title: Manual cleaning of hospital mattresses: an observational study comparing high- and low-resource settings.
abstract: BACKGROUND
  Hospital-associated infections (HAIs) are more frequently encountered in low- than in high-resource settings. There is a need to identify and implement feasible and sustainable approaches to strengthen HAI prevention in low-resource settings.
  
  
  OBJECTIVE
  To evaluate the biological contamination of routinely cleaned mattresses in both high- and low-resource settings.
  
  
  METHODS
  In this two-stage observational study, routine manual bed cleaning was evaluated at two university hospitals using adenosine triphosphate (ATP). Standardized training of cleaning personnel was achieved in both high- and low-resource settings. Qualitative analysis of the cleaning process was performed to identify predictors of cleaning outcome in low-resource settings.
  
  
  RESULTS
  Mattresses in low-resource settings were highly contaminated prior to cleaning. Cleaning significantly reduced biological contamination of mattresses in low-resource settings (P < 0.0001). After training, the contamination observed after cleaning in both the high- and low-resource settings seemed comparable. Cleaning with appropriate type of cleaning materials reduced the contamination of mattresses adequately. Predictors for mattresses that remained contaminated in a low-resource setting included: type of product used, type of ward, training, and the level of contamination prior to cleaning.
  
  
  CONCLUSIONS
  In low-resource settings mattresses were highly contaminated as noted by ATP levels. Routine manual cleaning by trained staff can be as effective in a low-resource setting as in a high-resource setting. We recommend a multi-modal cleaning strategy that consists of training of domestic services staff, availability of adequate time to clean beds between patients, and application of the correct type of cleaning products.
authors.affiliation: Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands; Academic Unit for Infection Prevention and Control, Division of Community Health, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa. Electronic address: Joost.Hopman@radboudumc.nl.
authors.forename: J
authors.initials: J
authors.lastname: Hopman
authors.affiliation: Academic Unit for Infection Prevention and Control, Division of Community Health, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
authors.forename: B
authors.initials: B
authors.lastname: Hakizimana
authors.affiliation: Academic Unit for Infection Prevention and Control, Division of Community Health, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
authors.forename: W A J
authors.initials: WA
authors.lastname: Meintjes
authors.affiliation: Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Nillessen
authors.affiliation: Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: de Both
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Radboud University Medical Center and Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Voss
authors.affiliation: Academic Unit for Infection Prevention and Control, Division of Community Health, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
authors.forename: S
authors.initials: S
authors.lastname: Mehtar
mesh_terms: D000255:Adenosine Triphosphate / Q000032:analysis*; D001513:Beds / Q000382:microbiology*; D003428:Cross Infection / Q000517:prevention & control; D006302:Health Services Research; D006785:Hospitals, University; D006797:Housekeeping, Hospital / Q000379:methods*; D006801:Humans; D017053:Infection Control / Q000379:methods
chemical_list: D000255:Adenosine Triphosphate
keywords: ATP bioluminescence; Cleaning; Environmental contamination; Low-income country; Mattresses; Middle-income country