Environmental hygiene programs in public hospitals: a pilot study of pre-implementation assessment

Environmental contamination contributes to the transmission of healthcare-associated pathogens, particularly multidrug-resistant microorganisms.

To perform a baseline assessment of environmental hygiene programs in public hospitals from the perspective of housekeeping personnel.

A cross-sectional, descriptive, and exploratory mixed-methods study was conducted in three public tertiary hospitals in São Paulo State, Brazil. Quantitative data were collected from environmental hygiene staff using the translated and adapted CDC Environmental Hygiene Program Improvement Toolkit, specifically the "B2 Baseline Assessment - Part 2 (Advanced Program)" instrument. Qualitative data were obtained through semi-structured interviews with direct supervisors of environmental hygiene teams from each participating hospital.

Forty-five housekeeping professionals participated. High frequencies were observed for infection prevention and control training, including hand hygiene and personal protective equipment use (100%), and supervisor availability during shifts (97.8%). Gaps were identified in structured monitoring of environmental hygiene quality (55.5%), continuous supply availability throughout shifts (51.1%), and performance feedback, with 46.7% reporting no feedback.

The main gaps were related to monitoring practices, feedback processes, and budget planning rather than task execution. The baseline assessment tool was successfully applied without operational difficulties, supporting its feasibility in Brazil and highlighting areas for strengthening environmental hygiene programs.