Finding a benchmark for monitoring hospital cleanliness

D. Mulvey, P. Redding, Christopher Robertson, C. Woodall, P. Kingsmore, D. Bedwell, S. J. Dancer

Research output: Contribution to journalArticle

132 Citations (Scopus)

Abstract

This study evaluated three methods for monitoring hospital cleanliness. The aim was to find a benchmark that could indicate risk to patients from a contaminated environment. We performed visual monitoring, ATP bioluminescence and microbiological screening of five clinical surfaces before and after detergent-based cleaning on two wards over a four-week period. Five additional sites that were not featured in the routine domestic specification were also sampled. Measurements from all three methods were integrated and compared in order to choose appropriate levels for routine monitoring. We found that visual assessment did not reflect ATP values nor environmental contamination with microbial flora including Staphylococcus aureus and meticillin-resistant S. aureus (MRSA). There was a relationship between microbial growth categories and the proportion of ATP values exceeding a chosen benchmark but neither reliably predicted the presence of S. aureus or MRSA. ATP values were occasionally diverse. Detergent-based cleaning reduced levels of organic soil by 32% (95% confidence interval: 16-44%; P < 0.001) but did not necessarily eliminate indicator staphylococci, some of which survived the cleaning process. An ATP benchmark value of 100 relative light units offered the closest correlation with microbial growth levels < 2.5 cfu/cm(2) (receiver operating characteristic ROC curve sensitivity: 57%; specificity: 57%). In conclusion, microbiological and ATP monitoring confirmed environmental contamination, persistence of hospital pathogens and measured the effect on the environment from current cleaning practices. This study has provided provisional benchmarks to assist with future assessment of hospital cleanliness. Further work is required to refine practical sampling strategy and choice of benchmarks. (C) 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

LanguageEnglish
Pages25-30
Number of pages6
JournalJournal of Hospital Infection
Volume77
Issue number1
Early online date3 Dec 2010
DOIs
Publication statusPublished - Jan 2011

Fingerprint

Benchmarking
Adenosine Triphosphate
Staphylococcus aureus
Methicillin
ROC Curve
Detergents
Environmental Monitoring
Growth
Staphylococcus
Soil
Confidence Intervals
Light

Keywords

  • atp
  • environmental monitoring
  • Hospital cleaning
  • meticillin-resistant staphylococcus aureus
  • Standards
  • resistant staphylococcus-aureas
  • environmental surfaces
  • aqcuitision
  • infection
  • standards
  • contamination
  • hygiene

Cite this

Mulvey, D., Redding, P., Robertson, C., Woodall, C., Kingsmore, P., Bedwell, D., & Dancer, S. J. (2011). Finding a benchmark for monitoring hospital cleanliness. Journal of Hospital Infection, 77(1), 25-30. https://doi.org/10.1016/j.jhin.2010.08.006
Mulvey, D. ; Redding, P. ; Robertson, Christopher ; Woodall, C. ; Kingsmore, P. ; Bedwell, D. ; Dancer, S. J. / Finding a benchmark for monitoring hospital cleanliness. In: Journal of Hospital Infection. 2011 ; Vol. 77, No. 1. pp. 25-30.
@article{2528abd14cfe41bba9bc476cbdf46d4a,
title = "Finding a benchmark for monitoring hospital cleanliness",
abstract = "This study evaluated three methods for monitoring hospital cleanliness. The aim was to find a benchmark that could indicate risk to patients from a contaminated environment. We performed visual monitoring, ATP bioluminescence and microbiological screening of five clinical surfaces before and after detergent-based cleaning on two wards over a four-week period. Five additional sites that were not featured in the routine domestic specification were also sampled. Measurements from all three methods were integrated and compared in order to choose appropriate levels for routine monitoring. We found that visual assessment did not reflect ATP values nor environmental contamination with microbial flora including Staphylococcus aureus and meticillin-resistant S. aureus (MRSA). There was a relationship between microbial growth categories and the proportion of ATP values exceeding a chosen benchmark but neither reliably predicted the presence of S. aureus or MRSA. ATP values were occasionally diverse. Detergent-based cleaning reduced levels of organic soil by 32{\%} (95{\%} confidence interval: 16-44{\%}; P < 0.001) but did not necessarily eliminate indicator staphylococci, some of which survived the cleaning process. An ATP benchmark value of 100 relative light units offered the closest correlation with microbial growth levels < 2.5 cfu/cm(2) (receiver operating characteristic ROC curve sensitivity: 57{\%}; specificity: 57{\%}). In conclusion, microbiological and ATP monitoring confirmed environmental contamination, persistence of hospital pathogens and measured the effect on the environment from current cleaning practices. This study has provided provisional benchmarks to assist with future assessment of hospital cleanliness. Further work is required to refine practical sampling strategy and choice of benchmarks. (C) 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.",
keywords = "atp, environmental monitoring, Hospital cleaning, meticillin-resistant staphylococcus aureus, Standards, resistant staphylococcus-aureas, environmental surfaces, aqcuitision, infection, standards, contamination, hygiene",
author = "D. Mulvey and P. Redding and Christopher Robertson and C. Woodall and P. Kingsmore and D. Bedwell and Dancer, {S. J.}",
year = "2011",
month = "1",
doi = "10.1016/j.jhin.2010.08.006",
language = "English",
volume = "77",
pages = "25--30",
journal = "Journal of Hospital Infection",
issn = "0195-6701",
number = "1",

}

Mulvey, D, Redding, P, Robertson, C, Woodall, C, Kingsmore, P, Bedwell, D & Dancer, SJ 2011, 'Finding a benchmark for monitoring hospital cleanliness' Journal of Hospital Infection, vol. 77, no. 1, pp. 25-30. https://doi.org/10.1016/j.jhin.2010.08.006

Finding a benchmark for monitoring hospital cleanliness. / Mulvey, D.; Redding, P.; Robertson, Christopher; Woodall, C.; Kingsmore, P.; Bedwell, D.; Dancer, S. J.

In: Journal of Hospital Infection, Vol. 77, No. 1, 01.2011, p. 25-30.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Finding a benchmark for monitoring hospital cleanliness

AU - Mulvey, D.

AU - Redding, P.

AU - Robertson, Christopher

AU - Woodall, C.

AU - Kingsmore, P.

AU - Bedwell, D.

AU - Dancer, S. J.

PY - 2011/1

Y1 - 2011/1

N2 - This study evaluated three methods for monitoring hospital cleanliness. The aim was to find a benchmark that could indicate risk to patients from a contaminated environment. We performed visual monitoring, ATP bioluminescence and microbiological screening of five clinical surfaces before and after detergent-based cleaning on two wards over a four-week period. Five additional sites that were not featured in the routine domestic specification were also sampled. Measurements from all three methods were integrated and compared in order to choose appropriate levels for routine monitoring. We found that visual assessment did not reflect ATP values nor environmental contamination with microbial flora including Staphylococcus aureus and meticillin-resistant S. aureus (MRSA). There was a relationship between microbial growth categories and the proportion of ATP values exceeding a chosen benchmark but neither reliably predicted the presence of S. aureus or MRSA. ATP values were occasionally diverse. Detergent-based cleaning reduced levels of organic soil by 32% (95% confidence interval: 16-44%; P < 0.001) but did not necessarily eliminate indicator staphylococci, some of which survived the cleaning process. An ATP benchmark value of 100 relative light units offered the closest correlation with microbial growth levels < 2.5 cfu/cm(2) (receiver operating characteristic ROC curve sensitivity: 57%; specificity: 57%). In conclusion, microbiological and ATP monitoring confirmed environmental contamination, persistence of hospital pathogens and measured the effect on the environment from current cleaning practices. This study has provided provisional benchmarks to assist with future assessment of hospital cleanliness. Further work is required to refine practical sampling strategy and choice of benchmarks. (C) 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

AB - This study evaluated three methods for monitoring hospital cleanliness. The aim was to find a benchmark that could indicate risk to patients from a contaminated environment. We performed visual monitoring, ATP bioluminescence and microbiological screening of five clinical surfaces before and after detergent-based cleaning on two wards over a four-week period. Five additional sites that were not featured in the routine domestic specification were also sampled. Measurements from all three methods were integrated and compared in order to choose appropriate levels for routine monitoring. We found that visual assessment did not reflect ATP values nor environmental contamination with microbial flora including Staphylococcus aureus and meticillin-resistant S. aureus (MRSA). There was a relationship between microbial growth categories and the proportion of ATP values exceeding a chosen benchmark but neither reliably predicted the presence of S. aureus or MRSA. ATP values were occasionally diverse. Detergent-based cleaning reduced levels of organic soil by 32% (95% confidence interval: 16-44%; P < 0.001) but did not necessarily eliminate indicator staphylococci, some of which survived the cleaning process. An ATP benchmark value of 100 relative light units offered the closest correlation with microbial growth levels < 2.5 cfu/cm(2) (receiver operating characteristic ROC curve sensitivity: 57%; specificity: 57%). In conclusion, microbiological and ATP monitoring confirmed environmental contamination, persistence of hospital pathogens and measured the effect on the environment from current cleaning practices. This study has provided provisional benchmarks to assist with future assessment of hospital cleanliness. Further work is required to refine practical sampling strategy and choice of benchmarks. (C) 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

KW - atp

KW - environmental monitoring

KW - Hospital cleaning

KW - meticillin-resistant staphylococcus aureus

KW - Standards

KW - resistant staphylococcus-aureas

KW - environmental surfaces

KW - aqcuitision

KW - infection

KW - standards

KW - contamination

KW - hygiene

UR - http://www.scopus.com/inward/record.url?scp=78650514084&partnerID=8YFLogxK

U2 - 10.1016/j.jhin.2010.08.006

DO - 10.1016/j.jhin.2010.08.006

M3 - Article

VL - 77

SP - 25

EP - 30

JO - Journal of Hospital Infection

T2 - Journal of Hospital Infection

JF - Journal of Hospital Infection

SN - 0195-6701

IS - 1

ER -