title: Improving environmental hygiene in 27 intensive care units to decrease multidrug-resistant bacterial transmission.
abstract: OBJECTIVE
  To determine the thoroughness of terminal disinfection and cleaning of patient rooms in hospital intensive care units and to assess the value of a structured intervention program to improve the quality of cleaning as a means of reducing environmental transmission of multidrug-resistant organisms within the intensive care unit.
  
  
  METHODS
  Prospective, multicenter, and pre- and postinterventional study.
  
  
  METHODS
  Intensive care unit rooms in 27 acute care hospitals. Hospitals ranged in size from 25 beds to 709 beds (mean, 206 beds).
  
  
  METHODS
  A fluorescent targeting method was used to objectively evaluate the thoroughness of terminal room cleaning before and after structured educational, procedural, and administrative interventions. Systematic covert monitoring was performed by infection control personnel to assure accuracy and lack of bias.
  
  
  RESULTS
  In total, 3532 environmental surfaces (14 standardized objects) were assessed after terminal cleaning in 260 intensive care unit rooms. Only 49.5% (1748) of surfaces were cleaned at baseline (95% confidence interval, 42% to 57%). Thoroughness of cleaning at baseline did not correlate with hospital size, patient volume, case mix index, geographic location, or teaching status. After intervention and multiple cycles of objective performance feedback to environmental services staff, thoroughness of cleaning improved to 82% (95% confidence interval, 78% to 86%).
  
  
  CONCLUSIONS
  Significant improvements in intensive care unit room cleaning can be achieved in most hospitals by using a structured approach that incorporates a simple, highly objective surface targeting method and repeated performance feedback to environmental services personnel. Given the documented environmental transmission of a wide range of multidrug-resistant pathogens, our findings identify a substantial opportunity to enhance patient safety by improving the thoroughness of intensive care unit environmental hygiene.
authors.affiliation: Department of Medicine (PCC), Boston University School of Medicine, Boston, MA, USA. pcarling@comcast.net
authors.forename: Philip C
authors.initials: PC
authors.lastname: Carling
authors.forename: Michael F
authors.initials: MF
authors.lastname: Parry
authors.forename: Lou Ann
authors.initials: LA
authors.lastname: Bruno-Murtha
authors.forename: Brian
authors.initials: B
authors.lastname: Dick
mesh_terms: D000328:Adult; D003428:Cross Infection / Q000517:prevention & control* / Q000635:transmission; D004203:Disinfection / Q000379:methods / Q000592:standards*; D024901:Drug Resistance, Multiple, Bacterial; D006742:Hospital Bed Capacity; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D055624:Methicillin-Resistant Staphylococcus aureus; D010564:Personnel, Hospital / Q000193:education; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000517:prevention & control