Improving patient room cleaning in two intensive care units using a new targeting methodology

BACKGROUND/OBJECTIVES: Despite isolation precautions and enhanced hand hygiene products, the transmission of healthcare-associated pathogens remains a major problem in a range of healthcare settings. Although not an independent factor, environmental contamination with these resilient pathogens is believed to play a significant role in the problem, particularly if cleaning/disinfecting activities are suboptimal. Microbial contamination of the environment in intensive care units (ICUs) in particular has been associated with both colonization and infection of patients. In order to comply with Centers for Disease Control and Prevention (CDC) recommendations that “healthcare facilities implement procedures that ensure consistent cleaning and disinfection of surfaces in close proximity to the patient,” we developed a novel methodology to enhance such activities in the acute care setting. METHODS: A transparent, environmentally stable solution was developed to become intensely fluorescent when exposed to a handheld portable blacklight. The solution was used to mark standardized test sites in ICU rooms following cleaning. Targets were then evaluated after the rooms were occupied and again cleaned. When preliminary results disclosed suboptimal cleaning of many surfaces, including those defined as “high touch” objects by CDC, we developed a quality improvement initiative to improve the thoroughness of terminal patient room cleaning/disinfecting activities. RESULTS: Initially, 38 rooms and 415 targets were evaluated in the ICUs of two hospitals. The markers were removed by cleaning activities in only 55% of targets in hospital A and 40% in hospital B. High rates of cleaning (greater than 88%) were found for toilet surfaces, sinks, bedside and overbed tables, and patient chairs, However, consistently low rates (less than 10%) were documented for several objects with high potentials for contamination by nosocomial pathogens, including bedpan cleaners, toilet area handholds, and room doorknobs. Following broadbased educational interventions, 28 rooms and 270 targets were evaluated in a manner identical to that used prior to interventions. Cleaning of targets improved to 89% in hospital A (p = <0.0001) and 72% in hospital B (p = <0.0001). CONCLUSIONS: Following documentation of deficiencies in the thoroughness of terminal room cleaning in the ICUs, we implemented structured quality improvement initiatives which objectively documented significant improvement in cleaning/disinfecting activities.