title: Reduction of Clostridium Difficile and vancomycin-resistant Enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods.
abstract: BACKGROUND
  Contaminated environmental surfaces may play an important role in transmission of some healthcare-associated pathogens. In this study, we assessed the adequacy of cleaning practices in rooms of patients with Clostridium difficile-associated diarrhea (CDAD) and vancomycin-resistant Enterococcus (VRE) colonization or infection and examined whether an intervention would result in improved decontamination of surfaces.
  
  
  METHODS
  During a 6-week period, we cultured commonly touched surfaces (i.e. bedrails, telephones, call buttons, door knobs, toilet seats, and bedside tables) in rooms of patients with CDAD and VRE colonization or infection before and after housekeeping cleaning, and again after disinfection with 10% bleach performed by the research staff. After the housekeeping staff received education and feedback, additional cultures were collected before and after housekeeping cleaning during a 10-week follow-up period.
  
  
  RESULTS
  Of the 17 rooms of patients with VRE colonization or infection, 16 (94%) had one or more positive environmental cultures before cleaning versus 12 (71%) after housekeeping cleaning (p = 0.125), whereas none had positive cultures after bleach disinfection by the research staff (p < 0.001). Of the 9 rooms of patients with CDAD, 100% had positive cultures prior to cleaning versus 7 (78%) after housekeeping cleaning (p = 0.50), whereas only 1 (11%) had positive cultures after bleach disinfection by research staff (p = 0.031). After an educational intervention, rates of environmental contamination after housekeeping cleaning were significantly reduced.
  
  
  CONCLUSIONS
  Our findings provide additional evidence that simple educational interventions directed at housekeeping staff can result in improved decontamination of environmental surfaces. Such interventions should include efforts to monitor cleaning and disinfection practices and provide feedback to the housekeeping staff.
authors.affiliation: Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA. brittcx16@aol.com <brittcx16@aol.com>
authors.forename: Brittany C
authors.initials: BC
authors.lastname: Eckstein
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Adams
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Eckstein
authors.forename: Agam
authors.initials: A
authors.lastname: Rao
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Sethi
authors.forename: Gopala K
authors.initials: GK
authors.lastname: Yadavalli
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Donskey
mesh_terms: D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000517:prevention & control; D003428:Cross Infection / Q000517:prevention & control*; D004203:Disinfection / Q000379:methods*; D004493:Education; D016983:Enterococcus; D004866:Equipment Contamination / Q000517:prevention & control; D050456:Fomites / Q000382:microbiology*; D016908:Gram-Positive Bacterial Infections / Q000517:prevention & control; D006787:Hospitals, Veterans; D006797:Housekeeping, Hospital / Q000379:methods* / Q000592:standards; D006801:Humans; D017053:Infection Control / Q000379:methods*; D010362:Patients' Rooms; D012973:Sodium Hypochlorite; D020713:Vancomycin Resistance
chemical_list: D012973:Sodium Hypochlorite