The role of environment in transmission of multidrug-resistant organisms (MDRO) is well-described. We implemented an intervention using adenosine triphosphate (ATP) bioluminescence assay data, education and feedback to environmental services (EVS) housekeeping staff in order to improve surface cleanliness in a medical intensive care unit (MICU).
Baseline and intervention data collection occurred from November 2014 to January 2015 and February to May 2015, respectively. During both periods, infection preventionists (IP) measured ATP on up to 10 high-touch surfaces (e.g. bed hand rail, medication scanner) in terminally cleaned patient rooms. The intervention consisted of EVS manager visual inspection of each terminally cleaned room, ATP swabbing of high-touch surfaces, feedback of results to housekeeping staff and real-time education on best practices. Rooms were re-cleaned when indicated. Data collected by both EVS and IP were regularly discussed with EVS and MICU management. Median relative light units (RLU) and percent of swabs with passing values (defined as ≤250 RLU) were measured. Median ATP value was tracked by surface over time. Baseline and intervention periods were compared. Chi-square and Wilcoxon rank-sum tests were performed where appropriate. Unit-related hospital-onset cases of Clostridium difficile (CDI), MRSA, VRE, and ESBL were assessed for both time periods.
835 swabs were recorded (baseline: 374; intervention: 461). The overall pass rate was 44%. The average pass rate increased during the intervention period (from 35% to 51%, p < .001).The median RLU decreased during the intervention period (from 432 to 246, p < .001). The interquartile range narrowed from 171-1197 RLU in the baseline period to 101-488 RLU in the intervention period. Problem surfaces identified included medication scanners, bed and bathroom hand rails, and family furniture. Unit-related CDI, MRSA, VRE, and ESBL infection rates decreased by 38-54% during the intervention (p > .05).
A simple, successful intervention to improve the cleanliness of high-touch surfaces was implemented. Promising trends in nosocomial MDRO infections were observed. Further research is needed to assess other factors that may contribute to the acquisition of nosocomial MDRO.
H. Young, None
A. Miller, None
K. Medero, None
M. Milner, None
C. Price, None