Major Article
Contact patterns during cleaning of vomitus: A simulation study

https://doi.org/10.1016/j.ajic.2017.07.005Get rights and content

Highlights

  • Cleaning of simulated vomitus was relatively quick.

  • Cleaners infrequently touched their own bodies while cleaning.

  • Cleaners touched the cleaning cart more often than other surfaces, on average.

  • Each participant used different cleaning practices, but used similar cleaning practices each time he or she cleaned.

  • Few cleaners followed the recommended protocol for cleaning bodily fluids.

  • Following the recommended protocol for cleaning bodily fluids was associated with fewer surface contacts and improved cleaning quality.

Background

Environmental service workers cleaning bodily fluids may transfer pathogens through the environment and to themselves through contacts.

Methods

Participants with experience in cleaning of hospital environments were asked to clean simulated vomitus using normal practices in a simulated patient room while being videorecorded. Contacts with environmental surfaces and self were later observed.

Results

In 21 experimental trials with 7 participants, environmental surfaces were contacted 26.8 times per trial, at a frequency of 266 contacts per hour, on average. Self-contact occurred in 9 of 21 trials, and involved 1-18 contacts, mostly to the upper body. The recommended protocol of cleaning bodily fluids was followed by a minority of participants (2 of 7), and was associated with fewer surface contacts, improved cleaning quality, and different tool use. Participants used different cleaning practices, but each employed similar practices each time they performed an experimental trial.

Conclusions

Training in the use of the recommended protocol may standardize cleaning practices and reduce the number of surface contacts.

Section snippets

Methods

Participants with experience cleaning in health care settings were recruited via e-mail, flyers, and presentations at staff meetings at 2 hospitals in the Chicago area. Participation involved a 2-hour time commitment, and was incentivized with a $40 gift card. The University of Illinois at Chicago Institutional Review Board approved this study (protocol 2015-0990).

Simulations were performed in a room-scale chamber (2.5 m × 4.5 m × 2.4 m high) with sheetrock walls and vinyl tile flooring,

Results

A total of 7 participants were recruited (6 men and 1 woman), and performed 21 trials with simulated vomitus (5 each with the low viscosity on gurney, HG, and low viscosity on floor conditions, and 6 with the high viscosity on gurney condition). Bodily fluid cleaning protocols recommended by the Healthcare Infection Control Practices Advisory Committee to the Centers for Disease Control and Prevention and by the Occupational Safety and Health Administration involve using an absorbent material

Discussion

We found that during cleaning participants touched the cleaning cart (to obtain and dispose of cleaning supplies) and the gurney (to move the gurney, clean the gurney, and for balance) far more frequently than they touched other surfaces, such as the floor (Table 1). Although this observation was true for all participants, there was substantial variability in the contact patterns between individuals (Fig 1). Participants tended to exhibit similar contact patterns in repeated trials; that is,

Acknowledgments

The authors thank Charline Gooley, superintendent of building Services at the University of Illinois Hospital for providing helpful assistance.

Electronic data tables for this article will be available at time of publication at UIC INDIGO (https://indigo.uic.edu); raw data will be available within 16 months at the same location.

References (20)

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This work was supported by the CDC Prevention Epicenters Program through cooperative agreement U54CK000445 with the UIC Epicenter for Prevention of Healthcare Associated Infections.

Conflicts of interest: None to report.

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