Assessing the Quality of Environmental Cleaning of Frequently Touched Surfaces in Contact Versus Non-contact Patient Rooms

Abstract

Introduction: In an attempt to fight the increasing incidence of hospital-acquired Clostridium difficile illness, a collaborative and interdisciplinary approach focusing on environmental cleaning was undertaken by New York University Langone Medical Center. The Clean Team (CT), a twice-daily disinfection program of Frequently Touched Surface (FTS) with was employed throughout the hospital. To determine whether contact-precautions modify housekeeping activity and deviation from standard environmental cleaning protocols of FTS we decided to conduct a prospective cohort study comparing ATP bioburden in contact versus non-contact patient rooms. No such study exists in literature. Methods: For the purpose of the study, five FTS are randomly selected as test spots in each room. Researchers performed unannounced evaluations of cleaning performance in randomly selected CIP and non-CIP patient rooms within five minutes of disinfection using a real-time bioluminescence monitor to measure ATP activity in relative light units (RLU) (3M Inc, St. Paul, MN) over a one-month study period. Differences between cleaning quality of FTS in CIP and non-CIP rooms were compared using Fisher's exact test. Results: A total of 61 surface contacts were recorded during the study period. Overall the study depicted no statistical association (p value 0.1290) in quality of cleaning of FTS between CIP and non-CIP patient rooms when testing for a 50% difference using the Fisher's exact test. The CIP rooms accounted for 35 (57.38%) surface contacts and the non-CIP rooms accounted for 26 (42.62%). In the CIP rooms, the mean ATP level of all surfaces after cleaning (79 RLU) was less than the 200 RLU benchmark. In comparison, the mean ATP level of all surfaces in the non-CIP rooms after cleaning was 34.76 RLU (p value 0.0094). The study depicted statistically significant difference in the actual means (t-statistic 2.71, p value 0.0094) using the Satterthwaite test. In the CIP rooms 4 (11.42%) of 35 FTS were rendered contaminated as compared to zero FTS in the non-CIP rooms. The contact rooms were also 1.13 times more likely to fail (relative risk 0.885, [95% CI 0.786 to 0.998]). Conclusion: This is the first study to compare the quality of environmental cleaning of FTS in CIP versus non-CIP patient room. The results of this study can also be used to provide feedback to housekeeping staff and direct cleaning towards specific contaminated surfaces in an attempt to decrease pathogen transmission of Clostridium difficile.