Multisite evaluation of environmental cleanliness of high-touch surfaces in intensive care unit patient rooms

doi:10.1016/j.ajic.2018.03.031

American Journal of Infection Control

Volume 46, Issue 10, October 2018, Pages 1198-1200

https://doi.org/10.1016/j.ajic.2018.03.031 Get rights and content

Highlights

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Large variations of environmental cleanliness of high-touch surfaces after discharge cleaning and disinfection are identified in ICU patient rooms in Brazil, Canada, the Netherlands and the US.
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Major differences exist in used cleaning and disinfection protocols, detergents and disinfectants.
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Monitoring of staff cleaning compliance using rapid methods such as reflective surface markers or adenosine triphosphate with ongoing staff feedback can ensure optimal cleaning and disinfection of high touch surfaces.
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The total aerobic count on high-touch surfaces provided limited value for routine cleanliness monitoring and should be used selectively during outbreaks.

The efficacy of discharge cleaning and disinfection of high-touch surfaces of intensive care unit patient rooms in Brazil, Canada, the Netherlands, and the United States was evaluated and the effect of an educational intervention was determined. Significant site-to-site differences in cleaning regimens and baseline cleanliness levels were observed using ATP levels, colony-forming units, and reflective surface marker removal percent pass rates. An educational intervention that includes rapid feedback of the ATP measurements could significantly improve the quality of the cleaning and disinfection regimens.

Section snippets

Methods

A prospective intensive care unit (ICU) intervention study assessed 5 high-touch surfaces in 50 rooms in each of 4 countries in 2015 and 2016. The efficacy of the discharge cleaning and disinfection regimens was evaluated by measuring ATP levels, microbiologic contamination, and RSM removal. The rooms were chosen based on convenience sampling.

Standard terminal cleaning and disinfection procedures for ICU patient rooms were collected and recorded for each of the 4 sites (Table 1). The 3M

Results

Baseline characteristics relevant for cleaning and disinfection of ICUs in Brazil, Canada, the Netherlands, and the United States are provided in Table 1. A variety of detergents, disinfectants, and combinations were used at the different study sites. Because it is an active compound, quaternary ammonium compounds were most frequently used (3 out of 4 sites) followed by hydrogen peroxide (2 out of 4 sites). During the preintervention and intervention periods, significant differences between

Discussion

In the context of increasing bacterial multidrug resistance the absence of a global cleaning and disinfection guideline is striking. In this multisite evaluation of environmental cleanliness of high-touch surfaces in ICU patient rooms, we were able to demonstrate large variations in cleaning and disinfection protocols, detergents and disinfectants used, and the resultant outcomes. Monitoring of staff cleaning compliance using rapid methods such as RSM or ATP with staff feedback can ensure

Acknowledgments

The authors thank Dan Morse, senior biostatistical specialist, Marco Bommarito, lead research specialist, and Maren David, clinical research specialist, 3M Company, St Paul, MN, for overall data tabulation and statistical analysis. The authors also thank Amanda Luiz Pires Maciel for sample collection, data recording, and the competency testing during the educational intervention at the Brazilian site; Nancy Olson and Pat DeGagne for sample collection, data recording, and the competency testing

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A recent multisite evaluation of environmental cleanliness of high-touch surfaces in the ICU demonstrated large variations in cleaning/disinfection protocols and product selection. The authors found that staff cleaning compliance using rapid methods such as relative surface marker assessment or adenosine triphosphate (ATP) bioluminescence with staff feedback was effective in assuring optimal disinfection of high-touch surfaces in the ICU.11 The authors suggested that total aerobic culture counts on high-touch surfaces provided limited value for routine monitoring of cleanliness.
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: 3M provided research funding and supplies for each of the study sites.

: Conflicts of interest: I.B. has served as a consultant on the scientific advisory board for 3M, and received support for travel to meetings for the study, payment for reviewing the manuscript, and provision of administrative support for this study from 3M. M.A. has served as a consultant on the scientific advisory board for 3M and has been a consultant on unrelated issues for Olympus, KARL STORZ, J&J, Novaflux, and MSPrebiotics Inc. M.A. receives royalties from the University of Manitoba for a patent licensed to Healthmark and has received honoraria as an invited speaker sponsored by Sealed Air-Diversey, Canadian Digestive Disease Week, International Association of Healthcare Central Service Material Management, Society of Gastroenterology Nurses and Associates, and te Association for Professionals in Infection Control and Epidemiology Inc. J.H. served as a Radboudumc consultant on the scientific advisory board for 3M during 2016 and received support for travel to meetings for the study from 3M. C.J.D. has served as a consultant on a scientific advisory board for 3M and has received research funding from EcoLab, Clorox, GOJO, Merck, and Altapure.

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Brief ReportMultisite evaluation of environmental cleanliness of high-touch surfaces in intensive care unit patient rooms

Highlights

Section snippets

Methods

Results

Discussion

Acknowledgments

J Hosp Infect

Am J Infect Control

Brief Report
Multisite evaluation of environmental cleanliness of high-touch surfaces in intensive care unit patient rooms