Welcome to Infection Control Week! Like us, many of you are probably launching a
series of events to highlight this important time of the year. The theme for our company is Disinfection
Delinquents: Crimes against Infection Prevention. The “CRIMEs” we will be focusing on are Compliance, Rushing, Insufficient
Information, Mucky Hands and Exposure.
I’m pretty sure you’ve guessed based on the awesomely
alliterated title where I’m going with the topic of this blog! I think we can all agree that reducing the
incidence of HAIs requires proper environmental cleaning and disinfection of
frequently touched objects in healthcare facilities. A quick PubMed search looking for “cleaning
compliance” provided hundreds of studies that are looking into the impact that
monitoring cleaning compliance can have on improved patient safety through
reduction of HAIs. I think we could all
say that we’ve likely read more than 1 study that has looked at testing patient
rooms pre and post-cleaning showing poor compliance. Many studies look at the level and/or type of
training provided to staff about proper cleaning. I would hazard a guess that the percentage of
cleaned surfaces improved showing that repeat training favorably changes
behavior in the staff.
But how is compliance measured? It depends on the outcome you are looking for
and the time and budget that you have.
Many facilities are utilizing the various UV reflective kits that are
available on the market. These UV
reflective kits can be an effective way of covertly monitoring what surfaces
have been cleaned and have certainly been used by a number of journalists
who have gone “undercover” to see how well hospitals clean. Many facilities
who use UV reflective kits as their monitoring tools have found that when
the staff achieves 80% or greater cleaning compliance of high touch surfaces, HAI
rates are dramatically reduced. The
downside of these kits is that some staff will go out and buy their own black
light to find the spots…..
ATP Meters are another method that has been gaining interest
as tool for monitoring cleaning compliance.
ATP is present in many types of organic material including food, microbes,
body fluids and other natural substances.
An enzymatic reaction with the ATP in bioburden results in
bioluminescence (biological production and emission of light) and the intensity
generated is proportional to the amount of organic material present on the
surface tested. The luminescence is
expressed in "relative light units" (RLU), providing a quantitative
measurement.
ATP has been used for many years in the food industry. While I agree that ATP has its use, there are
several
limitations to the use of ATP within healthcare facilities. First,
the absence of standardization of the ATP technology from various manufacturers
and RLU readings for use within healthcare makes cross-comparisons of readings
and benchmarking problematic. Second, the lack of documented
correlation between ATP readings and levels of microbial contamination on
environmental surfaces makes meaningful interpretation of the data difficult
and distinction between pathogenic and non-pathogenic microbes on the sampled
surface virtually impossible. Also, ATP kits cannot detect or measure viral
contamination because viruses do not possess ATP. Third, and perhaps
most important, many surface disinfectant chemistries and cleaning tools
interfere with ATP measurements. Therefore, the use of ATP as
a tool to determine the effectiveness of different cleaning practices or to
compare the effectiveness of different cleaning and disinfectant chemistries
remains a challenge.
Regardless of the method you use to measure compliance, the
key is to develop a program that can provide meaningful results for you. This should include a validation study to set
a baseline by which to measure yourself against so you can show improvements or
lapses in cleaning. It should also
include a training program to ensure that everyone tasked with measuring
compliance is doing it in the same way so that the results you are recording
can provide direction for where improvements need to be made. Either way, it is important that these
programs are introduced in a positive and not punitive manner. Our housekeeping staff are the backbone of our
cleaning and disinfection programs. We
need them to work with us, not against us and we need to let them know how
important their jobs are to the safety of our patients.
Bugging Off!
Nicole
PS – don’t forget to develop an equivalent program for our
clinical staff. Shared patient care
equipment is just as important as environmental surfaces!
