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If we look at the current state of environmental hygiene, what we need to ask ourselves is, Why is cleanliness still such a problem?
In the past, hospitals have measured cleanliness using patient satisfaction survey responses. There are several pros and cons of this approach, though satisfaction surveys measure a patients impression of cleanliness, it does not objectively tell whether a surface is clean. This can be dangerous as a surface could look fine but be contaminated with infection-causing pathogens.