Environmental contamination and cleaning practices in long-term care: a transdisciplinary mixed-methods study

Area of Science:

• Infection Prevention and Control
• Healthcare Environmental Services
• Long-Term Care Facility Management

Background:

• Environmental contamination with multi-drug resistant organisms (MDROs) is a significant concern in long-term care (LTC) facilities.
• Effective environmental cleaning and disinfection are critical for preventing healthcare-associated infections.

Purpose of the Study:

• To identify system-level barriers impacting environmental cleaning and disinfection practices in LTC facilities.
• To assess the burden of MDROs in LTC patient rooms and common areas in relation to cleaning practices.

Main Methods:

• A transdisciplinary, mixed-methods approach was employed, integrating human factors engineering and environmental sampling.
• Environmental sampling of high-touch surfaces (HTSs) was conducted in resident rooms, common areas, and nursing stations.
• System-level barriers were evaluated through direct observations and focus groups with environmental services (EVS) staff, utilizing the SEIPS model.

Main Results:

• 76% of patient room samples were positive for at least one MDRO, with Methicillin-resistant Staphylococcus aureus (MRSA) being most prevalent.
• Quantitative bacterial burden was highest in the area closest to the resident in patient rooms.
• Significant deviations from cleaning protocols were observed, with only 43% of HTSs cleaned according to policy, and systemic challenges like inconsistent training and communication were identified.

Conclusions:

• A substantial burden of MDRO contamination exists in LTC settings, linked to critical barriers in environmental cleaning.
• Standardized training, improved communication, and leadership engagement are essential to enhance infection prevention and resident safety.