Baylor University Medical Center Proceedings April 2014, Volume 27, Number 2 | Page 16

Figure. Percentage of high-touch objects cleaned after a training intervention for the three trial periods.

decrease in HAIs was due to environmental cleaning is difficult
to calculate; however, decreasing the contribution of pathogens
from the environment surely had an impact, as established by
the CDC and various studies. Current accomplishments in HAI
eradication have been encouraging, but much more needs to be
done to promote the elimination of HAIs due to environmental
contamination (13–24).
Other studies have also shown that targeted efforts to reduce
HAIs, including environmental cleaning, can have significant results. The Jewish Hospital (Mercy Health) in Cincinnati, Ohio,
formed a multidisciplinary task force that included physicians,
nurses, pharmacists, experts, administrators, and EVS staff. The
group concentrated on standardization of clinical care, broadspectrum antibiotic use, and environmental cleaning to reduce
the rate of C. difficile (primarily in the older population) from
25.27 per 10,000 to 3.08 per 10,000 in less than 2 years. The
emphasis on environmental cleaning had an instant effect on C.
difficile rates. The EVS staff changed curtains during cleaning of
rooms, cleaned bathrooms twice daily, used bleach, used soap
and water for handwashing instead of alcohol gel products, and
used laundry sanitizer to kill bacteria on microfiber mop strips
and clothes. They also used a real-time adenosine triphosphate
to detect any residual left behind after the room was cleaned,
which provided quick feedback that helped with effectively
cleaning HTOs after patient discharge (25).
Commonly, the focus of infection control is to prevent
provider or patient-to-patient transmission of infectious
microorganisms. A presentation at the annual meeting of the
Association of Operative Registered Nurses reported on a study
conducted in 79 operating rooms across five hospitals showing
that best practices, accurate products and tools, an unbiased
environmental monitoring tool, and timely staff feedback advance the value of disinfection cleaning (24). Successful strategies to control HAIs have been used in Colorado, Florida,
Wisc onsin, Oregon, and Minnesota to reduce infections with
carbapenem-resistant Enterobacteriaceae with increased surveillance, increased antibiotic stewardship, and isolation precautions. Tennessee and Colorado have reduced infections in
90

central line–associated bloodstream infections through increased
training and guidance, improved data collection, improved
communication during transfer of patients between facilities,
and improved tracking. Massachusetts, New York, and Illinois
have reduced the rate of infections with C. difficile by having statewide full-day regional workshops and using uniform
measurement and reporting tools. Improvements are patient
focused, and sampling of the environment is rarely mentioned
(1). The participation of the entire hospital staff and the use of
constructive methods to approach staff are critical for the success
of these public health achievements (1, 8, 14, 15, 19–22, 26).
Centers for Disease Control and Prevention. Healthcare-associated infections.
Available at http://www.cdc.gov/hai/.
2. Carling PC, Bartley JM. Evaluating hygienic cleaning in health care settings: what you do not know can harm your patients. Am J Infect Control
2010;38(5 Suppl 1):S41–S50.
3. Sehulster L, Chinn RY; CDC; HICPAC. Guidelines for environmental
infection control in health-care facilities. MMWR Recomm Rep 2003;52
(RR-10):1–42.
4. Siegel JD, Rhinehart E, Jackson M, Chiarello L; Healthcare Infection Control
Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Atlanta, GA: CDC.
Available at http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf
5. Mayo Clinic. C. difficile: Intervention drops hospital infection rate by a
third. ScienceDaily 2010 (March 30). Available at www.sciencedaily.com/
releases/2010/03/100319142658.htm.
6. Boyce JM, Pittet D; Healthcare Infection Control Practices Advisory
Committee; HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.
Guideline for hand hygiene in health-care settings. MMWR Recomm Rep
2002;51(RR-16):1–45.
7. Dancer SJ. Importance of the environment in meticillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning. Lancet Infect Dis
2008;8(2):101–113.
8. Dancer SJ. The role of environmental cleaning in the control of hospitalacquired infection. J Hosp Infect 2009;73(4):378–385.
9. Otter JA, French GL. Survival of nosocomial bacteria and spores on
surfaces and inactivation by hydrogen peroxide vapor. J Clin Microbiol
2009;47(1):205–207.
10. French GL, Otter JA, Shannon KP Adams NM, Watling D, Parks MJ. Tackling
,
contamination of the hospital environment by methicillin-resistant Staphylococcus
aureus (MRSA): a comparison between conventional terminal cleaning and
hydrogen peroxide vapour decontamination. J Hosp Infect 2004;57(1):31–37.
1.

Baylor University Medical Center Proceedings

Volume 27, Number 2