Related Experiment Video
Updated: Oct 5, 2025
Author Spotlight: Microbial Control and Monitoring Strategies for Cleanroom Environments and Cellular Therapies
Published on: March 17, 2023
Stopping Hospital Infections With Environmental Services (SHINE): A Cluster-randomized Trial of Intensive Monitoring
Matthew J Ziegler1,2,3,4, Hilary H Babcock5, Sharon F Welbel6,7
1Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Background:
Multidrug-resistant organisms (MDROs) frequently contaminate hospital environments. We performed a multicenter, cluster-randomized, crossover trial of 2 methods for monitoring of terminal cleaning effectiveness.
Methods:
Six intensive care units (ICUs) at 3 medical centers received both interventions sequentially, in randomized order. Ten surfaces were surveyed each in 5 rooms weekly, after terminal cleaning, with adenosine triphosphate (ATP) monitoring or an ultraviolet fluorescent marker (UV/F). Results were delivered to environmental services staff in real time with failing surfaces recleaned. We measured monthly rates of MDRO infection or colonization, including methicillin-resistant Staphylococcus aureus, Clostridioides difficile, vancomycin-resistant Enterococcus, and MDR gram-negative bacilli (MDR-GNB) during a 12-month baseline period and sequential 6-month intervention periods, separated by a 2-month washout. Primary analysis compared only the randomized intervention periods, whereas secondary analysis included the baseline.
Results:
The ATP method was associated with a reduction in incidence rate of MDRO infection or colonization compared with the UV/F period (incidence rate ratio [IRR] 0.876; 95% confidence interval [CI], 0.807-0.951; P = .002). Including the baseline period, the ATP method was associated with reduced infection with MDROs (IRR 0.924; 95% CI, 0.855-0.998; P = .04), and MDR-GNB infection or colonization (IRR 0.856; 95% CI, 0.825-0.887; P < .001). The UV/F intervention was not associated with a statistically significant impact on these outcomes. Room turnaround time increased by a median of 1 minute with the ATP intervention and 4.5 minutes with UV/F compared with baseline.
Conclusions:
Intensive monitoring of ICU terminal room cleaning with an ATP modality is associated with a reduction of MDRO infection and colonization.
Insights
Adenosine triphosphate (ATP) monitoring of hospital cleaning reduced multidrug-resistant organism (MDRO) infections and colonization. This method proved more effective than ultraviolet fluorescent markers in intensive care units.
Area of Science:
- Infection Control and Hospital Epidemiology
- Environmental Services Management
- Microbiology
Background:
- Multidrug-resistant organisms (MDROs) pose a significant threat in hospital environments, necessitating effective cleaning protocols.
- Terminal cleaning of patient rooms is a critical step in preventing the spread of healthcare-associated infections.
Purpose of the Study:
- To compare the effectiveness of adenosine triphosphate (ATP) monitoring versus an ultraviolet fluorescent marker (UV/F) for assessing terminal cleaning in intensive care units (ICUs).
- To evaluate the impact of these monitoring methods on MDRO infection and colonization rates.
Main Methods:
- A multicenter, cluster-randomized, crossover trial involving six ICUs across three medical centers.
- Two interventions, ATP monitoring and UV/F marking, were sequentially applied to assess terminal cleaning effectiveness on ten surfaces in five rooms weekly.
- Real-time feedback was provided to environmental services staff for immediate remediation of inadequately cleaned surfaces.
- MDRO infection/colonization rates (including MRSA, C. difficile, VRE, MDR-GNB) were measured during baseline and intervention periods.
Main Results:
- The ATP monitoring method was associated with a significant reduction in the incidence rate of MDRO infection or colonization compared to the UV/F method (IRR 0.876, P=.002).
- When including the baseline period, ATP monitoring showed reduced overall MDRO infection (IRR 0.924, P=.04) and specifically MDR-GNB infection/colonization (IRR 0.856, P<.001).
- The UV/F intervention did not demonstrate a statistically significant impact on MDRO outcomes. Room turnaround time increased minimally with ATP (1 min) and more with UV/F (4.5 min).
Conclusions:
- Intensive monitoring of terminal room cleaning in ICUs using an ATP modality is effective in reducing MDRO infection and colonization.
- ATP monitoring offers a superior approach to UV/F markers for enhancing environmental hygiene and patient safety in critical care settings.
