Background: Monitoring as an important quality process to ensure adequacy of environmental cleaning in healthcare is advocated. However, there is little data comparing monitoring using surface marker, colony count or ATP. The study objective was to determine the performance of these three monitoring methods in ICU discharge rooms in Canada and the Netherlands to identify if there were differences in clinical application of monitoring in different countries.
Methods: This prospective study assessed 5 high-touch sites (HTS) in 50 ICU rooms in both countries. HTS included any five of: procedure table, bedside table, computer keyboard, bedrail, pump or cardiac screen. A novel reflective surface marker (RSM) was used on each HTS after patient discharge but before cleaning (clean cutoff = total marker removal). Viable count was done using Rodac plates containing DEN agar (clean cutoff < 2.5 cfu/cm2) and ATP (measured as relative light units – RLUs) were tested before and after terminal cleaning (clean cutoff ≤ 250 RLUs).
Results: Pre-cleaning 92.8% and 25.6% of HTS were "dirty" by RLU in Canada and Netherlands, respectively. Post-clean 75.3% and 8.4% were still "dirty" by RLU in Canada and the Netherlands, respectively (Fig 1). The median pre and post clean CFUs and RLUs are shown in Fig 2. The bedrails pre-clean had the highest bacterial level of Canadian HTS and in the Netherlands (bedrails not tested) it was the computer keyboard. Post-cleaning RSM was removed from 84.5% and 60% of HTS, in Canada and the Netherlands, respectively (Fig 1).
Conclusion: The Netherlands pre and post-cleaning level of viable bacteria and ATP residuals were significantly lower (P<0.01) than in Canadian ICUs. A possible explanation could be the absence of handwash sinks in the Netherlands ICU rooms, with subsequent lower environmental contamination. Alternatively, surface material differences may be a factor. There was a significant reduction in colony count and ATP (p < 0.01) post-cleaning in both countries. In the Netherlands but not in Canada, a pass post-cleaning by the ATP test correlated with a pass by colony count. The clinical application of the monitoring tests studied differed between these two countries.
Figure 1 Environmental cleaning monitoring in ICUs in Canada and The Netherlands
Figure 2 Median RLUs and CFUs on ICU surfaces in Canada and The Netherlands
Boszczowski, 3M: Consultant , Investigator and Scientific Advisor , Consulting fee , Research support and Speaker honorarium
J. Hopman, 3M: Consultant , Investigator and Scientific Advisor , Consulting fee , Research support and Speaker honorarium