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
Methods
Results
Conclusion
Key words
Abbreviation:
Environmental Cleaning (VA), CleanR (Study)Purchase one-time access:
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- Estimating health care-associated infections and deaths in U.S. hospitals, 2002.Public Health Rep. 2007; 122: 160-166
- Contamination, disinfection, and cross-colonization: are hospital surfaces reservoirs for nosocomial infection?.Clin Infect Dis. 2004; 39: 1182-1189
- Environmental contamination makes an important contribution to hospital infection.J Hosp Infect. 2007; 65: 50-54
- Importance of the environment in meticillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning.Lancet Infect Dis. 2008; 8: 101-113
- The role played by contaminated surfaces in the transmission of nosocomial pathogens.Infect Control Hosp Epidemiol. 2011; 32: 687-699
- Role of the environment in the transmission of Clostridium difficile in health care facilities.Am J Infect Control. 2013; 41: S105-S110
- Multi-Drug Resistant Organisms within Biofilms on Dry Hospital Surfaces: Is this Worldwide?.The Society for Healthcare Epidemiology of America, San Diego, CA: presented at2017
- Risk of organism acquisition from prior room occupants: a systematic review and meta-analysis.J Hosp Infect. 2015; 91: 211-217
- Does improving surface cleaning and disinfection reduce health care-associated infections?.Am J Infect Control. 2013; 41: S12-S19
- AHRQ comparative effectiveness technical briefs.Environmental Cleaning for the Prevention of Healthcare-Associated Infections. Agency for Healthcare Research and Quality (US), 2015
- Variation in hospital cleaning practice and process in Australian hospitals: a structured mapping exercise.Infect Dis Health. 2017; 22 (2017/12/01/): 195-202
- Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination.Clin Microbiol Rev. 2014; 27: 665-690
- An environmental disinfection odyssey: evaluation of sequential interventions to improve disinfection of Clostridium difficile isolation rooms.Infect Control Hosp Epidemiol. 2013; 34: 459-465
- An intervention to decrease catheter-related bloodstream infections in the ICU.N Engl J Med. 2006; 355: 2725-2732
- Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update.Infect Control Hosp Epidemiol. Sep 2014; 35: S48-S65
- Prevention of Clostridioides difficile in hospitals: a position paper of the International Society for Infectious Diseases.Int J Infect Dis. 2021; 102: 188-195
- Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections.N Engl J Med. 2011; 364: 1419-1430
- Veterans Affairs methicillin-resistant Staphylococcus aureus prevention initiative associated with a sustained reduction in transmissions and health care-associated infections.Am J Infect Control. 2013; 41: 1093-1095
- Clostridium difficile infections in Veterans Health Administration acute care facilities.Infect Control Hosp Epidemiol. 2014; 35: 1037-1042
- Effect of a Clostridium difficile infection prevention initiative in veterans affairs acute care facilities.Infect Control Hosp Epidemiol. 2016; 37: 720-722
- Sanitation Procedure Guide. 2016;
- Trends in health care-associated infection prevention practices in us veterans affairs hospitals from 2005 to 2017.JAMA Netw Open. 2020; 3e1920464
- Building implementation science for veterans affairs healthcare associated infection prevention: VA Healthcare-Associated Infection Prevention Network (VHIN).Infection Control & Hospital Epidemiology. 2018; 39: 1-5
- A qualitative, interprofessional analysis of barriers to and facilitators of implementation of the Department of Veterans Affairs' Clostridium difficile prevention bundle using a human factors engineering approach.Am J Infect Control. 2018; 46: 276-284
Guh A, Carling P. Options for Evaluating Environmental Cleaning. Centers for Disease Control and Prevention. 2010. Accessed June 22, 2022. https://www.cdc.gov/hai/toolkits/evaluating-environmental-cleaning.html.
- Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC).MMWR Recomm Rep. 2003; 52: 1-42
- 2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings.Am J Infect Control. 2007; 35: S65-164
- Environmental cleaning and disinfection of patient areas.Int J Infect Dis. 2018; 67: 52-57
- Best practices for disinfection of noncritical environmental surfaces and equipment in health care facilities: a bundle approach.Am J Infect Control. 2019; 47s: A96-a105
- Understanding unwarranted variation in clinical practice: a focus on network effects, reflective medicine and learning health systems.Int J Qual Health Care. 2020; 32: 271-274
- Best practices for mixed methods research in health sciences.Office of Behavioral and Social Sciences: National Institute of Health, 2011
CDC Environmental Checklist for Monitoring Terminal Cleaning. Centers for Disase Control. 2010. Accessed June 22, 2022. https://www.cdc.gov/hai/pdfs/toolkits/environmental-cleaning-checklist-10-6-2010.
- Does sample size matter in qualitative research?: A review of qualitative interviews in is research. Article.J Comput Informat Systems. 2013; 54: 11-22
- How to plan and perform a qualitative study using content analysis.NursingPlus Open. 2016; 2 (2016/01/01/): 8-14
- Techniques to identify themes.Field Methods. 2003; 15 (2003/02/01): 85-109
- Qualitative research in health care. Analysing qualitative data.BMJ. 2000; 320: 114-116
- Qualitative content analysis: a focus on trustworthiness.SAGE Open. 2014; 4 (2014/01/01)2158244014522633
- Achieving integration in mixed methods designs-principles and practices.Health Serv Res. 2013; 48: 2134-2156
- Integrating quantitative and qualitative results in health science mixed methods research through joint displays.Ann Fam Med. 2015; 13: 554-561
- Evaluating hygienic cleaning in health care settings: what you do not know can harm your patients.Am J Infect Control. 2010; 38: S41-S50
- A quantitative approach to defining "high-touch" surfaces in hospitals.Infect Control Hosp Epidemiol. 2010; 31: 850-853
- Cleaning hospital room surfaces to prevent health care-associated infections: a technical brief.Ann Intern Med. 2015; 163: 598-607
- Environmental cleaning and decontamination to prevent Clostridioides difficile infection in health care settings: a systematic review.J Patient safety. 2020; 16: S12-S15
- The invisible staff": a qualitative analysis of environmental service workers' perceptions of the VA Clostridium difficile prevention bundle using a human factors engineering approach.J Patient Saf. 2021; 17: e806-e814
- Environmental service workers as potential designers of infection control policy in long-term care settings.Am J Infect Control. 2020; 48: 398-402
- EOC-113 - The Impact of Clutter on Healthcare Acquired Infections in a Long-Term Acute Care Hospital.Am J Infect Control. 2018; 46 (2018/06/01/): S71
- Improving daily patient room cleaning: an observational study using a human factors and systems engineering approach.IISE Trans Occup Ergon Hum Factors. 2018; 6: 178-191
- Understanding barriers to optimal cleaning and disinfection in hospitals: a knowledge, attitudes, and practices survey of environmental services workers.Infect Control Hosp Epidemiol. Dec 2016; 37: 1492-1495
- Relationship between hospital ward design and healthcare-associated infection rates: a systematic review and meta-analysis.Antimicrob Resist Infect Control. 2016; 5: 51
CDC A, APIC, ASHE. Using the health care physical environment to prevent and control infection: A Best Practice Guide to Help Healthcare Organizations Create Safe, Healing Environment. 2015.
- Best practices in disinfection of noncritical surfaces in the health care setting: creating a bundle for success.Am J Infect Control. 2013; 41: S26-S30
- Improving hospital environmental hygiene with the use of a targeted multi-modal bundle strategy.Infection Dis Health. 2018; 23: 107-113
- An environmental cleaning bundle and health-care-associated infections in hospitals (REACH): a multicentre, randomised trial.Lancet Infect Dis. 2019; 19: 410-418
- Audit and feedback: effects on professional practice and healthcare outcomes.Cochrane Database Syst Rev. 2012; CD000259
Centers for Medicare & Medicaid Service. 42 CFR 482.42 Condition of participation: Infection Prevention and Antibiotic Stewardship Programs. 2016.
- Evaluating hygienic cleaning in health care settings: what you do not know can harm your patients.Am J Infect Control. 2010; 38: S41-S50
- An international survey of cleaning and disinfection practices in the healthcare environment.J Hosp Infect. 2018; 100: 236-241
- Methods for assessing the adequacy of practice and improving room disinfection.Am J Infect Control. 2013; 41: S20-S25
- Effectiveness of visual inspection compared with non-microbiologic methods to determine the thoroughness of post-discharge cleaning.Antimicrob Resist Infect Control. 2013; 2: 26
- Evaluation of environmental cleaning of patient rooms: impact of different fluorescent gel markers.Infect Control Hosp Epidemiol. 2019; 40: 100-102
- Evaluating accuracy of sampling strategies for fluorescent gel monitoring of patient room cleaning.Infect Control Hosp Epidemiol. 2019; 40: 794-797
Article info
Publication history
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.