Healthcare Infection Healthcare Infection Society
Official Journal of the Australasian College for Infection Prevention and Control
RESEARCH ARTICLE (Open Access)

Evaluating environment cleanliness using two approaches: a multi-centred Australian study

Brett G. Mitchell A B D , Fiona Wilson C and Anne Wells C
+ Author Affiliations
- Author Affiliations

A Faculty of Arts, Nursing and Theology, Avondale College of Higher Education, Wahroonga, NSW 2076, Australia.

B School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Dickson, ACT 2602, Australia.

C Tasmanian Infection Prevention and Control Unit, Public Health Services, Department of Health and Human Services, Hobart, Tas. 7000, Australia.

D Corresponding author. Email: brett.mitchell@avondale.edu.au

Healthcare Infection 20(4) 95-100 https://doi.org/10.1071/HI15009
Submitted: 15 April 2015  Accepted: 10 June 2015   Published: 29 June 2015

Abstract

Introduction: A standardised approach to evaluating environmental cleanliness is important to ensure consistency of assessor training, allow benchmarking of results between facilities, ensure consistency of the assessment of the environment and assist in meeting national accreditation standards. This paper describes the development process and the findings of the first 12 months of data following the introduction of a standardised program for evaluating environmental cleanliness within Tasmanian healthcare facilities using two different evaluation methods.

Methods: Evaluation of environmental cleanliness was undertaken as part of a structured program and involved the use of an ultraviolet solution and fluorescent light in addition to a visual assessment. Twelve Tasmanian hospitals participated in this study.

Results: A total of 290 fluorescent light assessments and 232 visual inspections were conducted. Using the fluorescent light assessment, the percentage of correctly cleaned items increased from a baseline of 82.3% to 85.4% over the 12-month study period. Using the visual assessment, 92.5% of items were deemed acceptable during the study period.

Conclusions: Our multi-centred study identified a high baseline level of cleanliness using a fluorescent light. We identified that objects were frequently deemed to be visually acceptable, yet may not have been cleaned. The project was supported by a range of online tools for data submission, training tools and a formal assessment of auditors.


References

[1]  Barker J, Vipond IB, Bloomfield SF. Effects of cleaning and disinfection in reducing the spread of Norovirus contamination via environmental surfaces. J Hosp Infect 2004; 58 42–9.
Effects of cleaning and disinfection in reducing the spread of Norovirus contamination via environmental surfaces.CrossRef | 1:STN:280:DC%2BD2cvktlKisA%3D%3D&md5=ac49c73e8b2ca9ff090485b75acc0129CAS | 15350713PubMed |

[2]  Boyce JM. Environmental contamination makes an important contribution to hospital infection. J Hosp Infect 2007; 65 50–4.
Environmental contamination makes an important contribution to hospital infection.CrossRef | 17540242PubMed |

[3]  Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis 2006; 6 130
How long do nosocomial pathogens persist on inanimate surfaces? A systematic review.CrossRef | 16914034PubMed |

[4]  Wagenvoort JH, De Brauwer EI, Penders RJ, Willems RJ, Top J, Bonten MJ. Environmental survival of vancomycin-resistant Enterococcus faecium. J Hosp Infect 2011; 77 282–3.
Environmental survival of vancomycin-resistant Enterococcus faecium.CrossRef | 1:STN:280:DC%2BC3M3itVKktA%3D%3D&md5=5f7f81433388ccafa7c504c0ffe30dd5CAS | 21288596PubMed |

[5]  Dancer SJ. The role of environmental cleaning in the control of hospital-acquired infection. J Hosp Infect 2009; 73 378–85.
The role of environmental cleaning in the control of hospital-acquired infection.CrossRef | 1:STN:280:DC%2BD1MjmsFOqsQ%3D%3D&md5=a49d00bbbf5108a938db0f485d235c3dCAS | 19726106PubMed |

[6]  Dancer SJ. Hospital cleaning in the 21st century. Eur J Clin Microbiol Infect Dis 2011; 30 1473–81.
Hospital cleaning in the 21st century.CrossRef | 1:STN:280:DC%2BC3MbnslOlug%3D%3D&md5=8c3d4d7211d7f4b567b248d30603d5f3CAS | 21499954PubMed |

[7]  Dancer SJ, White LF, Lamb J, Girvan EK, Robertson C. Measuring the effect of enhanced cleaning in a UK hospital: a prospective cross-over study. BMC Med 2009; 7 28
Measuring the effect of enhanced cleaning in a UK hospital: a prospective cross-over study.CrossRef | 19505316PubMed |

[8]  Griffith CJ, Obee P, Cooper RA, Burton NF, Lewis M. The effectiveness of existing and modified cleaning regimens in a Welsh hospital. J Hosp Infect 2007; 66 352–9.
The effectiveness of existing and modified cleaning regimens in a Welsh hospital.CrossRef | 1:STN:280:DC%2BD2svnvFGgtg%3D%3D&md5=700551034c94b6fdd52bdc75a185951aCAS | 17655976PubMed |

[9]  Mitchell BG, Gardner A. Addressing the need for an infection prevention and control framework that incorporates the role of surveillance: a discussion paper. J Adv Nurs 2014; 70 533–42.
Addressing the need for an infection prevention and control framework that incorporates the role of surveillance: a discussion paper.CrossRef | 23789617PubMed |

[10]  Seto WH, Otaíza F, Pessoa Silva CL. Core components for infection prevention and control programs: a World Health Organization network report. Infect Control Hosp Epidemiol 2010; 31 948–50.
Core components for infection prevention and control programs: a World Health Organization network report.CrossRef | 20636135PubMed |

[11]  Tasmanian Infection Prevention and Control Unit. Evaluating Environmental Cleanliness 2014; Available at http://www.dhhs.tas.gov.au/publichealth/communicable_diseases_prevention_unit/tasmanian_infection_prevention_and_control_unit/evaluating_ environmental_cleanliness [Verified November 2014]

[12]  Australian Commission on Safety and Quality in Health Care. National Safety and Quality Health Service Standards. Sydney: Australian Commission on Safety and Quality in Health Care; 2011.

[13]  Carling PC, Briggs J, Hylander D, Perkins J. An evaluation of patient area cleaning in 3 hospitals using a novel targeting methodology. Am J Infect Control 2006; 34 513–9.
An evaluation of patient area cleaning in 3 hospitals using a novel targeting methodology.CrossRef | 17015157PubMed |

[14]  Carling PC, Briggs JL, Perkins J, Highlander D. Improved cleaning of patient rooms using a new targeting method. Clin Infect Dis 2006; 42 385–8.
| 16392086PubMed |

[15]  Carling PC, Parry MF, Bruno-Murtha LA, Dick B. Improving environmental hygiene in 27 intensive care units to decrease multidrug-resistant bacterial transmission. Crit Care Med 2010; 38 1054–9.
Improving environmental hygiene in 27 intensive care units to decrease multidrug-resistant bacterial transmission.CrossRef | 20081531PubMed |

[16]  Goodman ER, Platt R, Bass R, Onderdonk AB, Yokoe DS, Huang SS. Impact of an environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in intensive care unit rooms. Infect Control Hosp Epidemiol 2008; 29 593–9.
Impact of an environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in intensive care unit rooms.CrossRef | 18624666PubMed |

[17]  Murphy CL, Macbeth DA, Derrington P, Gerrard J, Faloon J, Kenway K, Lavender S, Leonard S, Orr A, Tobin D, Carling P. An assessment of high touch object cleaning thoroughness using a fluorescent marker in two Australian hospitals. Healthc Infect 2011; 16 156–63.
An assessment of high touch object cleaning thoroughness using a fluorescent marker in two Australian hospitals.CrossRef |

[18]  Bonten MJ, Slaughter S, Ambergen AW, Hayden MK, van Voorhis J, Nathan C, Weinstein RA. The role of ‘colonization pressure’ in the spread of vancomycin-resistant enterococci: an important infection control variable. Arch Intern Med 1998; 158 1127–32.
The role of ‘colonization pressure’ in the spread of vancomycin-resistant enterococci: an important infection control variable.CrossRef | 1:STN:280:DyaK1c3ms1yhsA%3D%3D&md5=61c0be59040d119af8ef35214ee5a06dCAS | 9605785PubMed |

[19]  Eveillard M, Lancien E, Hidri N, Barnaud G, Gaba S, Benlolo JA, Joly-Guillou ML. Estimation of methicillin-resistant Staphylococcus aureus transmission by considering colonization pressure at the time of hospital admission. J Hosp Infect 2005; 60 27–31.
Estimation of methicillin-resistant Staphylococcus aureus transmission by considering colonization pressure at the time of hospital admission.CrossRef | 1:STN:280:DC%2BD2M7ptV2ksg%3D%3D&md5=01d89cc43750b51b909908216e574338CAS | 15823653PubMed |

[20]  Merrer J, Santoli F, Appere de Vecchi C, Tran B, De Jonghe B, Outin H. “Colonization pressure” and risk of acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol 2000; 21 718–23.
“Colonization pressure” and risk of acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit.CrossRef | 1:STN:280:DC%2BD3M7js1answ%3D%3D&md5=0487ed8c6a74fb3f16b5c6d58ab74d1aCAS | 11089656PubMed |

[21]  Mitchell B, Wilson F, Ware C, Brown S, McGregor A, Dancer SJ. Evaluating environmental cleanliness in hospitals and other healthcare settings. What are the most effective and efficient methods to use? Hobart: Department of Health and Human Services; 2012.

[22]  Clinical Excellence Commission. Environmental Cleaning Policy. Sydney: NSW Ministry of Health; 2012.

[23]  Quality Safety and Patient Experience Branch. 2011. Department of Health. Cleaning standards for Victorian health facilities.

[24]  Mitchell B, Wilson F, McGregor A, Dancer S. Methods to evaluate environmental cleanliness in healthcare facilities. Healthc Infect 2013; 18 23–30.
Methods to evaluate environmental cleanliness in healthcare facilities.CrossRef |

[25]  Huang YC, Lee CY, Su LH, Chang LY, Lin TY. Methicillin-resistant Staphylococcus aureus bacteremia in neonatal intensive care units: genotyping analysis and case-control study. Acta Paediatrica Taiwanica 2005; 46 156–60.
| 16231563PubMed |

[26]  Mitchell BG, Digney W, Ferguson JK. Prior room occupancy increases risk of methicillin-resistant Staphylococcus aureus acquisition. Healthc Infect 2014; 19 135–40.
Prior room occupancy increases risk of methicillin-resistant Staphylococcus aureus acquisition.CrossRef |

[27]  Nseir S, Blazejewski C, Lubret R, Wallet F, Courcol R, Durocher A. Risk of acquiring multidrug-resistant Gram-negative bacilli from prior room occupants in the intensive care unit. Clin Microbiol Infect 2011; 17 1201–8.
Risk of acquiring multidrug-resistant Gram-negative bacilli from prior room occupants in the intensive care unit.CrossRef | 1:STN:280:DC%2BC3Mjgt1Cmuw%3D%3D&md5=a590dd41ffc59c751cf64cb9526e9baaCAS | 21054665PubMed |

[28]  Otter JA. How do we tackle contaminated hospital surfaces? Healthc Infect 2013; 18 42–4.
How do we tackle contaminated hospital surfaces?CrossRef |

[29]  Smith PW, Sayles H, Hewlett A, Cavalieri RJ, Gibbs SG, Rupp ME. A study of three methods for assessment of hospital environmental cleaning. Healthc Infect 2013; 18 80–5.
A study of three methods for assessment of hospital environmental cleaning.CrossRef |

[30]  Smith PW, Gibbs S, Sayles H, Hewlett A, Rupp ME, Iwen PC. Observations on hospital room contamination testing. Healthc Infect 2013; 18 10–3.
Observations on hospital room contamination testing.CrossRef |


Full Text PDF (402 KB) Export Citation

View Altmetrics