Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-30T23:22:38.171Z Has data issue: false hasContentIssue false
  • English
  • Français

Identifying Opportunities to Enhance Environmental Cleaning in 23 Acute Care Hospitals

Published online by Cambridge University Press:  02 January 2015

P. C. Carling ,
M. F. Parry ,
S. M. Von Beheren  and
Healthcare Environmental Hygiene Study Group
P. C. Carling*
Affiliation:
Infectious Diseases Section, Caritas Carney Hospital, Boston, Massachusetts Boston University School of Medicine, Boston, Massachusetts
M. F. Parry
Affiliation:
Department of Infectious Diseases, Stamford Hospital, Stamford, Connecticut Columbia University College of Physicians and Surgeons, Columbia University, New York, New York
S. M. Von Beheren
Affiliation:
Program of Hospital Epidemiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
*
Infectious Diseases Section, Caritas Carney Hospital, 2100 Dorchester Avenue, Boston, MA 02124 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

The quality of environmental hygiene in hospitals is under increasing scrutiny from both healthcare providers and consumers because the prevalence of serious infections due to multidrug-resistant pathogens has reached alarming levels. On the basis of the results from a small number of hospitals, we undertook a study to evaluate the thoroughness of disinfection and cleaning in the patient's immediate environment and to identify opportunities for improvement in a diverse group of acute care hospitals.

Methods.

Prospective multicenter study to evaluate the thoroughness of terminal room cleaning in hospitals using a novel targeting method to mimic the surface contamination of objects in the patient's immediate environment.

Setting.

Twenty-three acute care hospitals.

Results.

The overall thoroughness of terminal cleaning, expressed as a percentage of surfaces evaluated, was 49% (range for all 23 hospitals, 35%-81%). Despite the tight clustering of overall cleaning rates in 21 of the hospitals, there was marked variation within object categories, which was particularly notable with respect to the cleaning of toilet handholds, bedpan cleaners, light switches, and door knobs (mean cleaning rates, less than 30%; institutional ranges, 0%-90%). Sinks, toilet seats, and tray tables, in contrast, were consistently relatively well cleaned (mean cleaning rates, over 75%). Patient telephones, nurse call devices, and bedside rails were inconsistently cleaned.

Conclusion.

We identified significant opportunities in all participating hospitals to improve the cleaning of frequently touched objects in the patient's immediate environment. The information obtained from such assessments can be used to develop focused administrative and educational interventions that incorporate ongoing feedback to the environmental services staff, to improve cleaning and disinfection practices in healthcare institutions.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 1 , January 2008 , pp. 1 - 7
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Gerberding, JL. Hospital-onset infections: a patient safety issue. Ann Intern Med 2002;137:665–670.Google Scholar
2.Boyce, J, Havill, N, Kohan, C. Do infection control measures work for methicillin-resistant Staphylococcus aureus? Infect Control Hosp Epidemiol 2004;25:395–401.CrossRefGoogle ScholarPubMed
3.Pittet, D, Bendetta, A, Sax, H, et al.Evidence-based model for hand transmission during patent care and the role of improved practices. Lancet Infect Dis 2006;6:641–52.Google Scholar
4.Whitby, M, Pessoa-Silva, CL, McLaws, ML, et al.Behavioural considerations for hand hygiene practices: the basic building blocks. J Hosp Infect 2007;65:1–8.Google Scholar
5.Hayden, MK, Bonten, JM, Blom, DW, Lyle, EA. Reduction in acquisition of vancomycin-resistant Enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis 2006;42:1552–1560.Google Scholar
6.Carling, PC, Briggs, JL, Perkins, J, Highlander, D. Improved cleaning of patient rooms using a new target method. Clin Infect Dis 2006;42:385–388.CrossRefGoogle Scholar
7.Carling, PC, Briggs, J, Highlander, D, Perkins, J. An evaluation of patient area cleaning in three hospitals using a novel targeting methodology. Am J Infect Control 2006;34:513–519.Google Scholar
8.Eckmanns, T, Bessert, J. Behnke, M, Gastmeier, P, Ruden, H. Compliance with antiseptic hand rub use in intensive care units: the Hawthorne effect. Infect Control Hosp Epidemiol 2006;27:931–934.CrossRefGoogle ScholarPubMed
9.Centers for Disease Control and Prevention, Healthcare Infection Control Advisory Committee. Guidelines for environmental infection control in healthcare facilities, 2003. Available at: http://www.cdc.gov. Accessed January 20, 2007.Google Scholar
10.Muto, C, Jernigan, J, Ostrowsky, B, Richet, M, Jarvis, W, Boyce, J. SHEA Guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24:362–386.Google Scholar
11.Department of Health, England. Winning ways: working together to reduce healthcare associated infection in England. Report from the Chief Medical Officer, London: Crown Copyright, 2003. Available at: http://www.dh.gov.uk/assetRoot/04/06/46/89/04064689.pdf. Accessed January 20, 2007Google Scholar
12.Hota, B. Contamination, colonization and cross-colonization: are hospital surfaces reservoirs for nosocomial infection? Clin Infect Dis 2004;39:1182–1189.Google Scholar
13.Malik, RE, Cooper, RA, Griffith, CJ. Use of audit tools to evaluate the efficacy of cleaning systems in hospitals. Am J Infect Control 2003;31:181–187.CrossRefGoogle ScholarPubMed
14.Dancer, SJ. How do we assess hospital cleaning? A proposal for microbiological standards for surface hygiene in hospitals. J Hosp Infect 2004;56:10–15.CrossRefGoogle ScholarPubMed
15.Byers, K, Durbin, L, Simonton, B, Anglim, A, Adai, K, Farr, B. Disinfection of hospital rooms contaminated with vancomycin-resistant Enterococcus faecium. Infect Control Hosp Epidemiol 1998;19:261–264.Google Scholar
16.Bures, S, Fishbain, J, Uyehara, C, Parker, J, Berg, B. Computer keyboards and faucet handles as reservoirs of nosocomial pathogens in the intensive care unit. Am J Infect Control 2000;28:465–470.CrossRefGoogle ScholarPubMed
17.Oie, S, Hosokawa, H, Kamiya, A. Contamination of room door handles by methicillin-sensitive/methicillin-resistant Staphylococcus aureus. J Hosp Infect 2002;51:140–143.Google Scholar
18.Bhalla, A, Pultz, N, Gries, D, Ray, A, Eckstein, E, Aron, D. Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients. Infect Control Hosp Epidemiol 2004;25:164–167.Google Scholar
19.Lemmen, S, Hafner, H, Zolldann, D, Stanzel, S, Lutticken, R. Distribution of multi-resistant gram-negative versus gram-positive bacteria in the hospital inanimate environment. J Hosp Infect 2004;56:191–197.CrossRefGoogle ScholarPubMed
20.Byers, K, Durbin, L, Simonton, B, Anglim, A, Adai, K, Farr, B. Disinfection of hospital rooms contaminated with vancomycin-resistant Enterococcus faecium. Infect Control Hosp Epidemiol 1998;19:261–264.Google ScholarPubMed
21.Lai, K, Kelly, A, Melvin, Z, Belliveau, P, Fontecchio, S. Failure to eradicate vancomycin-resistant enterococci in a university hospital and the cost of barrier precautions. Infect Control Hosp Epidemiol 1998;19:647–652.Google Scholar
22.Linkin, D, Fishman, N, Patel, J, Merrill, J, Lautenbach, E. Risk factors for extended-spectrum β-lactamase-producing Enterobacteriaceae in a neonatal intensive are unit. Infect Control Hosp Epidemiol 2004;25:781–783.CrossRefGoogle Scholar
23.Rutala, WA, Stiegel, MM, Sarubbi, FA, Weber, DJ. Susceptibility of antibiotic-susceptible and antibiotic-resistant hospital bacteria to disinfectants. Infect Control Hosp Epidemiol 1997;18:417–421.CrossRefGoogle ScholarPubMed
24.Dancer, S, Coyne, M. MRSA acquisition in an intensive care unit. Am J Infect Control 2006;34:10–17.Google Scholar
25.Martinez, J, Ruthazer, R. Role of environmental contamination as a risk factor for acquisition of vancomycin-resistant enterococci in patient's treated in a medical intensive care unit. Arch Intern Med 2003;163:1905–1912.Google Scholar
26.Huang, S, Dotta, R, Platt, R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006;166:1945–1951.Google Scholar
27.Hardy, KJ, Oppeheim, BA. Gossain, S, Gao, F, Hawkey, PM. A study of the relationship between environmental contamination with methicillin-resistant Staphylococcus aureus (MRSA) and patients' acquisition of MRSA. Infect Control Hosp Epidemiol 2006;27:127–132.CrossRefGoogle ScholarPubMed
28.Sexton, T, Clarke, P, O'Neill, E. Environmental reservoirs of methicillin-resistant Staphylococcus aureus in isolation rooms: correlation with patient isolates and implications for hospital hygiene. J Hosp Infect 2006;62:187–194.CrossRefGoogle ScholarPubMed
29.Humphries, H. Response to Professor Kerr, (letter) J Hosp Infect 2006;64:302–303.Google Scholar
30.Wilks, M, Wilson, A. Control of an outbreak of multidrug-resistant Aci-netobacter baumannii-calcoaceticus colonization and infection in an intensive care unit (ICU) without closing the ICU or placing patients in isolation. Infect Control Hosp Epidemiol 2006;27:654–658.Google Scholar
31.Denton, M, Wilcox, M. Role of environmental cleaning in controlling an outbreak of Acinetobacter baumannii on a neurosurgical intensive care unit. Intensive Crit Care Nurs 2005;21:94–98.Google Scholar
32.Scott, P, Deye, G, Srinivasan, A, et al.An outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection in the US military health care system associated with military operations in Iraq. Clin Infect Dis 2007;44:1577–1584.CrossRefGoogle ScholarPubMed
33.Centers for Disease Control and Prevention, Healthcare Infection Control Advisory Committee. Management of multi-resistant organisms in healthcare settings, 2006. Available at http://www.cdc.gov. Accessed January 20, 2007.Google Scholar
34.Institute for Healthcare Improvement. Reduce methicillin-resistant Staphylococcus aureus (MRSA) infection: getting started kit—2006. Available at: http://www.ihi.org/IHI/Programs/Campaign/Campaign.htm. Accessed January 20, 2007.Google Scholar