ICT asked Philip Carling, MD, director of infectious diseases and epidemiology at Caritas Carney Hospital in Boston and a professor at Boston University School of Medicine, to share his insights on the topic of environmental cleaning.
Q: Your studies have indicated that hospitals have a lot of room for improvement in their surface cleaning protocols; to what degree is efficacious cleaning lacking in today’s hospitals and why?
A: Following completion of the Healthcare Environmental Hygiene Study Group (HEHSG)’s 36-hospital project, the results of which were published last fall, we have expanded the same programmatic analysis and process improvement intervention to almost 100 hospitals across the U.S., ranging in size from eight to 540 beds. One of the most interesting findings in our covert studies of the thoroughness of terminal room cleaning was the range as well as clustering of cleaning scores found (cleaning score equals the percentage of 14 high-risk objects in patient rooms and bathrooms cleaned following patient discharge). Most scores clustered around a mean of 63 percent with half of the hospitals having scores of 40 to 60. While some hospitals had much higher than average cleaning scores, several had scores which very much distressed them. In spite, or possibly because of, their low baseline cleaning scores, all of the low-scoring hospitals improved to 80 percent or greater following education and implementation of a structured monitoring and performance feedback intervention. On the basis of my discussion with dozens of infection preventionists participating in the HEHSG’s projects, it appears that the primary reasons for suboptimal performance in terminal room cleaning relate to shortcomings in the education of environmental services (ES) staff with regard to their understanding of specific, clinically relevant cleaning expectations, and their critical role in patient safety through the prevention of hospital-associated pathogen (HAP) transmission from near-patient environmental surfaces.
