Philip C. Carling

Improving Healthcare Environmental Cleaning and Disinfection Current and Evolving Issues - Volume 34 Issue 5 - Philip C. Carling, Susan S. Huang

Objective.: The prevalence of serious infections caused by multidrug-resistant pathogens transmitted in the hospital setting has reached alarming levels, despite intensified interventions. In the context of mandates that hospitals ensure compliance with disinfection procedures of surfaces in the environment surrounding the patient, we implemented a multihospital project to both evaluate and improve current cleaning practices.Design.: Prospective quasi-experimental, before-after, study.Setting.: Thirty-six acute care hospitals in the United States ranging in size from 25 to 721 beds.Methods.: We used a fluorescent targeting method to objectively evaluate the thoroughness of terminal room disinfection cleaning before and after structured educational and procedural interventions.Results.: Of 20,646 standardized environmental surfaces (14 types of objects), only 9,910 (48%) were cleaned at baseline (95% confidence interval, 43.4-51.8). Thoroughness of cleaning at baseline correlated only with hospital expenditures for environmental services personnel (P = .02). After implementation of interventions and provision of objective performance feedback to the environmental services staff, it was determined that 7,287 (77%) of 9,464 standardized environmental surfaces were cleaned (P < .001). Improvement was unrelated to any demographic, fiscal, or staffing parameter but was related to the degree to which cleaning was suboptimal at baseline (P < .001).Conclusions.: Significant improvements in disinfection cleaning can be achieved in most hospitals, without a substantial added fiscal commitment, by the use of a structured approach that incorporates a simple, highly objective surface targeting method, repeated performance feedback to environmental services personnel, and administrative interventions. However, administrative leadership and institutional flexibility are necessary to achieve success, and sustainability requires an ongoing programmatic commitment from each institution.

Objective.: The quality of environmental hygiene in hospitals is under increasing scrutiny from both healthcare providers and consumers because the prevalence of serious infections due to multidrug-resistant pathogens has reached alarming levels. On the basis of the results from a small number of hospitals, we undertook a study to evaluate the thoroughness of disinfection and cleaning in the patient's immediate environment and to identify opportunities for improvement in a diverse group of acute care hospitals.Methods.: Prospective multicenter study to evaluate the thoroughness of terminal room cleaning in hospitals using a novel targeting method to mimic the surface contamination of objects in the patient's immediate environment.Setting.: Twenty-three acute care hospitals.Results.: The overall thoroughness of terminal cleaning, expressed as a percentage of surfaces evaluated, was 49% (range for all 23 hospitals, 35%-81%). Despite the tight clustering of overall cleaning rates in 21 of the hospitals, there was marked variation within object categories, which was particularly notable with respect to the cleaning of toilet handholds, bedpan cleaners, light switches, and door knobs (mean cleaning rates, less than 30%; institutional ranges, 0%-90%). Sinks, toilet seats, and tray tables, in contrast, were consistently relatively well cleaned (mean cleaning rates, over 75%). Patient telephones, nurse call devices, and bedside rails were inconsistently cleaned.Conclusion.: We identified significant opportunities in all participating hospitals to improve the cleaning of frequently touched objects in the patient's immediate environment. The information obtained from such assessments can be used to develop focused administrative and educational interventions that incorporate ongoing feedback to the environmental services staff, to improve cleaning and disinfection practices in healthcare institutions.

We developed a new method using an invisible fluorescent marker to target standardized high-touch surfaces in hospital rooms. Evaluation of 1404 surf

Sir—The thoughtful and carefully annotated essay “Skepticism: A Lost Clinical Art,” written by Dr. Mark J. DiNubile [1], provided a lucid perspective on the importance of prudent skepticism in clinical practice. The essay called to mind advice given by Thomas Sydenham (1624–1689) in his monograph “Medical Observations Concerning the History and Cure of Acute Diseases,” which was published in 1666 (translated by R. G. Latham [2]). Sydenham, a diligent and insightful observer of clinical issues, was the first true epidemiologist, although he realized only limited success in categorizing many diseases on the basis of the nature and the patterns of the fevers with which they were associated. Despite the frustrations that he experienced in his attempts to understand infectious diseases prior to the advent of the germ theory, his skepticism regarding the use of unproven treatment modalities are as applicable today as they were more than 330 years ago: “It is difficult to lay down any general rules for treating these fevers. Hence, in darkness so dense, I prefer nothing, upon the breaking out of a new fever, to a little delay; and I proceed especially towards greater remedies, with a slow foot and with circumspection.”