Researchers Compare Visual Inspection, Other Methods of Assessing Post-Discharge Cleaning

Published data to date have provided a limited comparison between non-microbiologic methods -- particularly visual inspection -- and a microbiologic comparator to evaluate the effectiveness of environmental cleaning of patient rooms. Snyder, et al. (2013) sought to compare the accuracy of visual inspection with other non-microbiologic methods of assessing the effectiveness of post-discharge cleaning (PDC).
The researchers used prospective evaluation to determine the effectiveness of PDC in comparison to a microbiologic comparator. Using a highly standardized methodology examining 15 high-touch surfaces, the effectiveness of PDC was evaluated by visual inspection, the removal of fluorescent marker (FM) placed prior to room occupancy, quantification of adenosine triphosphate (ATP) levels, and culture for aerobic colony counts (ACC).
Twenty rooms including 293 surfaces were sampled in the study, including 290 surfaces sampled by all four methods. ACC demonstrated 72 percent of surfaces to be microbiologically clean. Visual inspection, FM, ATP demonstrated 57 percent, 49 percent, and 66 percent of surfaces to be clean. Using ACC as a microbiologic comparator, the sensitivity of visual inspection, FM, and ATP to detect a clean surface were 60 percent, 51 percent, and 70 percent, respectively; the specificity of visual inspection, FM, and ATP were 52 percent, 56 percent, and 44 percent.
The researchers concluded that in assessing the effectiveness of PDC, there was poor correlation between the two most frequently  studied commercial methods and a microbiologic comparator. Visual inspection performed at least as well as commercial methods, directly addresses patient perception of cleanliness, and is economical to  implement. Their research was published in Antimicrobial Resistance and Infection Control. 

Reference: Snyder GM, Holyoak AD, Leary KE, Sullivan BF, Davis RB and Wright SB. Effectiveness of visual inspection compared with non-microbiologic methods to determine the thoroughness of post-discharge cleaning. Antimicrobial Resistance and Infection Control 2013, 2:26 doi:10.1186/2047-2994-2-26