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Comparative analysis of four hospital cleaning validation methods
William A Rutala1, Hajime Kanamori2, Maria F Gergen3
1Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
American Journal of Infection Control
|August 5, 2026
Summary
Fluorescent markers best indicated hospital surface cleanliness, outperforming adenosine triphosphate (ATP) methods by better reflecting microbiological data. This study assessed four cleaning assessment tools in hospital settings.
Area of Science:
- Healthcare-associated infection control
- Environmental hygiene monitoring
- Microbiology and public health
Background:
- Assessing hospital surface cleanliness is crucial for infection prevention.
- Four distinct methods were evaluated for their efficacy in determining surface hygiene.
- Hospital environmental surfaces were sampled before and after cleaning protocols.
Purpose of the Study:
- To compare the effectiveness of four different methods for assessing hospital surface cleanliness.
- To identify the most reliable method for evaluating the thoroughness of cleaning and disinfection procedures.
- To determine which method best correlates with microbiological standards for surface hygiene.
Main Methods:
- A prospective study was conducted across 10 intensive care units and 14 non-intensive care units.
- Environmental surface samples were collected before and after daily cleaning and disinfection procedures.
- Four methods were used to assess cleanliness: fluorescent markers, adenosine triphosphate (ATP) testing at two thresholds, and standard aerobic plate counts.
Main Results:
- No statistical correlation was found between adenosine triphosphate (ATP) levels and standard aerobic plate counts.
- Fluorescent markers classified 72% of surfaces as clean compared to standard aerobic cultures.
- ATP methods classified significantly fewer surfaces as clean (13.5% and 27%) compared to standard cultures.
Conclusions:
- Fluorescent markers proved to be the most effective tool for assessing hospital surface cleanliness.
- The fluorescent marker method demonstrated the thoroughness of wiping, aligning better with microbiological data than ATP.
- This study highlights the superior utility of fluorescent markers over ATP for evaluating environmental hygiene in healthcare settings.
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