modern technologies to enhance cleaning, and evidence supports using these additional no-touch cleaning and disinfection methods to reduce environmental contamination (Donskey, 2013; Weber et al., 2019). Some questions under review are the benefits over standard cleaning and disinfecting Risk-based approach A risk-based approach (low, medium, high) is recommended to standardize cleaning frequency, methods, and processes (Assadian et al., 2021; CDC, 2020). Cleaning principles to consider when determining risk include the probability of contamination, the vulnerability of the patient to infection, and the potential for exposure to pathogens (CDC, 2020). A risk- based approach would highlight that more frequent cleaning is needed for areas with a high probability of contamination. A patient who is more vulnerable to infection (e.g., immunocompromised, on dialysis) would require more frequent cleaning than a less vulnerable patient, as the former is at higher risk. The potential for exposure comes from being in contact with high-touch surfaces that are heavily contaminated. Assadian and Adherence with cleaning As with any patient safety initiative, sustaining improvements over time is challenging. Methods to monitor performance include direct observation (e.g., using a checklist), taking swab cultures of the environment, fluorescent markers, and adenosine triphosphate (ATP) swabs (measuring bioburden) (Carling, 2013). Root causes of outbreaks are generally related to inadequate cleaning and disinfection practices related to shared patient care equipment (Kanamori et al., 2017; McCafferty et al., 2018). One method of measuring cleaning compliance is to place a fluorescent marker on targeted high-touch surfaces to see if it is removed with cleaning and disinfecting. The Johns Hopkins Hospital evaluated the cleanliness of high-touch surfaces in 228 patient care rooms (Rock et al., 2019). In general, the removal rate was 75%, with daily clean areas having a lower removal rate (71%) than the discharge room clean removal rate (88%). The high-touch surfaces in the patient room with the lowest removal rate were the vital sign monitors (26%) and the infusion pumps (54%); the highest removal rate was on the telephone (80%) and the main room sink faucet (85%). In the bathroom, the lowest removal rate was on the bathroom light switch (76%), and the highest was on the toilet flush handle (88%). This study highlights the need to clearly define who is responsible for cleaning and disinfecting patient equipment (housekeeping or nursing department) and provide regular training and feedback to improve performance. The high-touch surfaces that the nursing staff is more likely responsible for had the lowest removal rate (vital sign monitors and infusion pumps). Another study showed that 63% of high-touch surfaces were appropriately cleaned (Meyer et al., 2021). Several surfaces were marked using a fluorescent marker, five in the bathroom and five in the patient zone. The high-touch areas cleaned (marker not visible) were the toilet handle (80%) and the toilet seat (underside; 83%), and the areas where the marker was still visible were the bed rails (56%) and sink fixtures (in the patient’s room) (54%). A recent study measured environmental contamination on high- touch surfaces in long-term care facilities. The methods used to measure were a fecal contamination indicator, an adenosine triphosphate (ATP) hygienic monitoring tool, and environmental cultures (Cannon et al., 2022). Over 300 surfaces were sampled, and all the cultures were negative for norovirus. However, over 90% showed contamination with the fecal contamination indicator. This study highlights the presence of environmental contamination on high-touch surfaces and the opportunity for improved cleaning and disinfecting practices.
methods—does it eliminate or reduce pathogens? There are also no regulations for these technologies; therefore, there can be no reassurance to healthcare facilities that manufacturers’ claims are accurate (Donskey, 2013).
colleagues (2021) suggest an environmental cleaning bundle that includes a risk assessment, hand hygiene, implementation of best practices, and regular training with timely feedback. Self-Assessment Quiz Question #4 Which of the following is not an example of a high-touch surface? a. Bedrails. b. Tray table. c. Blood pressure cuff. d. Oxygen tank. Parry and colleagues (2022) sustained improvement after implementing their cleaning and disinfecting program. The study monitored environmental services cleaning and disinfection practices over 10 years on eight medical-surgical units. The education included formal education, monitoring, and monthly feedback, especially on the performance of cleaning and disinfecting high-touch surfaces. The authors were able to correlate improvements with reduced HAIs. In 2011, initial compliance with cleaning was 40%–50%, and when provided with feedback, the EVS staff became defensive. Four years later, they achieved 90% compliance with cleaning and attributed that to mentoring with positive feedback. The EVS staff have maintained compliance with cleaning above 90% for the past six years. Other quality improvement projects were occurring simultaneously, including hand hygiene and antimicrobial stewardship. The outcome showed that C. difficile infections decreased by 70% and surgical site infections decreased by 55%. This study highlights that with clear program objectives and staff engagement, long-term infection prevention improvements can be sustained. A cleaning and disinfecting program should be implemented to monitor compliance and outcomes in every healthcare setting. Many studies show that reducing environmental contamination reduces HAIs (Donskey, 2013; Parry et al., 2022). During the pandemic, it was hypothesized that transmission was occurring from contaminated surfaces when in fact, SARS-CoV-2 is easy to remove from surfaces with regular cleaning and disinfecting (Jablonska-Trypuc et al., 2022). Regular training and monitoring performance with feedback will aid in sustaining improvement (McCafferty et al., 2018; Parry et al., 2022). The general principles for cleaning should occur whether cleaning is done by environmental services or the nursing department. Multiple studies suggest environmental contamination plays a role in the transmission of pathogens in healthcare. While there are best practices for cleaning and disinfecting high-touch surfaces and resident rooms, there are still opportunities for improvement. Regular training, monitoring, and feedback on performance are essential to improve compliance. Due to challenges with traditional cleaning and disinfecting methods, several no-touch methods are under review as an adjunct to regular cleaning. Whether the environment is contaminated or not, the best strategy is to perform hand hygiene before patient contact.
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Book Code: RPTTX2024
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