gram-negative bacilli, etc.
can survive on inanimate surfaces from hours-days-months in a health-care settings.
Routine and terminal environmental cleaning/disinfection plays a vital role in minimizing
the outbreaks in hospitals which are recognized as a major contributor to morbidity
and mortality of hospitalized patients.
Pre and post intervention, environment cultures were taken anonymously, and data was
analyzed utilizing descriptive statistics. Causes and effects were studied, housekeeping
staff practices were observed through direct observations, camera, and secret shoppers.
Environmental cleaning guidelines and checklists were developed in the light of Center
for Disease Control (CDC) and Prevention guidelines (2020), hands on practice and
sessions were taken for housekeeping staff. Housekeeping supervisors were trained
as train the trainers (TOT) to ensure compliance in all shifts round the clock 24/7.
Plan-Do-Study-Act (PDSA) quality improvement methodology was followed together with
process and outcome key performance indicators.
Our MDRO rates decreased significantly i.e., from 4.7 to 2.8, the overall compliance
rate of environmental cleaning and disinfection went up from 53% to 87%, compliance
increased in 10 (71.4%) out of 14 components in checklist. Number of dusters and buckets
increased substantially. Knowledge and practice of all housekeeping staff increased
from 65% to 97%. All 380 (100%) housekeeping staff were trained and the concepts of
high/low touch surfaces, sequence of cleaning from clean to dirty, dilution of disinfectant
improved drastically. Zero MDROs were identified on pre and post cleaning of occupied
and unoccupied bed's side rails, doorknob, mattress, remote control, IV pole, cardiac
Cleaning and disinfection of environmental surfaces is essential to prevent transmission
of hospital acquired infections particularly MDROs.