title: Assessment of terminal cleaning in pediatric isolation rooms: Options for low-resource settings.
abstract: Few studies have evaluated terminal cleaning in low-resource settings.
  
  
  
  Adequacy of pediatric isolation room terminal cleaning was evaluated using quantitative bacterial surface cultures, ATP bioluminescence assays, and fluorescent high-touch surface markers at Tygerberg Children's Hospital in South Africa (August 1, 2014-October 31, 2015). Cleaning adequacy was assessed by comparing pre- and postcleaning measurements. Influence of verbal feedback was determined by comparing cleaners' first and subsequent cleaning episodes. Cleaning methods were compared for cost, time, and feasibility.
  
  
  
  Adequacy of terminal cleaning was evaluated in 25 isolation rooms after hospitalization for pulmonary tuberculosis (n = 13), respiratory (n = 5) and enteric viruses (n = 5), pertussis (n = 1), and methicillin-resistant Staphylococcus aureus (n = 1). Mean aerobic colony counts and mean ATP relative light units declined between pre- and postcleaning evaluations (39 ± 41 to 15 ± 30 [P < .001] and 72 ± 40 to 23 ± 11 [P < .001]). Fluorescent marker removal was initially poor, but improved significantly at subsequent cleaning episodes (17 out of 78 [22%] to 121 out of 198 [61%]; P < .001); mean aerobic colony counts and ATP values also declined significantly following feedback. Cost, time, and resources required for ATP and surface cultures far exceeded that required for fluorescent markers.
  
  
  
  Adequacy of isolation room cleaning improved following feedback to cleaning staff. Fluorescent markers are an inexpensive option for cleaning evaluation and training in low-resource settings.
authors: Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, Stellenbosch University, Cape Town, South Africa. Electronic address: dramowski@sun.ac.za.
authors: Angela
authors: A
authors: Dramowski
authors: Department of Medical Microbiology, Stellenbosch University and the National Health Laboratory Service, Cape Town, South Africa.
authors: Andrew
authors: A
authors: Whitelaw
authors: Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, Stellenbosch University, Cape Town, South Africa.
authors: Mark F
authors: MF
authors: Cotton
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004203:Disinfection / Q000379:methods*; D004783:Environmental Microbiology; D005260:Female; D006776:Hospitals, Pediatric; D006797:Housekeeping, Hospital; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008828:Microbiological Techniques; D010356:Patient Isolation; D010362:Patients' Rooms; D013019:South Africa
keywords: ATP bioluminescence; Fluorescent markers; Health care-associated infection; Infection control; Patient isolation; Surface cultures