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Background: There is a paucity of high-quality evidence based on clinical endpoints for routine cleaning of shared medical equipment. We assessed the effect of enhanced cleaning and disinfection of shared medical equipment on health-care-associated infections (HAIs) in hospitalised patients., Methods: We conducted a stepped-wedge, cluster randomised, controlled trial in ten wards of a single hospital located on the central coast of New South Wales, Australia. Hospitals were eligible for inclusion if they were classified as public acute group A according to the Australian Institute of Health and Welfare, were located in New South Wales, had an intensive care unit, had a minimum of ten wards, and provided care for patients aged 18 years or older. Each cluster consisted of two randomly allocated wards (by use of simple randomisation), with a new cluster beginning the intervention every 6 weeks. Wards were informed of their allocation 2 weeks before commencement of intervention exposure, and the researcher collecting primary outcome data and audit data was masked to treatment sequence allocation. In the control phase, there was no change to environmental cleaning practices. In the intervention phase, a multimodal cleaning bundle included an additional 3 h per weekday for the dedicated cleaning and disinfection of shared medical equipment by 21 dedicated cleaning staff, with ongoing education, audit, and feedback. The primary outcome was the number of confirmed cases of HAI, as assessed by a fortnightly point prevalence survey and measured in all patients admitted to the wards during the study period. The completed trial is registered with Australia New Zealand Clinical Trials Registry (ACTRN12622001143718)., Findings: The hospital was recruited on July 31, 2022, and the study was conducted between March 20 and Nov 24, 2023. We assessed 220 hospitals for eligibility, of which five were invited to participate, and the first hospital to formally respond was enrolled. 5002 patients were included in the study (2524 [50·5%] women and 2478 [49·5%] men). In unadjusted results, 433 confirmed HAI cases occurred in 2497 patients (17·3%, 95% CI 15·9 to 18·8) in the control phase and 301 confirmed HAI cases occurred in 2508 patients (12·0%, 10·7 to 13·3) in the intervention phase. In adjusted results, there was a relative reduction of -34·5% (-50·3 to -17·5) in HAIs following the intervention (odds ratio 0·62, 95% CI 0·45 to 0·80; p=0·0006), corresponding to an absolute reduction equal to -5·2% (-8·2 to -2·3). No adverse effects were reported., Interpretation: Improving the cleaning and disinfection of shared medical equipment significantly reduced HAIs, underscoring the crucial role of cleaning in improving patient outcomes. Findings emphasise the need for dedicated approaches for cleaning shared equipment., Funding: National Health and Medical Research Council., Competing Interests: Declaration of interests BGM declares grants from GAMA Healthcare paid to their institution; consulting fees from ICS Service Solutions paid to their institution; honoraria for their role as Editor-in-Chief of Infection, Disease and Health and from the Australasian College for Infection Prevention and Control; non-financial leadership roles within the Australian Government (Commonwealth) National Health and Medical Research Council,  the National Infection Control Guidelines Committee, and the Australian Infection Control Guidelines expert group; and receipt of Clinell wipes from GAMA Healthcare provided to their institution. ACC declares grant funding from the National Health and Medical Research Council and the Australian Government Department of Health; consulting fees from the Therapeutic Goods Administration; participation on advisory boards for non-pharmaceutical trials (on the topic of prevention of infections in haematological malignancy); a past role as President of the Australasian Society for Infectious Diseases; and other non-financial interests in the Australian Infection Control Guidelines expert group. PET declares grants from the Urgo Foundation,  the Australian Podiatry Association, the Department of Health and Aged Care, Wounds Australia, and the Australian Podiatry Education Research Foundation. MK declares former part-time consultant contracts from GAMA Healthcare and support for attending conferences from GAMA Healthcare, including travel expenses and accommodation. MK was an invited speaker at the conferences and did not receive any honoraria amount. AJS, DB, GM, JK, KB, KG, MA, MN, NMW, and PLR declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Background: Contaminated environmental surfaces play an important role in the transmission of pathogens that cause healthcare acquired infection (HAI). The present study aimed to assess the effect of enhanced cleaning techniques on bacterial contamination in high-touch areas compared to routine cleaning at the intensive care units (ICU) of the neurosurgery department of Alexandria Main University Hospital, Egypt., Methods: The assessment of the knowledge and practices of healthcare cleaning workers and nurses was conducted through a questionnaire and an observational checklist. An educational program about enhanced cleaning was carried out for healthcare cleaning workers and nurses in one room of the ICU unit. Environmental surface swabs were taken from the two rooms of the ICU before and after cleaning (room A and room B). Room A was selected to apply the enhanced cleaning, and room B was selected for routine cleaning., Results: A significant decrease in bacterial counts in the high-touch areas around the patients after the application of enhanced cleaning compared to routine cleaning (p < 0.001) was observed. Gram-negative bacteria isolated from high-touch areas accounted for 45.6% of the samples collected before enhanced cleaning, and they became 16.3% after enhanced cleaning (p < 0.001), while they accounted for 40% after routine cleaning. The enhanced cleaning intervention in Room A resulted in a significant reduction in total infections, decreasing from 18 cases in the six months prior to the intervention to 11 cases in the six months following its implementation. (p < 0.05)., Conclusion: The effect of enhanced cleaning was evident in decreasing bacterial counts in the high-touch areas around the patient and consequently in the records of the HAI rate inside the ICU., Clinical Trial Registration Number: PACTR202402531001186, date: 15 February 2024, 'retrospectively registered'., Competing Interests: Declarations Ethics approval and consent to participate The High Institute of Public Health at Alexandria University in Egypt approved the study, and it was carried out in accordance with the Declaration of Helsinki’s principles. The clinical trial registration number: PACTR202402531001186. Informed consent Each participant gave their informed consent before starting the research. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objective: To synthesize evidence and identify gaps in the literature on environmental cleaning and disinfection in the operating room based on a human factors and systems engineering approach guided by the Systems Engineering Initiative for Patient Safety (SEIPS) model., Design: A systematic scoping review., Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched 4 databases (ie, PubMed, EMBASE, OVID, CINAHL) for empirical studies on operating-room cleaning and disinfection. Studies were categorized based on their objectives and designs and were coded using the SEIPS model. The quality of randomized controlled trials and quasi-experimental studies with a nonequivalent groups design was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials., Results: In total, 40 studies were reviewed and categorized into 3 groups: observational studies examining the effectiveness of operating-room cleaning and disinfections (11 studies), observational study assessing compliance with operating-room cleaning and disinfection (1 study), and interventional studies to improve operating-room cleaning and disinfection (28 studies). The SEIPS-based analysis only identified 3 observational studies examining individual work-system components influencing the effectiveness of operating-room cleaning and disinfection. Furthermore, most interventional studies addressed single work-system components, including tools and technologies (20 studies), tasks (3 studies), and organization (3 studies). Only 2 studies implemented interventions targeting multiple work-system components., Conclusions: The existing literature shows suboptimal compliance and inconsistent effectiveness of operating-room cleaning and disinfection. Improvement efforts have been largely focused on cleaning and disinfection tools and technologies and staff monitoring and training. Future research is needed (1) to systematically examine work-system factors influencing operating-room cleaning and disinfection and (2) to redesign the entire work system to optimize operating-room cleaning and disinfection.

Quality Challenge: The Sierra Leone (SL) Ministry of Health and Sanitation's National Infection Prevention and Control Unit (NIPCU) launched National Infection and Prevention Control (IPC) Policy and Guidelines in 2015, but a 2017 assessment found suboptimal compliance with standards on environmental cleanliness (EC), waste disposal (WD) and personal protective equipment (PPE) use., Methods: ICAP at Columbia University (ICAP), NIPCU and the Centers for Disease Control and Prevention (CDC) designed and implemented a Rapid Improvement Model (RIM) quality improvement (QI) initiative with a compressed timeframe of 6 months to improve EC, WD and PPE at eight purposively selected health facilities (HFs). Targets were collaboratively developed, and a 37-item checklist was designed to monitor performance. HF teams received QI training and weekly coaching and convened monthly to review progress and exchange best practices. At the final learning session, a "harvest package" of the most effective ideas and tools was developed for use at additional HFs., Results: The RIM resulted in marked improvement in WD and EC performance and modest improvement in PPE. Aggregate compliance for the 37 indicators increased from 67 to 96% over the course of 4 months, with all HFs showing improvement. Average PPE compliance improved from 85 to 89%, WD from 63 to 99% and EC from 51 to 99%., Lessons Learned: The RIM QIC approach is feasible and effective in SL's austere health system and led to marked improvement in IPC performance. The best practices are being scaled up and the RIM QIC methodology is being applied to other domains., (© The Author(s) 2020. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Terminal room cleaning is critical in preventing pathogen transmission; however, the optimal cleaning effectiveness assessment modality is still being investigated. We sequentially compared cleanliness assessment agreement between a fluorescent marker and an adenosine triphosphate bioluminescence method, finding no significant differences between modalities., (Copyright © 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Implementing sustainable practice change in hospital cleaning has proven to be an ongoing challenge in reducing healthcare associated infections. The purpose of this study was to develop a reliable framework-based approach to implement and quantitatively evaluate the implementation of evidence-based practice change in hospital cleaning., Design/methods: The Researching Effective Approaches to Cleaning in Hospitals (REACH) trial was a pragmatic, stepped-wedge randomised trial of an environmental cleaning bundle implemented in 11 Australian hospitals from 2016 to 2017. Using a structured multi-step approach, we adapted the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to support rigorous and tailored implementation of the cleaning bundle intervention in eleven diverse and complex settings. To evaluate the effectiveness of this strategy we examined post-intervention cleaning bundle alignment calculated as a score (an implementation measure) and cleaning performance audit data collected using ultraviolet (UV) gel markers (an outcome measure)., Results: We successfully implemented the bundle and observed improvements in cleaning practice and performance, regardless of hospital size, intervention duration and contextual issues such as staff and organisational readiness at baseline. There was a positive association between bundle alignment scores and cleaning performance at baseline. This diminished over the duration of the intervention, as hospitals with lower baseline scores were able to implement practice change successfully., Conclusion: Using a structured framework-based approach allows for pragmatic and successful implementation of clinical trials across diverse settings, and assists with quantitative evaluation of practice change., Trial Registration: Australia New Zealand Clinical Trial Registry ACTRN12615000325505, registered on 4 September 2015.

The use of microfibre cloths with either water, detergent or disinfectant is currently recommended for hospital cleaning. This study explored the efficacy of a microfibre cloth with either water or detergent/disinfectant or sporicidal products using the ASTM2967-15 standard against Staphylococcus aureus, Acinetobacter baumannii and Clostridium difficile spores. The use of detergent/disinfectant or sporicidal products had a significantly (analysis of variance (ANOVA), P<0.001) better activity than water alone in reducing bacteria and spores' viability, and in reducing the transfer microorganisms between surfaces. The use of water alone with a microfibre cloth is less effective and should not replace the use of biocidal products., (Copyright © 2019 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

In the past several decades, the incidence of Klebsiella pneumoniae harboring resistance mechanisms against multiple antibiotic agents has increased on a global scale. We discuss reasons for ongoing transmission of multidrug-resistant K. pneumoniae in healthcare settings, which has resulted in the successful spread and establishment of this pathogen. It is now one of the most important causes of healthcare-associated infections worldwide.

We implemented a cleaning process for mobile patient equipment (MPE) and determined its success using adenosine trisphosphate (ATP) monitoring and data feedback. Following education for staff and ATP data feedback, the data suggest that the MPE cleaning program we implemented was successful.

We compared the fluorescent gel removal rate using fewer high-touch surfaces (HTSs) and rooms and determined the optimum number of HTSs and rooms needed to ensure accuracy using 2,942 HTSs in 228 rooms on 13 units. Randomly selecting 3 HTS in 2 rooms predicted the optimal removal rate.

The quality of daily cleaning was assessed comparing a standard bleach product with the bleach product containing a novel colorant additive in an inpatient setting. Effectiveness was assessed using fluorescent markings and microbiological analysis of environmental and experimental specimens. Our findings showed no significant difference in cleaning between these groups.

Background: An intervention was designed to test whether the addition of an ultraviolet (UV) disinfection step after terminal cleaning would be helpful in reducing Clostridium difficile infection (CDI) rates in a real-world situation., Methods: This study was a quasi-experimental design using 3 units as intervention units for the intervention and 3 similar units as control units. Intervention units 2 hematology and bone marrow transplant units and one medical-surgical unit at a large teaching hospital in the Midwest. UV disinfection was added after patient discharge and terminal cleaning in the intervention units., Results: At baseline, CDI rates in the intervention and control arms were similar. During the 6 months of UV disinfection, the CDI rate in the intervention units decreased to 11.2 per 10,000 patient days, compared with 28.7 per 10,000 patient days in the control units (P = .03). In addition, the intervention units also saw a reduction in vancomycin-resistant enterococci acquisition., Conclusions: The addition of UV disinfection to the terminal cleaning resulted in a reduction in CDI that has been sustained over several months 2 years., (Copyright © 2018. Published by Elsevier Inc.)

During health care, the patient is exposed to a wide variety of microorganisms. Maximum hygiene in all care activities is therefore essential in order to reduce the cross-transmission of preventable infectious diseases. The 3 key mechanisms for the prevention of infection in health centers are cleaning, disinfection and sterilization. The scientific and rational use of disinfectants and antiseptics, and the correct application of aseptic techniques in the care of patients and in the handling and supply of materials are the fundamental considerations for the prevention of healthcare related infections. Adequate knowledge of the concepts and standards of use of antiseptics and disinfectants offers healthcare workers the essential tool needed to avoid the spread of infectious agents, while also establishing the scientific basis for their rational use. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson., (Copyright © 2018. Publicado por Elsevier España, S.L.U.)

Wet surface biofilms are a potential reservoir for multidrug-resistant Gram-negative organisms, including carbapenemase-producing Enterobacteriaceae (CPE). Recognition of environmental sources is important in reducing secondary patient transmission. We report the increased detection of blaIMP-4 + CPE in environmental samples from floor drains in burns unit shower rooms, when collected following cleaning as compared to pre-cleaning. We propose that disruption of biofilms during cleaning may account for the increased detection of multi-resistant organisms. The results highlight the role of the wet environment as an under-recognized potential source of CPE transmission. Environmental screening focusing on pre-cleaning samples alone will likely underestimate environmental contamination., (Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.)

In this systematic evaluation of fluorescent gel markers (FGM) applied to high-touch surfaces with a metered applicator (MA) made for the purpose versus a generic cotton swab (CS), removal rates were 60.5% (476 of 787) for the MA and 64.3% (506 of 787) for the CS. MA-FGM removal interpretation was more consistent, 83% versus 50% not removed, possibly due to less varied application and more adhesive gel.

Background: Improvement of environmental cleaning in hospitals has been shown to decrease in-hospital cross transmission of pathogens. Several objective methods, including aerobic colony counts (ACCs), the adenosine triphosphate (ATP) bioluminescence assay, and the fluorescent marker method have been developed to assess cleanliness. However, the standard interpretation of cleanliness using the fluorescent marker method remains uncertain., Objective: To assess the fluorescent marker method as a tool for determining the effectiveness of hospital cleaning., Design: A prospective survey study., Setting: An academic medical center., Methods: The same 10 high-touch surfaces were tested after each terminal cleaning using (1) the fluorescent marker method, (2) the ATP assay, and (3) the ACC method. Using the fluorescent marker method under study, surfaces were classified as totally clean, partially clean, or not clean. The ACC method was used as the standard for comparison., Results: According to the fluorescent marker method, of the 830 high-touch surfaces, 321 surfaces (38.7%) were totally clean (TC group), 84 surfaces (10.1%) were partially clean (PC group), and 425 surfaces (51.2%) were not clean (NC group). The TC group had significantly lower ATP and ACC values (mean ± SD, 428.7 ± 1,180.0 relative light units [RLU] and 15.6 ± 77.3 colony forming units [CFU]/100 cm2) than the PC group (1,386.8 ± 2,434.0 RLU and 34.9 ± 87.2 CFU/100 cm2) and the NC group (1,132.9 ± 2,976.1 RLU and 46.8 ± 119.2 CFU/100 cm2)., Conclusions: The fluorescent marker method provided a simple, reliable, and real-time assessment of environmental cleaning in hospitals. Our results indicate that only a surface determined to be totally clean using the fluorescent marker method could be considered clean.

Background: The Researching Effective Approaches to Cleaning in Hospitals (REACH) study tested a multimodal cleaning intervention in Australian hospitals. This article reports findings from a pre/post questionnaire, embedded into the REACH study, that was administered prior to the implementation of the intervention and at the conclusion of the study., Methods: A cross-sectional questionnaire, nested within a stepped-wedge trial, was administered. The REACH intervention was a cleaning bundle comprising 5 interdependent components. The questionnaire explored the knowledge, reported practice, attitudes, roles, and perceived organizational support of environmental services staff members in the hospitals participating in the REACH study., Results: Environmental services staff members in 11 participating hospitals completed 616 pre- and 307 post-test questionnaires (n = 923). Increases in knowledge and practice were seen between the pre-and post-test questionnaires. Minimal changes were observed in attitudes regarding the role of cleaning and in perceived organizational support., Conclusion: To our knowledge, this is the first study to report changes in knowledge, attitudes, and perceived organizational support in environmental services staff members, in the context of a large multicenter clinical trial. In this underexplored group of hospital workers, findings suggest that environmental services staff members have a high level of knowledge related to cleaning practices and understand the importance of their role., (Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

In a tertiary hospital, Legionella spp were isolated from taps and from ward dishwashers connected to contaminated tap piping. Our investigation revealed favorable conditions for growth of Legionella, and showed that Legionella pneumophila SG6 isolates from the taps and dishwashers were all genetically identical by repetitive-element polymerase chain reaction. These results suggest that contaminated dishwashers might be a potential reservoir for the spread of Legionella in health care facilities., (Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Recognized issues with poor hand hygiene compliance among healthcare workers and reports of recontamination of previously chemically disinfected surfaces through hand contact emphasize the need for novel hygiene methods in addition to those currently available. One such approach involves antimicrobial (nano) coatings (AMCs), whereby integrated active ingredients are responsible for elimination of micro-organisms that come into contact with treated surfaces. While widely studied under laboratory conditions with promising results, studies under real-life healthcare conditions are scarce. The views of 75 contributors from 30 European countries were collated regarding specialized cleaning associated with AMCs for reduction of healthcare-associated infection. There was unanimous agreement that generation of scientific guidelines for cleaning of AMCs, using traditional or new processes, is needed. Specific topics included: understanding mechanisms of action of cleaning materials and their physical interactions with conventional coatings and AMCs; that assessments mimic the life cycle of coatings to determine the impact of repetitive cleaning and other aspects of ageing (e.g. exposure to sunlight); determining concentrations of AMC-derived biocides in effluents; and development of effective de-activation and sterilization treatments for cleaning effluents. Further, the consensus opinion was that, prior to widespread implementation of AMCs, there is a need for clarification of the varying responsibilities of involved clinical, healthcare management, cleaning services and environmental safety stakeholders., (Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Recent studies suggest that floors may be an underappreciated source for transmission of health care-associated pathogens. However, there are limited data on the effectiveness of current cleaning and disinfection methods in reducing floor contamination. We demonstrated that manual postdischarge cleaning by environmental services personnel significantly reduced floor contamination, and an automated ultraviolet C room disinfection device was effective as an adjunct to manual cleaning., (Published by Elsevier Inc.)

Background: Environmental cleaning is a fundamental principle of infection control in health care settings. We determined whether implementing separated environmental cleaning management measures in MICU reduced the density of HAI., Methods: We performed a 4-month prospective cohort intervention study between August and December 2013, at the MICU of Cathay General hospital. We arranged a training program for all the cleaning staff regarding separated environmental cleaning management measures by using disposable wipes of four colors to clean the patients' bedside areas, areas at a high risk of contamination, paperwork areas, and public areas. Fifteen high-touch surfaces were selected for cleanliness evaluation by using the adenosine triphosphate (ATP) bioluminescence test. Then data regarding HAI densities in the MICU were collected during the baseline, intervention, and late periods., Results: A total of 120 ATP readings were obtained. The total number of clean high-touch surfaces increased from 13% to 53%, whereas that of unclean high-touch surface decreased from 47% to 20%. The densities of HAI were 14.32‰ and 14.90‰ during the baseline and intervention periods, respectively. The HAI density did not decrease after the intervention period, but it decreased to 9.07‰ during the late period., Conclusion: Implementing separated environmental cleaning management measures by using disposable wipes of four colors effectively improves cleanliness in MICU environments. However, no decrease in HAI density was observed within the study period. Considering that achieving high levels of hand-hygiene adherence is difficult, improving environmental cleaning is a crucial adjunctive measure for reducing the incidence of HAIs., Competing Interests: Not applicableNot applicableThe authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

We conducted a study using a face-to-face survey to assess knowledge, attitudes, and practices of environmental service workers (ESWs) concerning routine cleaning and disinfection at 3 tertiary hospitals in China. There were 115 (89.1%) respondents who agreed that environmental cleaning can contribute to keep patients safe, whereas 63 (48.8%) reported they were very willing to make cleaning practices better. Only 15 (11.6%) ESWs agreed they were in risk of nosocomial infections during daily cleaning. Our findings suggest that the level of ESWs' knowledge regarding cleaning practices was passable, but the awareness of occupational safety and health was weak. There is a need to introduce sustained education and training aimed at ESWs., (Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

There has been extensive outsourcing of hospital cleaning services in the NHS in England, in part because of the potential to reduce costs. Yet some argue that this leads to lower hygiene standards and more infections, such as MRSA and, perhaps because of this, the Scottish, Welsh, and Northern Irish health services have rejected outsourcing. This study evaluates whether contracting out cleaning services in English acute hospital Trusts (legal authorities that run one or more hospitals) is associated with risks of hospital-borne MRSA infection and lower economic costs. By linking data on MRSA incidence per 100,000 hospital bed-days with surveys of cleanliness among patient and staff in 126 English acute hospital Trusts during 2010-2014, we find that outsourcing cleaning services was associated with greater incidence of MRSA, fewer cleaning staff per hospital bed, worse patient perceptions of cleanliness and staff perceptions of availability of handwashing facilities. However, outsourcing was also associated with lower economic costs (without accounting for additional costs associated with treatment of hospital acquired infections)., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Inspections are a key way to monitor and ensure quality of care and maintain high standards in the National Health Service (NHS) in England. Yet there is a perception that inspections can be gamed. This can happen, for example, when staff members know that an inspection will soon take place. Using data for 205 NHS hospitals for the period 2011-14, we tested whether patients' perceptions of cleanliness increased during periods when inspections occurred. Our results show that during the period within two months of an inspection, there was a significant elevation (2.5-11.0 percentage points) in the share of patients who reported "excellent" cleanliness. This association was consistent even after adjustment for secular time trends. The association was concentrated in hospitals that outsourced cleaning services and was not detected in those that used NHS cleaning services., (Project HOPE—The People-to-People Health Foundation, Inc.)

Background: Cleaning of environmental surfaces in hospitals is important for the control of methicillin-resistant Staphylococcus aureus (MRSA) and other hospital-acquired infections transmitted by the contact route. Guidance regarding the best approaches for cleaning, however, is limited., Methods: In this study, a mathematical model based on ordinary differential equations was constructed to study MRSA concentration dynamics on high-touch and low-touch surfaces, and on the hands and noses of two patients (in two hospitals rooms) and a health care worker in a hypothetical hospital environment. Two cleaning interventions - whole room cleaning and wipe cleaning of touched surfaces - were considered. The performance of the cleaning interventions was indicated by a reduction in MRSA on the nose of a susceptible patient, relative to no intervention., Results: Whole room cleaning just before first patient care activities of the day was more effective than whole room cleaning at other times, but even with 100% efficiency, whole room cleaning only reduced the number of MRSA transmitted to the susceptible patient by 54%. Frequent wipe cleaning of touched surfaces was shown to be more effective that whole room cleaning because surfaces are rapidly re-contaminated with MRSA after cleaning. Wipe cleaning high-touch surfaces was more effective than wipe cleaning low-touch surfaces for the same frequency of cleaning. For low wipe cleaning frequency (≤3 times per hour), high-touch surfaces should be targeted, but for high wipe cleaning frequency (>3 times per hour), cleaning should target high- and low-touch surfaces in proportion to the surface touch frequency. This study reproduces the observations from a field study of room cleaning, which provides support for the validity of our findings., Conclusions: Daily whole room cleaning, even with 100% cleaning efficiency, provides limited reduction in the number of MRSA transmitted to susceptible patients via the contact route; and should be supplemented with frequent targeted cleaning of high-touch surfaces, such as by a wipe or cloth containing disinfectant.

Terminal disinfection and daily cleaning have been performed in hospitals in Taiwan for many years to reduce the risks of healthcare-associated infections. However, the effectiveness of these cleaning approaches and dynamic changes of surface microbiota upon cleaning remain unclear. Here, we report the surface changes of bacterial communities with terminal disinfection and daily cleaning in a medical intensive care unit (MICU) and only terminal disinfection in a respiratory care center (RCC) using 16s ribosomal RNA (rRNA) metagenomics. A total of 36 samples, including 9 samples per sampling time, from each ward were analysed. The clinical isolates were recorded during the sampling time. A large amount of microbial diversity was detected, and human skin microbiota (HSM) was predominant in both wards. In addition, the colonization rate of the HSM in the MICU was higher than that in the RCC, especially for Moraxellaceae. A higher alpha-diversity (p = 0.005519) and a lower UniFrac distance was shown in the RCC due to the lack of daily cleaning. Moreover, a significantly higher abundance among Acinetobacter sp., Streptococcus sp. and Pseudomonas sp. was shown in the RCC compared to the MICU using the paired t test. We concluded that cleaning changes might contribute to the difference in diversity between two wards.

Background: Enhanced environmental cleaning practices are among the most accepted measures for controlling the spread of carbapenem-resistant Acinetobacter baumannii (CR-Ab)., Aim: To evaluate the impact of heightened cleaning on an ongoing CR-Ab outbreak in a burn intensive care unit (BICU) of an Italian teaching hospital, where chlorhexidine-60% isopropyl alcohol was applied as a complementary disinfectant on high-touch surfaces., Methods: Compliance with the microbial limit proposed for the BICU by AFNOR-NF-S90-351 (20 colony-forming units/100cm 2 ) was assessed by plate count, and compared with the results obtained with intracellular adenosine triphosphate (ATP) detection. Genotyping was performed using pulsed-field gel electrophoresis., Findings: During the standard cleaning regimen, three out of 23 samples (13%) gave results over the AFNOR limit and five (21.7%) showed unacceptable ATP levels with 100 relative light units/100cm 2 as the benchmark limit (sensibility 86.4%, specificity 92.2%). Following improvement of the cleaning procedure, only two samples out of 50 (4%) did not satisfy the microbiological criteria and seven (14%) exceeded the ATP limit. In a successive phase, eight of 30 samples collected showed unacceptable results (27%)., Conclusions: Adding chlorhexidine-60% isopropyl alcohol as complementary disinfectant proved to be effective for reducing environmental microbial contamination, ATP levels and CR-Ab infection/colonization in patients admitted to the BICU. Real-time monitoring by ATP assay was useful for managing the cleaning schedule and reducing hospital infections, although the calculated values must be interpreted as cleanliness indicators rather than risk indicators., (Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Background: Environmental cleaning is a fundamental principle of infection prevention in hospitals, but its role in reducing transmission of health care-acquired pathogens has been difficult to prove experimentally. In this study we analyze the influence of cleaning previously uncleaned patient care items, grey zones (GZ), on health care-acquired transmission rates., Methods: The intervention consisted of specific GZ cleaning by an extra cleaner (in addition to routine cleaning) on 2 structurally different acute care medical wards for a period of 6 months each, in a crossover design. Data on health care-acquired transmissions of vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus, and Clostridium difficile were collected during both periods. Adjusted incidence rate ratios (IRRs) using Poisson regression were calculated to compare transmission of pathogens between both periods on both wards., Results: During the intervention VRE transmission was significantly decreased (2-fold) on the ward where patients had fewer roommates; cleaning of GZ did not have any effect on the ward with multiple-occupancy rooms. There was no impact on methicillin-resistant S aureus transmission and only a nonsignificant decrease in transmission of C difficile., Conclusions: Our data provide evidence that targeted cleaning interventions can reduce VRE transmission when rooming conditions are optimized; such interventions can be cost-effective when the burden of VRE is significant. Enhanced cleaning interventions are less beneficial in the context of room sharing where many other factors contribute to transmission of pathogens., (Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.)

Treating hospital patient textiles with ionic silver after each washing results in a significant decrease in microbial contamination. Although further study is needed to better understand the role textiles play in hospital-acquired infections and to quantify the influence of silver textile treatment on health care-associated infection risk and patient outcomes, ionic silver treatment of textiles may prove useful in hospital-acquired infection reduction strategies., (Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

The purpose of this quality improvement project was to identify differences in cleaning practices between isolation rooms and standard precaution rooms in the hospital setting. An ultravoilet marking system was used to evaluate high-touch surfaces throughout the patient environment. Results reveal the importance of refining training systems to reflect staff perceptions and improve evaluation processes across systems in an effort to reduce health care-associated infections., (Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Purpose of Review: More evidence is emerging on the role of cleaning and decontamination for reducing hospital-acquired infection. Timely and adequate removal of environmental pathogens leads to measurable clinical benefits for patients. This article considers studies published from 2013 examining hospital decontamination technologies and evidence for cost-effectiveness., Recent Findings: Novel biocides and cleaning products, antimicrobial coatings, monitoring practices and automated equipment are widely accessible. They do not necessarily remove all environmental pathogens, however, and most have yet to be comprehensively assessed against patient outcome. Some studies are confounded by concurrent infection control and/or antimicrobial stewardship initiatives. Few contain data on costs., Summary: As automated dirt removal is assumed to be superior to human effort, there is a danger that traditional cleaning methods are devalued or ignored. Fear of infection encourages use of powerful disinfectants for eliminating real or imagined pathogens in hospitals without appreciating toxicity or cost benefit. Furthermore, efficacy of these agents is compromised without prior removal of organic soil. Microbiocidal activity should be compared and contrasted against physical removal of soil in standardized and controlled studies to understand how best to manage contaminated healthcare environments.

Disinfection of noncritical environmental surfaces and equipment is an essential component of an infection prevention program. Noncritical environmental surfaces and noncritical medical equipment surfaces may become contaminated with infectious agents and may contribute to cross-transmission by acquisition of transient hand carriage by health care personnel. Disinfection should render surfaces and equipment free of pathogens in sufficient numbers to prevent human disease (ie, hygienically clean)., (Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Audit and feedback programmes (AFPs) using fluorescent marking lead to improvements in room cleaning but have not been linked to reduced Clostridium difficile infection (CDI) incidence., Aim: To evaluate the impact of an AFP on hospital-acquired CDI incidence., Methods: In 2012, a hospital-wide AFP was implemented. Fluorescent marking of high-touch surfaces was used to assess discharge cleaning thoroughness. Weekly audit results were presented to cleaning staff. Interrupted time-series analysis was used to test for changes in the trend and level of hospital-acquired CDI incidence between the pre-intervention (January 2008 to December 2011) and post-intervention (April 2012 to June 2015) periods., Findings: In all, 1002 audits were performed and room cleaning thoroughness improved from 49% to 90%. Hospital-acquired CDI incidence fell from 54 to 42 cases per 100,000 patient-days following the intervention whereas non-hospital-acquired CDI incidence rose from 43 to 52 cases per 100,000 patient-days, although both exhibited a downward trend post intervention. Time-series analysis showed that hospital-acquired CDI incidence was declining at a rate of 0.59 cases per 100,000 patient-days per quarter before the intervention. Following programme implementation, the rate of decline accelerated by an additional 1.35 cases per 100,000 patient-days per quarter (P < 0.05). Hand hygiene compliance increased minimally post intervention., Conclusion: Implementation of an AFP using fluorescent marking resulted in improved thoroughness of room cleaning and appeared to result in an enhanced downward trend in CDI incidence, although part of this decline could be due to changes in local CDI epidemiology or improved hand hygiene., (Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Background: Hospital-associated infections (HAIs) are more frequently encountered in low- than in high-resource settings. There is a need to identify and implement feasible and sustainable approaches to strengthen HAI prevention in low-resource settings., Aim: To evaluate the biological contamination of routinely cleaned mattresses in both high- and low-resource settings., Methods: In this two-stage observational study, routine manual bed cleaning was evaluated at two university hospitals using adenosine triphosphate (ATP). Standardized training of cleaning personnel was achieved in both high- and low-resource settings. Qualitative analysis of the cleaning process was performed to identify predictors of cleaning outcome in low-resource settings., Findings: Mattresses in low-resource settings were highly contaminated prior to cleaning. Cleaning significantly reduced biological contamination of mattresses in low-resource settings (P < 0.0001). After training, the contamination observed after cleaning in both the high- and low-resource settings seemed comparable. Cleaning with appropriate type of cleaning materials reduced the contamination of mattresses adequately. Predictors for mattresses that remained contaminated in a low-resource setting included: type of product used, type of ward, training, and the level of contamination prior to cleaning., Conclusion: In low-resource settings mattresses were highly contaminated as noted by ATP levels. Routine manual cleaning by trained staff can be as effective in a low-resource setting as in a high-resource setting. We recommend a multi-modal cleaning strategy that consists of training of domestic services staff, availability of adequate time to clean beds between patients, and application of the correct type of cleaning products., (Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Microfiber and steam technology is a novel cleaning method that has advantages for clinical applications. We describe its use in the operating room. The benefits include improved cleaning for every patient regardless of known or perceived risk, occupational health and safety advantages, and reduced cost of cleaning, allowing for expansion of cleaning activity without the need for additional human resources. Continuous surgical site infection surveillance demonstrated that infections remained at previously low levels., (Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Health care-acquired infections (HAIs) constitute an increasing threat for patients worldwide. Potential contributors of HAIs include environmental surfaces in health care settings, where ultraviolet-C radiation (UV-C) is commonly used for disinfection. This UV-C intervention-based pilot study was conducted in a hospital setting to identify any change in the incidence of HAIs before and after UV-C intervention, and to determine the effectiveness of UV-C in reducing pathogens., Methods: In a hospital in Culver City, CA, during 2012-2013, bactericidal doses of UV-C radiation (254 nm) were delivered through a UV-C-based mobile environmental decontamination unit. The UV-C dosing technology and expertise of the specifically trained personnel were provided together as a dedicated service model by a contracted company. The incidence of HAIs before and after the intervention period were determined and compared., Results: The dedicated service model dramatically reduced HAIs (incidence difference, 1.3/1000 patient-days, a 34.2% reduction). Reductions in the total number and incidence proportions (28.8%) of HAIs were observed after increasing and maintaining the coverage of UV-C treatments., Conclusion: The dedicated service model was found to be effective in decreasing the incidence of HAIs, which could reduce disease morbidity and mortality in hospitalized patients. This model provides a continuously monitored and frequently UV-C-treated patient environment. This approach to UV-C disinfection was associated with a decreased incidence of HAIs., (Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: The annual incidence of Clostridium difficile infection (CDI) in the United States is estimated to be 330,000 cases. We evaluated the impact of using a launderable mattress and bed deck cover on the incidence of hospital-onset CDI in 2 long-term acute care hospitals (LTACHs)., Methods: Two LTACHs began using a launderable mattress and bed deck cover on beds starting in May 2013. One facility had 74 beds, and the other had 30 beds. Covers were changed after every patient. The covers were laundered using hot water, detergent, and chlorine. Rates for CDIs were compared using Poisson regression between the 16 months before use of the launderable cover and the 14 months after the cover started being used., Results: At hospital A, the use of bedcovers reduced the rate of infection by 47.8% (95% confidence interval [CI], 47.1-48.6), controlling for the rate of handwashing compliance and length of stay in days. At hospital B, the use of bedcovers reduced the rate of infection by 50% (95% CI, 47.5-52.7), controlling for the rate of handwashing compliance and length of stay in days., Conclusion: The use of a launderable cover for mattresses and bed decks of hospital beds was associated with a decreased rate of health care-associated CDI in 2 LTACHs., (Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: The adenosine triphosphate (ATP) method is widely accepted as a quality control method to complement visual assessment, in the specifications of requirements, when purchasing cleaning contractors in Swedish hospitals., Aim: To examine whether the amount of biological load, as measured by ATP on frequently touched near-patient surfaces, had been reduced after an intervention; to evaluate the correlation between visual assessment and ATP levels on the same surfaces; to identify aspects of the performance of the ATP method as a tool in evaluating hospital cleanliness., Methods: A prospective intervention study in three phases was carried out in a medical ward and an intensive care unit (ICU) at a regional hospital in mid-Sweden between 2012 and 2013. Existing cleaning procedures were defined and baseline tests were sampled by visual inspection and ATP measurements of ten frequently touched surfaces in patients' rooms before and after intervention. The intervention consisted of educating nursing staff about the importance of hospital cleaning and direct feedback of ATP levels before and after cleaning., Findings: The mixed model showed a significant decrease in ATP levels after the intervention (P < 0.001). Relative light unit values were lower in the ICU. Cleanliness as judged by visual assessments improved. In the logistic regression analysis, there was a significant association between visual assessments and ATP levels., Conclusion: Direct feedback of ATP levels, together with education and introduction of written cleaning protocols, were effective tools to improve cleanliness. Visual assessment correlated with the level of ATP but the correlation was not absolute. The ATP method could serve as an educational tool for staff, but is not enough to assess hospital cleanliness in general as only a limited part of a large area is covered., (Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

This was a two-phase prospective intervention study in the cardiology intensive care unit (CICU) and medical intensive care unit (MICU) and of a public 1800-bed medical centre in Taiwan. In phase I, cleaning efficacy was monitored by ATP bioluminescence after daily morning cleaning, and only 43.9% of 221 tested surfaces passed. The baseline data were used to define an intervention consisting of a new cleaning protocol as well as a new education/training programme. In phase II, following the intervention, 88.1% of 270 surfaces were found to be clean. The combined infection rate in the CICU and MICU showed a statistically significant decrease of 49.7%., (Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Background: Environmental surfaces in health care facilities contaminated with Clostridium difficile spores can be a reservoir that contribute to transmission of hospital-acquired infections. Microfiber cleaning cloths may improve the effectiveness of surface cleaning. The objective of this study was to assess the removal and transfer of C difficile spores on surfaces cleaned by microfiber compared with cotton cloths., Methods: C difficile spores (approximately 4.2 log(10)/site) were applied to ceramic surfaces. Microfiber or cotton cloths were used to wipe the surfaces that were sprayed with either buffer or a nonsporicidal cleaning agent. To ensure reproducible pressure and surface contact time, a drill apparatus was used. The pressure was 1.5-1.77 N, and the total number of rotations was 10. Viable counts were used to assess the efficiency of microfiber and cotton cloths in removing and transferring spores., Results: Of 4.4 log(10)C difficile spores inoculated on a ceramic surface, microfiber and cotton cloths removed 2.4 and 1.7 log(10), respectively. Microfiber cloths containing 4.2 log(10)C difficile spores transferred 1.7 log(10) C difficile spores when used to wipe a ceramic surface compared with cotton cloths that transferred 2.4 log(10). Similarly microfiber wipes transferred fewer spores on consecutive surfaces wiped compared with cotton cloths (0.8 log(10) vs 1.80 log(10))., Conclusion: The use of microfiber cloths may reduce the risk of C difficile spore transfer during surface cleaning., (Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)