Contamination of reusable cleaning tools in healthcare settings: a study based on the longitudinal surveillance in...

Healthcare-associated infections (HAIs) have become global public health threat to human health. Contaminated hospital environments are increasingly recognized as critical reservoirs and vectors in the transmission of HAIs. Cleaning tools are important instruments in cleaning and disinfecting healthcare-associated facilities, of which cleanliness significantly impact the effectiveness of environmental cleaning.

This research was a part of the longitudinal environmental surveillance, which was conducted in inpatient settings across Shanghai. Staphylococcus aureus, Acinetobacter baumannii and Klebsiella pneumoniae were collected from the sample solution. VITEK MS automatic rapid microbial mass spectrometry detection system was used to identify bacteria. The pathogen positive rate generated by three bacteria was used to indicate the contamination of cleaning tools. Pearson's chi-square (χ²) test was applied for nominal categorical variables. A two-sided p-value < 0.05 was considered statistically significant. To identify the effects of various factors on the detection rate of pathogens, a multivariable logistic regression analysis was conducted.

A total of 5,000 samples of healthcare reusable cleaning tools were collected, and the positive detection rate of pathogens was 7.44%. Compared to ICU, several departments exhibited a higher risk of pathogen detection: the internal medicine department (OR = 1.901, 95% CI: 1.460 ~ 2.476, p < 0.001), the surgical department (OR = 1.921, 95% CI: 1.443 ~ 2.556, p < 0.001), and other departments (OR = 6.183, 95% CI: 3.264 ~ 11.711, p < 0.001). Regarding cleaning tools, compared to mops, buckets or basins (OR = 1.792, 95% CI: 1.267 ~ 2.534, p = 0.001), medical trash can (OR = 2.631, 95% CI: 1.911 ~ 3.623, p < 0.001) and other cleaning tools (OR = 4.490, 95% CI: 1.055 ~ 23.127, p = 0.043) showed a higher risk of pathogen detection. In contrast, cleaning tools that did not receive routine disinfection were associated with a higher risk of positive detection compared to those that did (OR = 1.859, 95% CI: 1.283-2.691, p = 0.001). There was a higher positive detection rate in medical cleaning carts disinfected by wiping with a rag than by wiping with disposable disinfectant wipes (p = 0.038).

The overall pathogen positivity rate was 7.44%. Routine disinfection of cleaning tools appears to be associated with a lower detective rate of pathogens on the surface of cleaning tools. The integration of behavioral surveillance of disinfection practices, environmental microbiological surveillance, and pathogen isolate surveillance warrants consideration in future studies. Although this study provides a preliminary understanding of the contamination status and disinfection practices of cleaning tools in medical institutions, further research is warranted to evaluate specific disinfection measures and their effectiveness on these items.