Highlights
- •Cleaning variations occur within the complexity of healthcare settings.
- •Using a mixed method design identified significant determinants of practice variation.
- •A significant barrier to cleaning was observed in semi-private patient rooms.
- •A significant facilitator to cleaning was detected with patient absence from the room.
Objectives
To describe daily environmental cleaning and disinfection practices and their associations
with cleaning rates while exploring contextual factors experienced by healthcare workers
involved in the cleaning process.
Methods
A convergent mixed methods approach using quantitative observations (ie, direct observation
of environmental service staff performing environmental cleaning using a standardized
observation form) and qualitative interviews (ie, semistructured interviews of key
healthcare workers) across 3 Veterans Affairs acute and long-term care facilities.
Results
Between December 2018 and May 2019 a total of sixty-two room observations (N = 3602
surfaces) were conducted. The average observed surface cleaning rate during daily
cleaning in patient rooms was 33.6% for all environmental surfaces and 60.0% for high-touch
surfaces (HTS). Higher cleaning rates were observed with bathroom surfaces (Odds Ratio
OR = 3.23), HTSs (OR = 1.57), and reusable medical equipment (RME) (OR = 1.40). Lower
cleaning rates were observed when cleaning semiprivate rooms (OR = 0.71) and rooms
in AC (OR = 0.56). In analysis stratified by patient presence (ie, present, or absent)
in the room during cleaning, patient absence was associated with higher cleaning rates
for HTSs (OR = 1.71). In addition, the odds that bathroom surfaces being cleaned more
frequently than bedroom surfaces decreased (OR = 1.97) as well as the odds that private
rooms being cleaned more frequently than semi-private rooms also decreased (OR = 0.26;
0.07-0.93). Between January and June 2019 eighteen qualitative interviews were conducted
and found key themes (ie, patient presence and semiprivate rooms) as potential barriers
to cleaning; this supports findings from the quantitative analysis.
Conclusion
Overall observed rates of daily cleaning of environmental surfaces in both acute and
long-term care was low. Standardized environmental cleaning practices to address known
barriers, specifically cleaning practices when patients are present in rooms and semi-private
rooms are needed to achieve improvements in cleaning rates.
Key words
Abbreviation:
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Article info
Publication history
Published online: May 26, 2022
Footnotes
Funding: This work was supported by the VA-CDC Practice-Based Research Network, which was funded collaboratively by the VA Health Services Research & Development Service (HSR&D) service, the Centers for Disease Control & Prevention (CDC), and the Collaborative Research to Enhance and Advance Transformation and Excellence (CREATE) program (CRE 12-289, HSR) from the VA HSR&D.
Conflicts of interest: All authors report no conflicts of interest relevant to this article.
Identification
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Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.
