Identifying Opportunities To Enhance Environmental Cleaning in Twelve Acute Care Hospitals

BACKGROUND/OBJECTIVES: Despite activities aimed at enhancing isolation practices and promoting increased use of hand hygiene products, the spread of health care associated pathogens continues to be a major problem. While clearly not an independent factor, environmental contamination with these resistent and resiliant pathogens in combination with suboptimal cleaning/disinfection activities has been shown to play a role in perpetuating the transmission of these pathogens in many settings. In this context we undertook a multi-institutional prospective evaluation of cleaning/disinfecting activities to determine if opportunities to enhance these activities could be identified. METHODS: An evaluation of the thoroughness of cleaning of the near patient environment using a non-biological targeting method was undertaken in twelve acute care hospitals ranging in size from 46 to 568 beds. The proportion of frequently touched objects cleaned as part of terminal room cleaning/disinfecting activities was calculated for between 30 and 52 rooms in each facility in a confidential manner. The results were analyzed to determine how specific interventions could be developed to enhance such cleaning activities. RESULTS: Substantial opportunites for improving terminal room cleaning were identified in all hospitals. While the overall thoroughness of cleaning of objects in the near patient environment was quite similar in this cohort of hospitals (mean % of objects cleaned = 45.3, SD = 3.4), wide differences in how well specific objects were cleaned both within and between institutions were noted. Analysis of these results disclosed a range of institutional specific opportunities for a) educational interventions, b) the re-assessment of environmental services personnel allocation and c) the identification of possible motivational issues as well as inter-institutional analyses of issues for which highly specific interventions could be implemented and their impact objectively measured. CONCLUSIONS: The programmatic use of a simple user-friendly targeting method to evaluate the thoroughness of terminal patient room cleaning identified many specific opportunities for improving cleaning/disinfecting activities in each of the twelve acute care hospitals studied.