title: Visualization of hospital cleanliness in three Japanese hospitals with a tendency toward long-term care.
abstract: BACKGROUND
  Hospital cleanliness in hospitals with a tendency toward long-term care in Japan remains unevaluated. We therefore visualized hospital cleanliness in Japan over a 2-month period by two distinct popular methods: ATP bioluminescence (ATP method) and the standard stamp agar method (stamp method).
  
  
  METHODS
  The surfaces of 752 sites within nurse and patient areas in three hospitals located in a central area of Sapporo, Japan were evaluated by the ATP and stamp methods, and each surface was sampled 8 times in 2 months. These areas were located in different ward units (Internal Medicine, Surgery, and Obstetrics and Gynecology). Detection limits for the ATP and stamp methods were determined by spike experiments with a diluted bacterial solution and a wipe test on student tables not in use during winter vacation, respectively. Values were expressed as the fold change over the detection limit, and a sample with a value higher than the detection limit by either method was defined as positive.
  
  
  RESULTS
  The detection limits were determined to be 127 relative light units (RLU) per 100 cm2 for the ATP method and 5.3 colony-forming units (CFU) per 10 cm2 for the stamp method. The positive frequency of the ATP and stamp methods was 59.8% (450/752) and 47.7% (359/752), respectively, although no significant difference in the positive frequency among the hospitals was seen. Both methods revealed the presence of a wide range of organic contamination spread via hand touching, including microbial contamination, with a preponderance on the entrance floor and in patient rooms. Interestingly, the data of both methods indicated considerable variability regardless of daily visual assessment with usual wiping, and positive surfaces were irregularly seen. Nurse areas were relatively cleaner than patient areas. Finally, there was no significant correlation between the number of patients or medical personnel in the hospital and organic or microbiological contamination.
  
  
  CONCLUSIONS
  Ongoing daily hospital cleanliness is not sufficient in Japanese hospitals with a tendency toward long-term care.
authors.forename: Reina
authors.initials: R
authors.lastname: Watanabe
authors.forename: Tomoko
authors.initials: T
authors.lastname: Shimoda
authors.forename: Rika
authors.initials: R
authors.lastname: Yano
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Shinji
authors.initials: S
authors.lastname: Nakamura
authors.forename: Junji
authors.initials: J
authors.lastname: Matsuo
authors.affiliation: Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Nishi-5 Kita-12 Jo, Kita-ku, Sapporo, Hokkaido 060-0812, Japan. hiroyuki@med.hokudai.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamaguchi
mesh_terms: D000255:Adenosine Triphosphate / Q000378:metabolism; D001419:Bacteria / Q000145:classification / Q000254:growth & development / Q000302:isolation & purification; D001431:Bacteriological Techniques / Q000295:instrumentation / Q000379:methods; D004203:Disinfection / Q000379:methods / Q000592:standards*; D006757:Hospital Units; D006761:Hospitals / Q000592:standards; D006797:Housekeeping, Hospital / Q000379:methods / Q000592:standards*; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards*; D007297:Inpatients / Q000706:statistics & numerical data; D007564:Japan; D008134:Long-Term Care / Q000592:standards; D008163:Luminescent Measurements / Q000295:instrumentation / Q000379:methods; D008330:Management Audit / Q000379:methods / Q000592:standards*; D009873:Operating Rooms; D010362:Patients' Rooms; D010564:Personnel, Hospital / Q000706:statistics & numerical data; D014038:Toilet Facilities
chemical_list: D000255:Adenosine Triphosphate