title: Surface cleaning effectiveness in a walk-in emergency care unit: Influence of a multifaceted intervention.
abstract: Cleaning of surfaces is essential in reducing environmental bioburdens and health care-associated infection in emergency units. However, there are few or no studies investigating cleaning surfaces in these scenarios. Our goal was to determine the influence of a multifaceted intervention on the effectiveness of routine cleaning of surfaces in a walk-in emergency care unit.
  
  
  
  This prospective, before-and-after interventional study was conducted in 4 phases: phase I (situational diagnosis), phase II (implementation of interventions-feedback on results, standardization of cleaning procedures, and training of nursing staff), phase III (determination of the immediate influence of interventions), and phase IV (determination of the late influence of interventions). The surfaces were sampled before and after cleaning by visual inspection, adenosine triphosphate bioluminescence assay, and microbiologic culture.
  
  
  
  We sampled 240 surfaces from 4 rooms. When evaluated by visual inspection and adenosine triphosphate bioluminescence, there was a progressive reduction of surfaces found to be inadequate in phases I-IV (P < .001), as well as in culture phases I-III. However, phase IV showed higher percentages of failure by culture than phase I (P = .004).
  
  
  
  The interventions improved the effectiveness of cleaning. However, this effect was not maintained after 2 months.
authors: School of Medicine, Program of Health and Development in the Center-West Region, Federal University of Mato Grosso do Sul, Campo Grande, Brazil. Electronic address: olecifrota@gmail.com.
authors: Oleci P
authors: OP
authors: Frota
authors: School of Medicine, Program of Health and Development in the Center-West Region, Federal University of Mato Grosso do Sul, Campo Grande, Brazil.
authors: Adriano M
authors: AM
authors: Ferreira
authors: School of Medicine, Program of Health and Development in the Center-West Region, Federal University of Mato Grosso do Sul, Campo Grande, Brazil.
authors: Rodrigo
authors: R
authors: Koch
authors: Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
authors: Denise
authors: D
authors: de Andrade
authors: Course of Nursing, Federal University of Mato Grosso do Sul, Três Lagoas, Brazil.
authors: Marcelo A
authors: MA
authors: Rigotti
authors: Department of Public Health of Campinas, Municipality of Campinas, São Paulo, Brazil.
authors: Najla M A
authors: NMA
authors: Borges
authors: Faculty of Medicine of São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil.
authors: Margarete T G
authors: MTG
authors: Almeida
mesh_terms: D003428:Cross Infection / Q000517:prevention & control; D004203:Disinfection / Q000379:methods*; D004636:Emergency Service, Hospital; D004783:Environmental Microbiology; D006801:Humans; D008828:Microbiological Techniques; D011446:Prospective Studies; D013997:Time Factors
keywords: Equipment contamination; High-touch surfaces; Infection prevention; Patient safety; Quality management/improvement; Staff work area; Training