A Multi-Disciplinary Approach to Improve Room Cleanliness across a Large Academic Medical Center Using Adenosine Triphosphate Technology
Background: The hospital environment poses a substantial risk for transmission of pathogens. Assessing cleaning efficacy is difficult and often relies on a subjective visual check. A multidisciplinary approach is required to evaluate and improve hospital cleanliness. However, an objective, reliable quality indicator is needed as an outcome metric to assess the cleanliness of the environment. Technology is available to detect adenosine triphosphate (ATP), a substance present in organic matter, which can generate a measure of cleanliness.
Methods: From August 2013-March 2014, we swabbed 30 discharge-cleaned rooms per week using the ATP technology in six nursing units, selected based on historical multi-drug-resistant organism (MDRO) transmission data. Up to 17 high-touch surfaces were sampled per room. The 3M Clean-Trace luminometerTM quantifies organic material on each surface. A reading below 250 RLU is considered a clean surface. If more than 30% of surfaces per room fail, recleaning is required. Metrics included: percentage of surfaces that fail, room fail rate, percent fails by surface, percent fails by unit, room fail rate, and MDRO transmission in relation to surface fails. Nursing, Infection Prevention, and Environmental Services management were responsible to test rooms. The data were used to formulate intervention strategies.
Results: Weekly data showed an improvement over time trending towards the goal of 90% (figure 1) Over eight months, the average monthly clean surface rate increased from 77% pre-intervention to 84% post-intervention (figure 2). We also saw a relationship between multi-drug resistant organism (MDRO) transmission and room cleanliness (figure 3.). Intervention strategies included retraining EVS staff on appropriate cleaning practices, posting pictures of high-touch surfaces, distributing a “fact of the week,” weekly data feedback, and performing real-time ATP process with the EVS staff that cleaned the room.
Conclusion: The ability to assess cleaning performance with an objective, reliable metric, and analyze the data by individual touch point and staff accountability, led to improved cleanliness, reduced MDRO transmission risk, and enhanced collaboration efforts among Nursing, IP and EVS.
M. Slade, None
N. Rave, None
F. Woodson, None
J. Lawlor, None
M. Mielnicki, None
R. Costello, None