Identifying Opportunities to Improve Environmental Hygiene in Multiple Healthcare Settings Identifying Opportunities to Improve Environmental Hygiene in Multiple Healthcare Settings

Background: Observational studies have suggested that improving environmental disinfection cleaning (EDC) of patient rooms decreases transmission of MRSA, VRE, C. difficile and A. baumanii. Prospective studies of EDC and transmission of MRSA and VRE have confirmed that suboptimal thoroughness of disinfection cleaning (TDC) facilitates transmission of MRSA and VRE and that improved EDC can decrease transmission. To improve EDC practices and, thereby, patient safety, one must first document that TDC needs improvement.

 Objective: To evaluate the thoroughness of hygienic cleaning of surfaces that have significant potential for transmitting hospital-associated pathogens in a range of healthcare facilities and settings. 

 Methods: A novel fluorescent targeting system was covertly used to objectively evaluate if TDC of standardized sets of high risk objects was performed in a manner consistent with established guidelines and the Center for Medicare and Medicaid Services’ requirements.

 Results: Terminal TDC in the first 36 acute care hospitals studied (48%) was similar to that found in 50 hospitals participating in the Iowa MRSA Reduction Project (62%), 14 other test hospitals (42%), 16 hospitals’ operating rooms (32%), and 7 hospitals’ neonatal intensive care units (36%) (Figure). Daily TDC in ICU isolation rooms in 7 hospitals (31%), in 4 ambulatory chemotherapy suites (26%), in 4 dialysis units (28%), and in 4 longterm care facilities (34%) was also suboptimal (Figure). Overall the mean TDC was 47.9 (Range = 3 to 88, 95% CI - 44.8 – 50.9). 

 Conclusions: Nine studies of TDC which included > 62,500 high-touch surfaces in 103 different institutions and 142 study sites identified opportunities for improving such cleaning in all venues, documenting that TDC must be improved across a broad range of U.S. healthcare settings as part of efforts to prevent transmission of pathogens. In addition, these results indicate that our methodology meets the specifications of the Department of Health and Human Services Action Plan to Prevent Healthcare Associated Infections (June, 2009), which stated: “Standardized methods (i.e., performance methods) that are feasible, valid, and reliable” should be used “for measuring and reporting compliance with broadbased HAI prevention practices that must be practiced consistently by a large number of healthcare personnel”. [D.1.c.]