A Checklist for Terminal Cleaning is Only as Good as the List Itself

A thorough, terminal cleaning of hospital rooms between patients is essential for eliminating environmental contamination, and a checklist is a standard tool to guide the cleaning staff. But new research presented at the 45th Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC) offers an important reminder that the checklist is only as good as the list itself.

The environmental services team at Summit Health, a hospital in rural Pennsylvania, used a 175-item checklist in 2017 to guide terminal room cleaning. The list included the dry-erase white boards used for communications. However, it did not include the markers or the erasers.

In an inspection of 55 cleaned and prepared patient rooms, 39 markers and 52 erasers were identified and tested for the presence of Adenosine triphosphate (ATP), an indicator for the presence of biological residues. Not a single marker and only two erasers passed the test.

This was in stark contrast to the more than 95 percent of checklist surfaces that passed.

“Although they are just small writing instruments, both the markers and erasers tested at 40 times the threshold,” said Ericka Kalp, PhD, MPH, CIC, FAPIC, lead study author and director of epidemiology and infection prevention at Summit Health. “Because these are a main communication tool for nurses, cleaning them properly is of great significance to improving infection prevention.”

The ATP testing was performed with environmental services staff in attendance. If results were over the threshold, the infection preventionist conducting the test then demonstrated how to properly clean and retest.

“Environmental cleaning is essential to preventing the spread of infection,” said 2018 APIC president Janet Haas, PhD, RN, CIC, FSHEA, FAPIC. “This study emphasizes the importance of not only using a checklist as a reminder of what needs to be cleaned, but also making sure the list includes all frequently touched items.”

Summit Health has utilized the 175-item checklist since 2012. Both the markers and the erasers have since been added to the checklist.

Source: APIC