Assessment of Hospital Cleaning Practices Using ATP Bioluminiscence in a Teaching Hospital in Chile

Background:

Environmental contamination contributes to spread healthcare-associated pathogens. Housekeeping practices are often suboptimal and the environment may remain contaminated after cleaning. It has been demonstrate that interventions that improve the cleaning process reduce VRE acquisition in hospitals settings. Visual assessment of surfaces as a method for monitoring the effectiveness of cleaning may not be enough to document the level of cleanliness of high touch surfaces after routine daily cleaning in patient rooms. It is necessary to introduce quantitative methods to document the results of this practice. Within the last years detection of adenosine triphosphate (ATP) bioluminescence method has been used for monitoring cleanliness in hospitals.

Objective:

To evaluate the efficacy of hospital cleaning procedure performed after patient discharge, using an adenosine triphosphate (ATP) bioluminescence method in a teaching hospital, in Santiago, Chile.

Methods:

The terminal cleaning procedures were done by an external housekeeping service as well as internal cleaning personnel using the same hospital policies. During 2008 we performed an evaluation using ATP bioluminescence LIGHTNING MVP^TM (Arquimed). The proposed cut-off value was the Arquimed recommended (3 relative lights units (RLU)). The surfaces evaluated were: over bed table, bedside table, telephone, bedside rail, mattress, toilet seat and sink. In operating rooms (OR): OR beds, surgical light, surgical table, nursing and anesthetic table and laryngoscope. After the initial evaluation, we implemented an intervention including education, cleaning practice as well as informing personnel of their evaluation using this method. Chi-square method was used to compare the following results: external versus internal personnel, before versus after cleaning, single terminal cleaning procedure versus double terminal cleaning procedure and previous versus after intervention.

Results:

We performed 198 evaluations in 33 patient units and 9 OR, immediately after terminal cleaning was performed. 68.8% were done by external personnel and 20,8% by internal personnel. Previous cleaning we observed <3RLU in 14.7% versus 68.8% after cleaning (p<0.001).After intervention we observed <3RLU in 80% in internal personnel (p<0.009) versus 73,3% in external personnel (p<0.44). The comparison of single versus double terminal cleaning did not show significant results in any phase of the study.

Conclusions:

Cleaning procedure performed by external personnel was more effective compared with the internal personnel during the initial evaluation. However, after intervention best results were obtained by internal personnel. This study suggests that visual assessment is not enough to ensure the quality of the process and it is necessary to document the level of cleanliness by quantitative methods.