Abstract
BackgroundPublished data to date have provided a limited comparison between non-microbiologic methods—particularly visual inspection—and a microbiologic comparator to evaluate the effectiveness of environmental cleaning of patient rooms. We sought to compare the accuracy of visual inspection with other non-microbiologic methods of assessing the effectiveness of post-discharge cleaning (PDC).MethodsProspective evaluation to determine the effectiveness of PDC in comparison to a microbiologic comparator. Using a highly standardized methodology examining 15 high-touch surfaces, the effectiveness of PDC was evaluated by visual inspection, the removal of fluorescent marker (FM) placed prior to room occupancy, quantification of adenosine triphosphate (ATP) levels, and culture for aerobic colony counts (ACC).ResultsTwenty rooms including 293 surfaces were sampled in the study, including 290 surfaces sampled by all four methods. ACC demonstrated 72% of surfaces to be microbiologically clean. Visual inspection, FM, ATP demonstrated 57%, 49%, and 66% of surfaces to be clean. Using ACC as a microbiologic comparator, the sensitivity of visual inspection, FM, and ATP to detect a clean surface were 60%, 51%, and 70%, respectively; the specificity of visual inspection, FM, and ATP were 52%, 56%, and 44%.ConclusionsIn assessing the effectiveness of PDC, there was poor correlation between the two most frequently studied commercial methods and a microbiologic comparator. Visual inspection performed at least as well as commercial methods, directly addresses patient perception of cleanliness, and is economical to implement.
Highlights
Published data to date have provided a limited comparison between non-microbiologic methods— visual inspection—and a microbiologic comparator to evaluate the effectiveness of environmental cleaning of patient rooms
A recent study investigating the efficacy of post-discharge cleaning (PDC) on five high-touch surfaces quantified aerobic colony count (ACC) and adenosine triphosphate (ATP) immediately before and after PDC, as well as removal of fluorescent marker (FM) placed immediately before PDC [21]
Of the three surfaces sampled not included in the analysis, two surfaces in one room could not be evaluated due to interruption by patient admission, and for one surface ACC was not adequately obtained
Summary
Study design This study was conducted from April through June 2011, at the Beth Israel Deaconess Medical Center (BIDMC), a 661-bed academic tertiary care hospital in Boston, Massachusetts, U.S.A. A convenience sample of all unoccupied terminally-cleaned rooms available during weekday business hours were evaluated for this study. In these terminally-cleaned rooms prior to patient occupancy, pre-determined surfaces were tagged with a low-visibility FM. After patient discharge and prior to occupancy by the patient, PDC was evaluated by assessing removal of FM, visual inspection, quantification of ATP, and microbiologic sampling. Visual inspection of the entire surface was performed after PDC and at the time of FM assessment. Statistical analysis We compared the three non-microbiologic methods to assess effectiveness of PDC to each other and to a microbiologic comparator through three analyses: the thoroughness of disinfection cleaning (TDC) score, the concordance of clean/dirty test results with the microbiologic comparator, and test characteristics compared with the microbiologic comparator. Statistical analyses were performed using STATA software (version 10.0, Stata Corp)
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