Abstract
BackgroundCleaning of environmental surfaces in hospitals is important for the control of methicillin-resistant Staphylococcus aureus (MRSA) and other hospital-acquired infections transmitted by the contact route. Guidance regarding the best approaches for cleaning, however, is limited.MethodsIn this study, a mathematical model based on ordinary differential equations was constructed to study MRSA concentration dynamics on high-touch and low-touch surfaces, and on the hands and noses of two patients (in two hospitals rooms) and a health care worker in a hypothetical hospital environment. Two cleaning interventions – whole room cleaning and wipe cleaning of touched surfaces – were considered. The performance of the cleaning interventions was indicated by a reduction in MRSA on the nose of a susceptible patient, relative to no intervention.ResultsWhole room cleaning just before first patient care activities of the day was more effective than whole room cleaning at other times, but even with 100% efficiency, whole room cleaning only reduced the number of MRSA transmitted to the susceptible patient by 54%. Frequent wipe cleaning of touched surfaces was shown to be more effective that whole room cleaning because surfaces are rapidly re-contaminated with MRSA after cleaning. Wipe cleaning high-touch surfaces was more effective than wipe cleaning low-touch surfaces for the same frequency of cleaning. For low wipe cleaning frequency (≤3 times per hour), high-touch surfaces should be targeted, but for high wipe cleaning frequency (>3 times per hour), cleaning should target high- and low-touch surfaces in proportion to the surface touch frequency. This study reproduces the observations from a field study of room cleaning, which provides support for the validity of our findings.ConclusionsDaily whole room cleaning, even with 100% cleaning efficiency, provides limited reduction in the number of MRSA transmitted to susceptible patients via the contact route; and should be supplemented with frequent targeted cleaning of high-touch surfaces, such as by a wipe or cloth containing disinfectant.
Highlights
Cleaning of environmental surfaces in hospitals is important for the control of methicillin-resistant Staphylococcus aureus (MRSA) and other hospital-acquired infections transmitted by the contact route
MRSA can be transmitted by the contact route [2], which is consistent with the influence of MRSA-contaminated environmental surfaces, equipment, and hands of health care workers (HCWs)
In both rooms, variation from 9:00 to 17:00 is driven by visits by the HCW, after which MRSA emission into the air and onto surfaces continues while the patient sleeps
Summary
Cleaning of environmental surfaces in hospitals is important for the control of methicillin-resistant Staphylococcus aureus (MRSA) and other hospital-acquired infections transmitted by the contact route. Methicillin-resistant Staphylococcus aureus (MRSA) has become an important cause of hospital-acquired infections (HAIs) worldwide [1]. MRSA can be transmitted by the contact route [2], which is consistent with the influence of MRSA-contaminated environmental surfaces, equipment, and hands of health care workers (HCWs). Cleaning may involve the whole room, or targeted to specific surfaces While both strategies are recommended by the Health Care Infection Control Practices Advisory Committee (HICPAC), the HICPAC guidelines do not recommend specific. More cleaning, when done so as to prevent cross-contamination, will always remove more MRSA and other pathogens from environmental surfaces, but additional cleaning incurs costs, including: personnel time [5], consumption of cleaning products, and disruption of patients. Little research has explored when, and how frequently surface cleaning should be performed in a health care facility
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