Effective disinfection of hospital rooms after discharge of patients with Clostridium difficile infection (CDI) is necessary to prevent transmission. Unfortunately, several studies have demonstrated that it is not uncommon for environmental cultures to remain positive for C. difficile after cleaning and disinfection of rooms in which a patient with CDI has been hospitalized (CDI rooms) by environmental services personnel. Cultures for C. difficile could potentially be useful to monitor disinfection of CDI rooms, but they are neither widely available nor efficient. There is a need for easy-to use and rapid methods to assess the effectiveness of CDI room disinfection. Adenosine triphosphate (ATP) bioluminescence assays provide a rapid assessment of cleaning effectiveness, because detection of ATP on surfaces indicates the presence of residual organic material (eg, bacteria, human secretions or excretions, and food). Detection of ATP is commonly used in the food and beverage industry and is increasingly being used in health care facilities to assess the adequacy of cleaning procedures. It is not known whether measurement of ATP on surfaces is useful to evaluate disinfection of CDI rooms. Here, we tested the hypothesis that low ATP readings on cleaned surfaces in CDI rooms would be predictive of negative cultures for C. difficile.

In the intensive care unit (ICU), our sickest patients receive our most invasive treatments and are therefore highly vulnerable to hospital-acquired infection. Up to one-third of ICU patients develop infectious complications of care, with associated increases in morbidity, mortality, and healthcare costs. Earlier research has indicated substantial heterogeneity in uptake of infection prevention best practices in North American hospitals, and this variability may also exist in ICUs. We hypothesized that ICU system-level characteristics, including closed model of care, academic affiliation, and availability of a dedicated infection control practitioner (ICP), may be associated with improved infection prevention practices.

During July 2011, we conducted a province-wide survey of nurse directors in ICUs across Ontario, Canada (population, 12 million). We developed a 77-item questionnaire to broadly capture ICU structures and processes relevant to infection prevention. The questionnaire was developed (item generation and reduction) by the authors and was further improved through pilot and sensibility testing by 3 ICU nurse directors and 2 ICPs. It was then distributed via e-mail by the Ontario Ministry of Health and Long-Term Care Critical Care Secretariat to nurse directors of all ICUs. A second email was sent to nonrespondents 2 weeks later. Approval was granted by the research ethics board at Sunnybrook Health Sciences Centre in Toronto, Canada.