of the room, the high-touch surfaces were surveyed by study
personnel, and the rooms were scored according to the
percentage of surfaces appropriately cleaned. Twenty-four
different housekeepers were involved, and their identities
were not recorded as part of the project. The amount of
time spent by housekeepers to clean a room was monitored
through use of an automated system that required personnel
to document by telephone when they arrived at the room
and when room cleaning was complete.
Six hundred high-touch surfaces were marked in 40 critical
care rooms (10 rooms per unit). Cleaning thoroughness ranged
from a low of 5 percent for the monitor to a high of 79 percent
for the computer mouse. Cleaning of high-touch surfaces
was similar from unit to unit except for the room door handle
(which was cleaned less well in unit B; and cabinet handle
(which was cleaned less well in units B and D). The room
cleaning checklist was completed less frequently in unit C (30
percent completion) than in the other three units (60 percent
to 90 percent completion). However, the median number of
surfaces cleaned was similar for a room whether the checklist
was completed or not. The overall thoroughness of cleaning
(percentage of high-touch surfaces cleaned) was 41 percent
and ranged from 33 percent to 51 percent among intensive
care units. Specific room cleanliness ranged from a low of
0 percent to a high of 80 percent. There was no significant
correlation between the thoroughness of cleaning high-touch
surfaces (with or without consideration of the three surfaces
that housekeepers were not responsible for cleaning) and
the amount of time required to clean the room. There was
Continued from page 14
contamination through either direct contact with the
patient’s skin or by personal contact with the fomite
and subsequent skin to skin or glove to skin contact
with the patient.”
The guideline adds, “A high risk for pathogen
transmission exists in the perioperative setting because
of multiple contacts between perioperative team mem-
bers, patience, and environmental services. Cleaning
and disinfecting the environment is a basic infection
prevention principle used to reduce the likelihood that
exogenous sources will contribute to healthcare-as-
sociated infections. Operating room environmental
surfaces and equipment can become contaminated
with pathogens that cause surgical site infections,
particularly if cleaning is suboptimal, and pathogens can
then be transmitted to the hands of perioperative team
members. Thus, thorough cleaning and disinfection
of high touch objects as part of a comprehensive
environmental cleaning and disinfection program that
includes hand hygiene are essential in preventing the
spread of potentially pathogenic microorganisms.”
Many practitioners instinctively know that to
achieve optimal results, environmental hygiene should
not be rushed. Unfortunately, great emphasis on
quickness-driven efficiencies persists, such as a scoring
system promulgated by a 2006 opinion piece that
Continued on page 16
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