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Improving Cleaning of the Environment Surrounding Patients in 36 Acute Care Hospitals

Published online by Cambridge University Press:  02 January 2015

Philip C. Carling ,
Michael M. Parry ,
Mark E. Rupp ,
John L. Po ,
Brian Dick ,
Sandra Von Beheren  and
Healthcare Environmental Hygiene Study Group
Philip C. Carling*
Affiliation:
Infectious Diseases Section, Caritas Carney Hospital, Boston, Massachusetts Boston University School of Medicine, Boston, Massachusetts
Michael M. Parry
Affiliation:
Department of Infectious Diseases, Stamford Hospital, Stamford, Connecticut Columbia College of Physicians and Surgeons, Columbia University, New York, New York
Mark E. Rupp
Affiliation:
Department of Infectious Diseases, Nebraska Medical Center, andUniversity of Nebraska, Omaha, Nebraska
John L. Po
Affiliation:
Boston University School of Medicine, Boston, Massachusetts Department of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
Brian Dick
Affiliation:
Department of Hospital Epidemiology, The Toledo Hospital, Toledo, Ohio
Sandra Von Beheren
Affiliation:
Department of Hospital Epidemiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
*
Infectious Diseases Section, Caritas Carney Hospital, 2100 Dorchester Avenue, Boston, MA 02124 (pcarling@cchcs.org)
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Abstract

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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 11 , November 2008 , pp. 1035 - 1041
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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References

1.Zell, BL, Goldmann, DA. Healthcare-associated infection and antimicrobial resistance: moving beyond description to prevention. Infect Control Hosp Epidemiol 2007;28:261–264.CrossRefGoogle ScholarPubMed
2.Sax, H, Allegranzi, B, Uçkay, I, Larson, E, Boyce, J, Pittet, D. ‘My five moments of hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 2007;67:9–21.CrossRefGoogle ScholarPubMed
3.Hugo, S, Uçkay, I, Richet, H, Allegranzi, B, Pittet, D. Determinants of good adherence to hand hygiene among healthcare workers who have extensive exposure to hand hygiene campaigns. Infect Control Hosp Epidemiol 2007;28:1267–1274.Google Scholar
4.Rupp, ME, Fitzgerald, T, Puumala, S, Anderson, JR. Prospective, controlled, cross-over trial of alcohol-based hand gel in critical care units. Infect Control Hosp Epidemiol 2008;29:8–15.CrossRefGoogle ScholarPubMed
5.Weber, DJ, Sickbert-Bennett, EE, Brown, VM, et al.Compliance with isolation precautions at a university hospital. Infect Control Hosp Epidemiol 2007;28:358–361.CrossRefGoogle ScholarPubMed
6.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;34:513–519.CrossRefGoogle ScholarPubMed
7.Eckstein, BC, Adams, DA, Eckstein, EC, Rao, A. Reduction of Clostridium diffidle and vancomycin-resistant Enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods. BMC Infect Dis 2007;7:61.CrossRefGoogle ScholarPubMed
8.Boyce, JM, Havill, NL, Otter, JA, Adams, NM. Widespread environmental contamination associated with patients with diarrhea and methicillin-resistant Staphylococcus aureus colonization of the gastrointestinal tract. Infect Control Hosp Epidemiol 2007;28:1142–1147.CrossRefGoogle ScholarPubMed
9.Dancer, SJ. Importance of the environment in methicillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning. Lancet Infect Dis 2008;8:101–113.CrossRefGoogle ScholarPubMed
10.Dancer, SJ, Coyne, M, Robertson, C, Thomson, A. Antibiotic use is associated with resistance of environmental organisms in a teaching hospital. J Hosp Infect 2006;62:200–206.CrossRefGoogle ScholarPubMed
11.Boyce, JM, Potter-Bynoe, G, Chenevert, C, King, T. Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications. Infect Control Hosp Epidemiol 1997;18:622–627.CrossRefGoogle ScholarPubMed
12.Bhalla, A, Pultz, NJ, Gries, DM, Ray, AJ. Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients. Infect Control Hosp Epidemiol 2004;25:164–167.CrossRefGoogle ScholarPubMed
13.Hayden, MK, Blom, DW, Lyle, EA, Moore, CG, Weinstein, RA. Risk of hand or glove contamination after contact with patients colonized with vancomycin-resitant Enterococcus or the colonized patients' environment. Infect Control Hosp Epidemiol 2008;29:149–154.CrossRefGoogle ScholarPubMed
14.Duckro, AN, Blom, DW, Lyle, EA, Weinstein, RA. Transfer of vancomycin-resistant enterococci via health care worker hands. Arch Intern Med 2005;165:302–307.CrossRefGoogle ScholarPubMed
15.Huang, S, Dotta, R, Platt, R. Risk of acquiring antiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006;166:1945–1951.CrossRefGoogle ScholarPubMed
16.Hardy, KJ, Oppeheim, BA, Gossain, S, Gao, F. A study of the relationship between environmental contamination with methicillin-resistant Staphylococcus aureus (MRSA) and patients' acquisition of MRSA. Infect Control Hosp Epidemiol 2006;27:127–132.CrossRefGoogle ScholarPubMed
17.Sexton, T, Clarke, P, O'Neill, E, Dillane, T, Humphreys, H. Environmental reservoirs of methicillin-resistant Staphylococcus aureus in isolation rooms: correlation with patient isolates and implications for hospital hygiene. J Hosp Infect 2006;62:187–194.CrossRefGoogle ScholarPubMed
18.Martinez, J, Ruthazer, R. Role of environmental contamination as a risk factor for acquisition of vancomycin-resistant enterococci in patients treated in a medical intensive care unit. Arch Intern Med 2003;163:1905–1912.CrossRefGoogle Scholar
19.White, LR, Dancer, SJ, Robertson, C, McDonald, J. Are hygiene standards useful in assessing infection risk?Am J Infect Control 2008. In press.Google Scholar
20.Drees, M, Sndyman, DR, Schmid, CH, et al.Prior environmental contamination increases risk acquisition of vancomycin-resistant enterococci. Clin Infect Dis 2008;46:678–685.Google Scholar
21.Denton, M, Wilcox, MH, Parnell, P, et al.Role of environmental cleaning in controlling an outbreak of Acinetobacter baumannii on a neurosurgical intensive care unit. Intensive Crit Care Nurs 2005;21:94–98.CrossRefGoogle ScholarPubMed
22.Centers for Disease Control and Prevention (CDC). Guidelines for Environmental Infection Control in Health-Care Facilities. Recommendation of CDC and the Healthcare Infection Control Advisory Committee (HICPAC), 2003. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Enviro_guide_03.pdf. Accessed January 20, 2007.Google Scholar
23.Carling, PC, Briggs, JL, Perkins, J, Highlander, D. Improved cleaning of patient rooms using a new target method. Clin Infect Dis 2006;42:385–388.CrossRefGoogle Scholar
24.American Hospital Directory Data Base. American Hosital Directory, Inc. Available at: http://www.ahd.com. Accessed January 20, 2008.Google Scholar
25.Carling, PC, Parry, MF, Von Beheren, SM. Identifying opportunities to enhance environmental cleaning in 23 acute care hospitals. Infect Control Hosp Epidemiol 2008;29:1–7.CrossRefGoogle ScholarPubMed
26.Carling, PC, Von Beheren, S, Kim, P, Woods, C. Intensive care unit environmental cleaning: an evaluation in sixteen hospitals using a novel assessment tool. J Hosp Infect 2008;68:39–44.Google Scholar
27.U.S. Census Bureau. Maps in American FactFinder. Available at: http://factfinder.census.gov/jsp/saff/SAFFInfo.jsp?_pageId=gn7_maps&_submenuld=maps_0. Accessed January 18, 2006.Google Scholar
28.Layton, M, Perez, M, Heald, P, Patterson, J. An outbreak of mupirocin-resistant Staphylococcus aureus on a dermatology ward associated with an environmental reservoir. Infect Control Hosp Epidemiol 1993;14:369–375.CrossRefGoogle ScholarPubMed
29.Dancer, SJ, Coyne, M, Speekenbrink, A, Samavedam, S. MRSA acquisition in an intensive care unit. Am J Infect Control 2006;34:10–17.CrossRefGoogle Scholar
30.de Lassence, A, Hidri, N, Timsit, JF, Joly-Guillou, ML. Control and outcome of a large outbreak of colonization and infection with glycopeptide-intermediate Staphylococcus aureus in an intensive care unit. Clin Infect Dis 2006;42:170–178.CrossRefGoogle Scholar
31.Kaatz, G, Gitlin, S, Schaberg, D, Wilson, K. Acquisition of Clostridium difficile from the hospital environment. Am J Epidemiol 1988;127:1289–1293.CrossRefGoogle ScholarPubMed
32.Apisarnthanarak, A, Zack, J, Mayfield, J, et al.Effectiveness of environmental and infection control programs to reduce transmission of Clostridium diffidle. Clin Infect Dis 2004;39:601–602.Google Scholar
33.Linkin, D, Fishman, N, Patel, J, Merrill, J. Risk factors for extended-spectrum Beta-lactamase-producing Enterobacteriaceae in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2004;25:781–783.CrossRefGoogle Scholar
34.Byers, K, Durbin, L, Simonton, B, Anglim, A. Disinfection of hospital rooms contaminated with vancomycin-resistant Enterococcus faecium. Infect Control Hosp Epidemiol 1998;19:261–264.Google ScholarPubMed
35.Smith, T, Iwen, P, Olson, S, Rupp, M. Environmental contamination with vancomycin-resistant enterococci in an outpatient setting. Infect Control Hosp Epidemiol 1998;19:513–515.CrossRefGoogle Scholar
36.Hayden, MK, Bonten, MJ, Blom, DW, Lyle, EA. Reduction in acquisition of vancomycin-resistant Enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis 2006;42:1552–1560.CrossRefGoogle ScholarPubMed
37.Wilks, M, Wilson, A, Warwick, S. Control of an outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus colonization and infection in an intensive care unit (ICU) without closing the ICU or placing patients in isolation. Infect Control Hosp Epidemiol 2006;27:654–658.CrossRefGoogle ScholarPubMed
38.Maragakis, LL, Perl, TM. Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis 2008;46:1254–1263.CrossRefGoogle ScholarPubMed
39. Table 5.12. Short-Stay Hospital (SSH) Discharges and Case-Mix Index, by Location and Bedsize of Hospital, and Procedure Status: Calandar Year 2006. Washington, DC: Center for Medicare Services. Available at: http://www.cms.hhs.gov/MedicareMedicaidStatSupp/downloads/2007Table5.12b.pdf. Accessed January 23, 2008.Google Scholar
40.Berwick, DM. Disseminating innovations in health care. JAMA 2003;289:1969–1975.CrossRefGoogle ScholarPubMed