Rapid Improvement in the Cleaning of High Touch Surfaces in the ICU and Non-ICU Setting with Audits Using Fluorescent Targeting

Background:   Failure to adequate clean high touch surfaces in patientsÕ rooms is associated with an increased risk of transmission of C.difficile, MRSA, VRE and other pathogens.  Fluorescent targeting methods have been used as an auditing tool to evaluate the thoroughness of room cleaning.  This approach has shown promise but is not well validated in the ICU setting.

 

Objective: To evaluate the efficacy of an audit and feedback program (AFP) that used fluorescent targeting of high touch surfaces in both ICU and non-ICU setting to provide feedback to environmental service workers (ESW).

Methods:  Trained observers marked predefined high touch surfaces in patient rooms using a transparent solution that fluoresces under UV light (GlitterBugª) prior to room cleaning.  Identification of fluorescence 1 hour after cleaning was considered a cleaning failure.  ESW were aware of the study but marking was conducted covertly. The outcome was the proportion of high touch surfaces evaluated that were free of fluorescence (Ôproportion cleanedÕ) calculated as the number of surfaces cleaned over the number of surfaces evaluated.  Rooms were observed daily in 2 ICUs (a 24 bed medical-surgical ICU and a 16 bed cardiovascular ICU) and on an 86 bed medical unit for 3 weeks (baseline period).  This was followed by an intervention period during which weekly meetings were held and ESW received education on surfaces frequently missed and positive feedback on surfaces consistently cleaned.  The intervention phase was continued in each clinical setting until consistent performance >80% was demonstrated for 2 consecutive weeks.  

Results:   The proportion of surfaces cleaned during the baseline period was 38% (134/355) on the ward and 52% (113/206) in the ICU.  The proportion of individual surfaces cleaned ranged from 0% (toilet grab bar) to 93% (tray table) on the ward and from 13% (light switch) to 89% (countertop) in the ICU.  The intervention phase lasted 4 weeks on the ward and 3 weeks in the ICU, at which point both units had achieved >80% success at cleaning all items for 2 consecutive weeks (Figure 1).  The overall proportion cleaned improved significantly between baseline and intervention phases in both areas, with the proportion cleaned on the ward rising from 38% (134/355) in the baseline period to 68% (316/468) in the intervention period (p<0.05) and in the ICU from 52% (113/206) in the baseline period to 78% (203/259) during the intervention phase (p<0.05).  

 

Conclusions: Providing audit results on the thoroughness of cleaning high touch surfaces to ESW in a simple and straightforward manner can result in rapid improvements in the thoroughness of cleaning and can be adapted to both the ward and ICU setting.

Figure 1:  Proportion of High Touch Surfaces Cleaned Weekly