Improving and sustaining environmental cleaning compliance in a large academic hospital using fluorescent targeting audits, education, and feedback

Abstract

BACKGROUND: A contaminated patient environment contributes to pathogen transmission and plays a significant role in healthcare-associated infections (HAIs). Studies have shown that reducing environmental contamination through improved cleaning practices reduces the risk of acquiring an HAI, but sustaining a hospital-wide culture of cleanliness over time can be challenging. We sought to improve and sustain environmental cleaning compliance long-term for both environmental services (EVS) and the clinical staff using fluorescent audits and a feedback program. METHODS: From October 1, 2016 to September 30, 2018, interventions directed towards improving environmental cleaning included: fluorescent marker audits, monthly meetings with EVS and hospital leaders, attending EVS and clinical staff meetings, modification of hospital cleaning policies, 1-on-1 audit walk-throughs with staff, testing additional surfaces over time, and a data feedback program. Each inpatient unit was audited every other month by Infection Prevention and Control (IPC). Compliance data (% surfaces with fluorescent marker removed) was grouped by quarter (3 months) to show the impact of the interventions over time. RESULTS: The first quarter of audits revealed a compliance rate of 49% for EVS (455 surfaces cleaned of 923 observations) and 15% for clinical staff (26 surfaces cleaned of 173 observations). At the end of two years, the final quarter compliance rate for EVS was 85% (2004 surfaces cleaned of 2366 observations; p CONCLUSIONS: This study found that significant and sustained improvements in environmental cleaning performance can be achieved through education, audit feedback, and the support of hospital and EVS leadership in conjunction with IPC.