732. Self-monitoring of hospital room cleaning by Environmental Services (EVS) may not accurately measure cleanliness
Session: Oral Abstract Session: Preventing Hospital Transmission: Environment and Hands
Friday, October 9, 2015: 10:45 AM
Room: 7--AB
Background: Environmental decontamination is increasingly a point of emphasis in the prevention of healthcare-associated infections. Self-monitoring of hospital room cleanliness by EVS is often used to ensure effective terminal cleaning, yet it is unclear whether this an effective method of quality assurance. We compared room surface cleanliness as checked by EVS versus non-EVS personnel (validators).

Methods: As part of the Benefits of Enhanced Terminal Room (BETR) Disinfection study, EVS supervisors placed fluorescent dots on 5-7 high-touch surfaces in study rooms prior to terminal cleaning in and examined the dots with a black light after cleaning.  If the dot was not visible or smeared, the surface was considered to be clean and was otherwise considered dirty.  Validators performed the same process in 56 rooms at two study hospitals from April-June 2014.  Rooms tested by validators and EVS were matched by unit, cleaning date and shift.  The overall proportion of cleaned surfaces and the cleanliness of the 6 most-tested surfaces (bathroom handrail, door knobs, light switches, toilet seat, sink and chair) were compared between EVS and validators. Proportions were compared using the 2-tailed chi-square test.

Results: Of the 256 rooms in which EVS Supervisors performed objective monitoring of room cleaning in the study period, 56 were matched to reviews performed by validators.  A large discrepancy existed between rooms tested by EVS supervisors versus study personnel.  Overall, EVS supervisors determined that 82.5% (264/320) of tested surfaces were clean, whereas our validation only found 52.4% (153/292) of surfaces to be clean (p<0.001).  We identified a significant difference between EVS and validation testing of door knobs and light switches.  EVS found 90.5% (19/21) of door knobs and  95.2% (20/21) of light switches to be clean whereas study personnel found 23.1% (3/13) of door knobs and 23.8% (5/21) of light switches to be clean (both, p<0.001).  This pattern held for the other 4 surfaces, but the differences were not statistically significant.

Conclusion: EVS self-monitoring of hospital room cleanliness may not accurately measure how well high-touch room surfaces are cleaned.  Similar to hand hygiene, validation of room cleaning may be a useful tool to improve terminal cleaning and decrease the risk of bacterial transmission between patients.

Lauren P. Knelson, MSPH1,2,3, Gemila Ramadanovic, LPN4, Luke F. Chen, MBBS, MPH, CIC, FRACP1,2,3, Rebekah W. Moehring, MD, MPH1,2,3,5, Sarah S. Lewis, MD MPH1,2,3, William Rutala, PhD, MPH, FSHEA6,7, David J. Weber, MD, MPH, FIDSA, FSHEA8,9,10, Daniel J. Sexton, MD, FIDSA, FSHEA2,3, Deverick Anderson, MD, MPH, FIDSA, FSHEA1,2,3,5 and CDC Prevention EpiCenter Program, (1)Duke University CDC Prevention Epicenter Program, Durham, NC, (2)Division of Infectious Diseases, Duke University Medical Center, Durham, NC, (3)Duke Infection Control Outreach Network, Duke University Medical Center, Durham, NC, (4)Duke University Medical Center, Durham, NC, (5)Duke Antimicrobial Stewardship Outreach Network, Durham, NC, (6)Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, (7)Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC, (8)University of North Carolina, School of Public Health, Chapel Hill, NC, (9)Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, (10)Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC


L. P. Knelson, None

G. Ramadanovic, None

L. F. Chen, None

R. W. Moehring, None

S. S. Lewis, None

W. Rutala, None

D. J. Weber, None

D. J. Sexton, None

D. Anderson, None

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