Evaluating and operationalizing an environmental auditing program: a pilot study

Public Buses Decontamination by Automated Hydrogen Peroxide Aerosolization System

BACKGROUND: Public transportation has been linked to an increase in the risk of coronavirus disease 2019 transmission. The effective decontamination system using aerosolized hydrogen peroxide can mitigate the transmission risk from using public transportation. AIM: The aim of this study was to develop and validate an effective decontamination system for public transport. METHODS: The experimental research was performed in 13 inter-city public buses. The aerosol generator with ultrasonic atomizer was used in the experiment. The validation process for disinfection was conducted using both a chemical indicator (CI) and spore discs biological indicator (inoculated with 106 Geobacillus stearothermophilus enclosed in glassine envelopes). The CIs and biological indicators were marked by number and placed in nine locations on each bus. The decontamination cycle was developed by analyzed of various aerosolized and decomposition period. Both concentrations of hydrogen peroxide, 5% and 7%, were used for comparison. RESULTS: In an aerosolized period, both concentrations of hydrogen peroxide at 30 min were effective for sporicidal 6-log reductions. The decontamination cycle totaled 100 min, based on a 70 min average decomposition time. CONCLUSIONS: The automated hydrogen peroxide aerosolized system is a highly effective and safe method of decontaminating public buses.

An evaluation of cleaning practices at a teaching hospital

BACKGROUND

The COVID-19 outbreak has highlighted the role of hospital-acquired infections in spreading epidemics. Adequately cleaning surfaces in patient rooms is an essential part of this fight to reduce the spread. Traditional audits, however, are insufficient. This study assesses surface cleaning practices using ultravoilet (UV) marker technology and the extent to which this technology can help improve cleaning audits and practices.

METHODS

One hundred and forty-four audits (1,235 surfaces) were retrieved. UV-marker cleaning audits conducted at a major teaching hospital in 2018 after implementing a new cleaning protocol. In addition, semi-structured interviews were conducted with cleaning staff and supervisors.

RESULTS

On average, 63% of surfaces were appropriately cleaned. Toilet handles (80%) and toilet seats underside (83%) scored highest while main room sink fixtures (54%), light switch (55%), and bedrails (56%) scored lowest. Training, staffing and time constraints may play a role in low cleaning rates.

DISCUSSION

The high-touch patient surfaces in the bedroom remain neglected and a potential source of infections. UV marker audits provided an objective measure of cleaning practices that managers and staff were unaware of.

CONCLUSIONS

UV-markers audits can play a key role in revealing deficiencies in cleaning practices and help in raising awareness of these deficiencies and improving cleaning practices.

Effectiveness of clinical surface cleaning and disinfection: evaluation methods

OBJECTIVE

To discuss the methods employed to evaluate the effectiveness of clinical surface cleaning and disinfection (C&D).

METHOD

This is a theoretical reflection based on scientific studies and the experience of the authors. Knowledge and current gaps, the need for further studies, and practical application of the methods were approached.

RESULTS

There are four main methods used to evaluate the effectiveness of clinical surface C&D: visual inspection, fluorescent markers, microbiological cultures, and adenosine triphosphate (ATP) bioluminescence. The first two are used to evaluate the process and to predict adherence to protocols by the staff, and the last two are employed to evaluate the results, therefore being the most relevant to assess the risk of infection.

FINAL CONSIDERATIONS

The ideal method was not found, because all of them showed limitations. There is a need for strategies to optimize the precision of these methods.

Efficiency of cleaning and disinfection of surfaces: correlation between assessment methods

OBJECTIVE

to assess the correlation among the ATP-bioluminescence assay, visual inspection and microbiological culture in monitoring the efficiency of cleaning and disinfection (C&D) of high-touch clinical surfaces (HTCS) in a walk-in emergency care unit.

METHOD

a prospective and comparative study was carried out from March to June 2015, in which five HTCS were sampled before and after C&D by means of the three methods. The HTCS were considered dirty when dust, waste, humidity and stains were detected in visual inspection; when ≥2.5 colony forming units per cm2 were found in culture; when ≥5 relative light units per cm2 were found at the ATP-bioluminescence assay.

RESULTS

720 analyses were performed, 240 per method. The overall rates of clean surfaces per visual inspection, culture and ATP-bioluminescence assay were 8.3%, 20.8% and 44.2% before C&D, and 92.5%, 50% and 84.2% after C&D, respectively (p<0.001). There were only occasional statistically significant relationships between methods.

CONCLUSION

the methods did not present a good correlation, neither quantitative nor qualitatively.

Failure analysis in the identification of synergies between cleaning monitoring methods

BACKGROUND

The 4 monitoring methods used to manage the quality assurance of cleaning outcomes within health care settings are visual inspection, microbial recovery, fluorescent marker assessment, and rapid ATP bioluminometry. These methods each generate different types of information, presenting a challenge to the successful integration of monitoring results. A systematic approach to safety and quality control can be used to interrogate the known qualities of cleaning monitoring methods and provide a prospective management tool for infection control professionals. We investigated the use of failure mode and effects analysis (FMEA) for measuring failure risk arising through each cleaning monitoring method.

METHODS

FMEA uses existing data in a structured risk assessment tool that identifies weaknesses in products or processes. Our FMEA approach used the literature and a small experienced team to construct a series of analyses to investigate the cleaning monitoring methods in a way that minimized identified failure risks.

RESULTS

FMEA applied to each of the cleaning monitoring methods revealed failure modes for each. The combined use of cleaning monitoring methods in sequence is preferable to their use in isolation.

CONCLUSIONS

When these 4 cleaning monitoring methods are used in combination in a logical sequence, the failure modes noted for any 1 can be complemented by the strengths of the alternatives, thereby circumventing the risk of failure of any individual cleaning monitoring method.

How clean is clean: a new approach to assess and enhance environmental cleaning and disinfection in an acute tertiary care facility

Traditional environmental cleaning monitoring through visual assessment can identify gross lapses in practice. However, in recent years the limitations underlying this need for ongoing compliance with cleaning and disinfection policies in the patient's immediate surroundings have become widely recognised. The value of objectively monitoring and improving environmental cleaning and disinfection in healthcare settings is becoming increasingly identified as a crucial element of strategies to mitigate the transmission of healthcare-associated infections. Mafraq Hospital has adopted a new method using an invisible fluorescent marker system to target on surfaces in patient's immediate surroundings. Evaluation of at least 30 surfaces and objects in patient rooms revealed that only 11% of targets had been cleaned. Simulation training, educational interventions, empowerment, change involvement and acknowledgment were executed, leading to a sustained improvement of 77% in both quarter 2 and 3 of 2013 in cleaning and disinfecting of all surfaces and objects.