An evaluation of the efficacy of hospital environmental cleanliness assessment methods

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An evaluation of the efficacy of hospital environmental cleanliness assessment methods


Author: Wong, Yin-yin
Title: An evaluation of the efficacy of hospital environmental cleanliness assessment methods
Degree: M.Sc.
Year: 2010
Subject: Hong Kong Polytechnic University -- Dissertations
Hospital buildings -- Disinfection
Department: Faculty of Health and Social Sciences
Pages: vii, 86 leaves : col. ill. ; 30 cm.
InnoPac Record:
Abstract: Background: The hospital environment is playing an ever greater role in the transmission of multidrug-resistant organisms (MDRO) which contributes to hospital acquired infection (HAI) (Dancer, 1999). Effective cleaning is universally recognized as an important aspect of controlling HAI. All Hospitals are expected to maintain the strictest hygiene standards and safety in all aspects of care. However, there is some evidence to suggest that hygiene may be inadequate and fail to achieve the desired cleanliness. Thus, it is important to assess hospital cleaning practices in order to determine their effectiveness. Traditionally, assessment of environmental cleanliness was carried out through visual inspection alone and occasionally with the aid of microbiological testing, i.e. aerobic colony count (ACC) method. Currently, different approaches of assessment methods are available, including the use of a novel technology called an Adenosintriphosphate (ATP) bioluminescence swabbing method. Although this method has been well validated in the food industry, there is less data regarding its use in the healthcare setting and its efficacy has not been well studied. Objectives: This study aims to evaluate the efficacy of the ATP bioluminescence swabbing method for assessing hospital environmental cleanliness. Method: Bedside tables (n = 33) were selected by convenience sampling in the entire hospital. Each sampling site was examined by visual assessment, microbiological swabbing method and ATP bioluminescence swabbing method. Assessment was performed immediately following discharge or died of each patient and was re-examined with the same methods following the terminal cleaning procedure. A total of 198 assessments were generated.
Results: Respectively, 60.6%, 48.5% and 60.6% of visual, ATP and ACC assessments were considered acceptable or 'clean' before terminal cleaning, while 93.9 %, 93.9% and 100% for each assessment was considered acceptable or 'clean' after terminal cleaning, according to each test standard. The disinfection process of the patient environment reduced ACC on bedside tables from a mean of 1.95 cfu/cm² (range: 0.09-4.22) before cleaning to 0.41 cfu/cm2 (range: 0-2.16) after cleaning; the accepted standard is ≤ 2.5 cfu/cm². The mean ATP value before cleaning was 517.06 RLU (range: 55-1730) and 120.52 RLU (range: 15-622) after cleaning; the accepted standard is 500 RLU. If ATP values and ACC values are compared directly, Kappa of 0.35 is estimated, indicating a fair level of agreement and showed a statistically significant correlation (p = 0.004) between the two methods. However, if Visual values and ACCs values are compared directly, Kappa of 0.64 is estimated, indicating a substantial level of agreement and showed a much stronger and good correlation (p = 0.000) between the two methods. Visual assessment alone did provide a meaningful measure of surface cleanliness or cleaning efficacy in this study. Conclusions: Choosing a hospital assessment system to evaluate cleaning was challenging. In order to improve and maintain hospital hygiene, there is a need for a simple, rapid and inexpensive method for assessing cleanliness. Results from previous studies indicate that ATP bioluminescence swabbing method is a useful monitoring cleaning method in hospitals. The results of this study showed that visual assessment was a useful indicator in terms of accuracy when compared with the ACC method which is considered to be the 'Gold Standard'. Although ATP bioluminescence swabbing method was more sensitive in detecting inadequate cleaning, when compared with visual assessment in term of efficacy, visual assessment was better in detecting cleanliness in terms of the ease of use, acceptance, testing time, testing cost, manpower and the restriction of assessment area. The ATP bioluminescence swabbing method is frequently touted as the real time qualitative environmental cleanliness indicator. Based on the results of this study, its implementation in a hospital setting need not be universal or automatic, but should be determined by hospital management, according to necessity, purpose and consideration of the testing costs.

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