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Background: Hamilton Health Sciences (HHS) is a large teaching hospital with over 1000 beds consisting of three acute care sites, one regional cancer center and two rehabilitation/complex chronic care facilities. The use of chemical dilution control systems to dilute concentrated accelerated hydrogen peroxide (AHP) disinfectant to an ideal strength for effective environmental decontamination is a growing trend in healthcare. These systems, compared to manual dilution methods, are economical, efficient and promote a safer workplace. However, quality control (QC) and preventative maintenance standards to ensure performance are lacking in the environmental and healthcare cleaning industries. The automated systems used to dilute concentrated AHP products for disinfection cleaning were assessed for reliability at HHS-Henderson acute care site., Method: The control systems used on three clinical units to dilute concentrated AHP products, 7% Percept at 1:16 dilution (0.5%) and 3% PerDiem at 1:256 dilution (0.01%), were evaluated daily for reliability over 30 days. Virox AHP indicator test strips were used once a day to check use-dilution of Percept at 5000 parts per million (ppm) AHP and PerDiem at 100 ppm AHP.QC was repeated if the initial test was outside the acceptable range. Vendor service was arranged for the dilution system when repeat QC failed. Ready-to-use AHP product was employed until the system was functional., Results: Overall, nine QC failures were detected on all systems during a 30-day testing period, specifically, five failures on one system, three on the second and one on the third. Seven failures involved Percept with results at < or =500 ppm, well below the acceptable 5000 ppm concentration, and two involved PerDiem at 500 ppm, well above the required concentration., Conclusion: Disinfectants must be used in the dilution specified by the manufacturer for optimal decontamination. Although there are benefits with using automated dilution systems in healthcare settings, findings show that attention must be given to quality control and preventative maintenance to ensure optimum results.

Background: Hamilton Health Sciences is a large teaching hospital with over 1,000 beds and consists of three acute care sites, one Regional Cancer Center and two Rehabilitation/Chronic Care facilities. An environmental cleaning pilot project was initiated at the acute care Henderson site, following an outbreak of vancomycin-resistant Enterococcus (VRE). Healthcare-associated infections (HAI) due to antibiotic-resistant organisms are increasing in Southern Ontario. Environmental cleaning plays a key role in eradicating resistant organisms that live in hospital environments, thereby helping to reduce HAIs. The environmental cleaning practices on the Orthopaedic Unit were identified as a contributing factor to the VRE outbreak after visual assessments were completed using a Brevis GlitterBug product, a chemical that fluoresces under an ultraviolet (UV) lamp. These findings led to a hospital-wide cleaning improvement initiative on all units except critical care areas. The GlitterBug potion was employed by Infection Control and Customer Support Services (CSS) as a tool to evaluate the daily cleaning of patient washrooms as well as discharge cleaning of contact precaution isolation rooms., Method: Over a four-week period, the GlitterBug potion was applied to seven frequently touched standard targets in randomly selected patient bathrooms on each unit and 14 frequently touched targets prior to cleaning in the rooms used for isolation. The targets were then evaluated using the UV lamp to detect objects that were not cleaned and the results were recorded on a standardized form. The rate of targets cleaned versus the targets missed was calculated., Results: The overall rate for daily cleaning of bathrooms and cleaning of isolation rooms was poor with only 23% of the targets cleaned. Based on these findings, several interventions were implemented. This resulted in a significant improvement in cleaning practices during the pilot project. Greater than 80% of the targets were cleaned compared to the baseline findings of 23%. Subsequently, nosocomial cases of VRE have declined despite the increased prevalence of VRE in the Hamilton and surrounding regions., Conclusion: The GlitterBug product is an effective tool to evaluate environmental cleaning and adherence to policies and procedures and this method was superior to previous visual inspection methods. The use of GlitterBug potion improved physical cleaning and enhanced staff contribution. The Brevis GlitterBug product was incorporated into the CSS environmental cleaning program at Hamilton Health Sciences as a quality indicator to monitor environmental cleaning practices.