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healthcare-associated infections (HAI) program

Monitoring Cleaning

Clipboard checklist. ​​

​How do we know when a hospital room is clean?

  • Visually clean or finger-swipe clean

    • Fast and inexpensive, but lacks objectivity
  • Confirm using technology, e.g. ultra-violet (UV) light or ATP bioluminescence

  • Increasingly becoming the community standard (read article via Infectious Disease Special Edition)

Bartley et al. Clinical Microbiology Newsletter. 2008 (read article via Clinical Microbiology Newsletter) Technical Brief via Agency for Healthcare Research and Quality)

​​What technologies are available to monitor environmental cleaning?

  • Fluorescence or UV light
  • An environmental marker is used prior to cleaning
  • The marker is visible to UV light if still present after cleaning
  • Adenosine Triphosphate (ATP) monitoring
    • Measures residual organic matter left on a surface after cleaning

CDC, Options for Evaluating Environmental Cleaning (read more about Environmental Cleaning Programs via CDC)

Lillis. ATP Testing: A Proven Method to Measure Cleanliness. 2015 (read article via Infection Control Today)

​​What are the pros and cons of monitoring technologies?


​Why should we assess adequacy of environmental cleaning?

  • High-touch surfaces are frequently overlooked by hospital environmental services staff. 
  • In one study,  the adequacy of cleaning of high-touch surfaces was found to be 48% in 36 hospitals
    • Assessing adequacy of environmental cleaning is essential
    • Feedback to cleaning assessment data to environmental services personnel can drive performance improvement

 Carling et al.ICHE 2008 (read article via PubMed)

​Can use of monitoring technology help improve adequacy of room cleaning?

  • Monitoring technology can be used to assess adequacy of environmental cleaning and inform staff education and administrative interventions.
  • In one study, 36 hospitals used a fluorescent monitoring method to evaluate the thoroughness of patient room disinfection.
    • Each hospital met with administrative personnel to review monitoring technology findings and develop intervention plans
    • Education of and feedback to environmental services personnel resulted in significant improvements in environmental cleaning

Carling. ICHE. 2008 (read article via PubMed)

​Summary of Key Points

  • A properly cleaned care environment is essential to prevent or contain HAIs

  • A surface must be physically cleaned before it can be disinfected

  • Consistent use of best practices and clarity of roles should be emphasized

  • Use of technologies such as microfiber, monitoring systems, and whole-room disinfection after cleaning are increasingly becoming the community standard of care

  • EVS staff should be valued and supported so they can maximize their unique contributions to preventing HAI

Environmental Cleaning Resources

CDC/HICPAC Guidelines for Environmental Infection Control in Health-Care Facilities, 2003

CDC/HICPAC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008

CDC Options for Evaluating Environmental Cleaning Toolkit

CDC Environmental Checklist for Monitoring Terminal Cleaning

CDC Environmental Checklist (scroll to bottom of page and download word doc)

CDC Environmental Cleaning Eval Worksheet (scroll to bottom of page and download excel doc)

CDC/HICPAC Guidelines for Hand Hygiene in Healthcare Settings Published 2002

WHO Guidelines on Hand Hygiene in Healthcare (2009) 

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