I gave a webinar last week for 3M (you can download my slides here) on “Your hospital room can make you sick: How improved cleaning and disinfection can help”. I asked the audience what they were doing to improve cleaning and disinfection, and thought I would share the findings. I don’t know the exact size of the audience (but it’s usually a couple of hundred mainly US based IPC folks), and the audience were allowed to choose any answers that applied to them for the second two questions.
I was surprised that so many people chose contaminated hands as the most important reservoir. I appreciate that this is received wisdom, but I really do think that this depends on pathogen and context. If you are looking at ‘same room’ acquisition of A. baumannii then contaminated surfaces are the most important reservoir, even if contaminated hands are the ‘terminal event’ in the chain of transmission.
Over 80% of the respondents had some sort of system for visual assessment of cleanliness – but what are the other 20% doing? Surely we need mechanisms in place to ensure that hospital rooms are visibly clean (although it’s important to understand that this may not necessarily correlate with microbiological contamination level). Around half of hospitals were using a measure of cleaning performance (either ATP or fluorescent markers), which seems to be the way forward in providing some objectivity in performance managing the cleaning process. And it was interesting to see that 15% of respondents had gone down the route of routine microbiological cultures. I’d like to do this – I really would – but I am not sure whether there is room for ATP / fluorescent markers and routine microbiological cultures in the same programme (correct me if I’m wrong here please readers!).
Finally, I was surprised to see over 80% of hospitals had implemented disinfectant wipes. I’d love to see what types of wipes there are – QAC? Sporicidal wipes? Over half had also made a change in disinfectant in their attempts to improve hospital cleaning and disinfection, and a little under half had implemented chlorhexidine bathing. I was a bit disappointed to see that <10% of respondents had implemented automated room decontamination, which I see as part of the future of hospital cleaning and disinfection.
Any reflections on this reflection welcome, as always.