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Intensive care unit environmental cleaning: an evaluation in sixteen hospitals using a novel assessment tool
P C Carling1, S Von Beheren, P Kim
1Department of Hospital Epidemiology, Carney Hospital and Boston University School of Medicine, Boston, MA 02124, USA. pcarling@cchcs.org
Abstract:
Despite isolation precautions and enhanced hand hygiene product use, the transmission of healthcare-associated pathogens remains a major problem. Recent studies have confirmed that microbial contamination of the environment in intensive care units (ICUs) can lead to colonisation and infection of patients. Although environmental disinfectants have been used to minimise the spread of microbial pathogens, suboptimal cleaning may limit the effectiveness of such activities. In order to evaluate the thoroughness of cleaning near-patient surfaces, a transparent, easily cleanable and environmentally stable solution was developed that fluoresces when exposed to UV light. The solution was used to mark a standardised group of frequently touched objects in ICU patient rooms following discharge cleaning. These sites were then evaluated after at least two patients had occupied the room and at least two terminal cleanings had been completed. Evaluation of 2320 objects in 197 patient areas disclosed that 57.1% of the standardised sites were cleaned following discharge of the room's occupant in the 16 ICUs studied. Although high rates of cleaning (>80%) were found for toilet seats, sinks and tray tables, consistently low rates of cleaning (<30%) were documented for several objects at high risk of becoming contaminated with nosocomial pathogens, including bedpan cleaners, toilet area handholds, doorknobs and light switches.
Insights
Thorough cleaning of intensive care unit (ICU) patient rooms is crucial for preventing healthcare-associated infections. A fluorescent marker study revealed that over half of high-touch surfaces were not adequately cleaned between patients, highlighting a significant gap in disinfection protocols.
Area of Science:
- Infection Control
- Environmental Hygiene
- Healthcare Epidemiology
Background:
- Healthcare-associated pathogens continue to spread despite precautions.
- Environmental contamination in intensive care units (ICUs) is a known source of patient colonization and infection.
- Suboptimal environmental cleaning may undermine the effectiveness of disinfectants.
Purpose of the Study:
- To develop and utilize a novel fluorescent marker to objectively assess the thoroughness of cleaning near-patient surfaces in ICUs.
- To evaluate the effectiveness of terminal cleaning protocols in reducing microbial contamination on frequently touched objects.
Main Methods:
- A transparent, UV-fluorescent solution was developed to mark frequently touched objects in ICU rooms.
- The marked objects were assessed for cleanliness after at least two subsequent patients occupied the room and terminal cleaning was performed.
- A total of 2320 standardized sites across 197 patient areas in 16 ICUs were evaluated.
Main Results:
- Only 57.1% of standardized high-touch sites were found to be adequately cleaned after discharge cleaning.
- High cleaning rates (>80%) were observed for toilet seats, sinks, and tray tables.
- Consistently low cleaning rates (<30%) were documented for critical items like bedpan cleaners, toilet handholds, doorknobs, and light switches.
Conclusions:
- Current terminal cleaning practices in ICUs are insufficient to ensure thorough disinfection of all near-patient surfaces.
- Specific high-risk objects are frequently missed during cleaning, potentially contributing to pathogen transmission.
- Improved cleaning protocols and monitoring are necessary to enhance environmental hygiene and reduce healthcare-associated infections.
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