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210 Goo be Gone - Evaluation of compliance with cleaning of multiple high touch (HT) surfaces using fluorescent “Goo”

Friday, March 19, 2010
Grand Hall (Hyatt Regency Atlanta)
Patricia Clark, BSN, CIC , UPMC Presbyterian Hospital, Pittsburgh, PA
Leon Young, BSMT , UPMC Presbyterian Hospital, Pittsburgh, PA
Sandra Silvestri, BSN, RN, CIC , University of Pittsburgh Medical Center, Pittsburgh, PA
Carlene A. Muto, MD , University of Pittsburgh Medical Center, Pittsburgh, PA
Background:   Contaminated environmental surfaces play an important role in the transmission of epidemiologic significant organisms.  It has been well documented that pathogens such as MRSA, VRE, C.diff, MDR Acinetobacter, and other gram negative rod's are transmitted from environmental surfaces to HCW's hand.   The University of Pittsburgh Medical Center (UPMC) Presbyterian is a 766-bed tertiary care facility. An average of 164 (21%) patients are in contact precautions daily.  Environmental rounds are conducted in all ICUs and attended by infection control (IC), environmental services (ES) and clinical staff. Patient care areas appeared unsoiled but there was concern that all surfaces were not getting effectively cleaned.
Objective: To evaluate compliance with cleaning multiple HT surfaces in patient rooms post discharge before and after feedback (F) of initial results and education (E).
Methods:   An electronic Bed Tele Tracking process (BTT) was used to monitor patient discharges.  At discharge, IC was notified and room was "spotted" with a fluorescent "goo" solution. If available, 14 HT sites per room were sampled.Upon arrival of ES, the BTT was updated to “clean in progress” and upon completion to “cleaned”. Each “cleaned” room was evaluated by IC using an UV light to determine if the spots were removed by routine cleaning. Overall, 70 rooms were to be evaluated. Interim analysis was performed after 35. Results were shared with ES and group and individual E was provided. Post intervention evaluations are underway.  To date, data is available for 8 rooms post intervention.
Results:

 

Compliance with spot removal of High-touch Surfaces
 Pre N = 35
Post N =8
   
Object
# spotted
# spotless
%
# spotted
# spotless
%
OR
CI
P value
Toilet Seat
29
16
55
8
7
88
0.18
0.01,1.81
0.12
Toilet Handle
24
10
42
8
6
75
0.24
0.03,1.78
0.22
Toilet Hand Hold (s)
22
6
27
8
4
50
0.38
0.05,2.63
0.38
Sink Top
25
18
64
8
4
50
2.57
0.38,17.94
0.39
Light Switch In Room
32
3
9
8
4
50
0.10
0.01,0.85
0.02
BR Door Closers
24
4
17
8
6
75
0.07
0.01,0.59
0.004
Side Rail
31
17
55
8
1
13
8.50
0.84,207
0.05
Bedside Table
22
15
68
8
4
50
2.14
0.31,15.21
0.42
Telephone
23
7
30
7
5
71
0.17
0.02,1.45
0.08
Call Box
27
16
59
7
6
88
0.24
0.01,2.65
0.38
Tray Table
26
19
73
6
6
100
0
0,3.43
1.00
Pt Chair
25
12
48
3
3
100
0
0,2.61
0.23
Room Door Closers
28
2
7
8
5
63
0.05
0,0.47
0.003
BR Light Switch
7
3
43
8
5
63
0.69
.25,1.88
0.62
Total
345
148
43
103
66
64
0.42
0.26,0.68
0.0002
Compliance for each room (range)
8-100 (43)
15 -100% (64)

Conclusions: Despite the facilities appearance of cleanliness, overall thoroughness of discharge cleaning prior to F and E was 43% for all surfaces evaluated and C within a room was as low as 8%.  ES do not routinely get feedback on their performance. Providing group and individual E significantly improved overall C with spot removal and bettered cleaning methods and C with all HT surfaces significantly increased. All HT surfaces initially associated with low C (<20%) significantly improved C post intervention.