Visualization of hospital cleanliness in three Japanese hospitals with a tendency toward long-term care

BMC Research Notes

Hiroyuki Yamaguchi¹  Junji Matsuo¹  Shinji Nakamura³  Yasuhiro Hayashi²  Rika Yano⁴  Tomoko Shimoda⁴  Reina Watanabe⁴ 

[1] Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Nishi-5 Kita-12 Jo, Kita-ku, Sapporo, Hokkaido 060-0812, Japan;Hokkaido University Hospital, Nishi-5 Kita-14 Jo, Kita-ku, Sapporo, Hokkaido 068-8648, Japan;Division of Biomedical Imaging Research, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan;Departments of Fundamental Nursing, Faculty of Health Sciences, Hokkaido University, North-12, West-5, Kita-ku, Sapporo 060-0812, Japan

关键词: Japan;    Long-term care;    Stamp agar culture method;    ATP bioluminescence;    Hospital cleanliness;   

Others  :  1134395
DOI  :  10.1186/1756-0500-7-121

 received in 2013-02-15, accepted in 2014-01-30,  发布年份 2014

【 摘 要 】

Background

Hospital cleanliness in hospitals with a tendency toward long-term care in Japan remains unevaluated. We therefore visualized hospital cleanliness in Japan over a 2-month period by two distinct popular methods: ATP bioluminescence (ATP method) and the standard stamp agar method (stamp method).

Methods

The surfaces of 752 sites within nurse and patient areas in three hospitals located in a central area of Sapporo, Japan were evaluated by the ATP and stamp methods, and each surface was sampled 8 times in 2 months. These areas were located in different ward units (Internal Medicine, Surgery, and Obstetrics and Gynecology). Detection limits for the ATP and stamp methods were determined by spike experiments with a diluted bacterial solution and a wipe test on student tables not in use during winter vacation, respectively. Values were expressed as the fold change over the detection limit, and a sample with a value higher than the detection limit by either method was defined as positive.

Results

The detection limits were determined to be 127 relative light units (RLU) per 100 cm² for the ATP method and 5.3 colony-forming units (CFU) per 10 cm² for the stamp method. The positive frequency of the ATP and stamp methods was 59.8% (450/752) and 47.7% (359/752), respectively, although no significant difference in the positive frequency among the hospitals was seen. Both methods revealed the presence of a wide range of organic contamination spread via hand touching, including microbial contamination, with a preponderance on the entrance floor and in patient rooms. Interestingly, the data of both methods indicated considerable variability regardless of daily visual assessment with usual wiping, and positive surfaces were irregularly seen. Nurse areas were relatively cleaner than patient areas. Finally, there was no significant correlation between the number of patients or medical personnel in the hospital and organic or microbiological contamination.

Conclusions

Ongoing daily hospital cleanliness is not sufficient in Japanese hospitals with a tendency toward long-term care.

【 授权许可】

   
2014 Watanabe et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Boyce JM: Environmental contamination makes an important contribution to hospital infection. J Hosp Infect 2007, 65(Suppl. 2):50-54.
• [2]Dettenkofer M, Spencer RC: Importance of environmental contamination–a critical view. J Hosp Infect 2007, 65(Suppl. 2):55-57.
• [3]Fraise AP: Decontamination of the environment. J Hosp Infect 2007, 65(Suppl. 2):58-59.
• [4]Lemmes SW, Hafner H, Zolldann D, Stanzel S, Lutticken R: Distribution of multi-resistant gram-negative versus gram-positive bacteria in the hospital inanimate environment. J Hosp Infect 2004, 56:191-197.
• [5]Hayden MK, Bonten MJM, Blom DW, Lyle EA, van de Vijver DAMC, Weinstein RA: Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis 2006, 42:1552-1560.
• [6]Hardy KJ, Oppenheim BA, Gossain S, Gao F, Hawkey PM: A study of the relationship between environmental contamination with methicillin-resistant Staphylococcus aureus (MRSA) and patients’ acquisition of MRSA. Infect Cont Hosp Epidemiol 2006, 27:127-132.
• [7]Dancer SJ, White LF, Lamb J, Girvan EK, Robertson C: Measuring the effect of enhanced cleaning in a UK hospital: a prospective cross-over study. BMC Med 2009, 7:28. BioMed Central Full Text
• [8]Liz E: Essential practice for infection prevention and control, guidance for nursing staff. 20 Cavendish Square London W1G 0RN; RCN Direct 0345 772 6100: Published by the Royal College of Nursing; 2012. http://www.rcn.org.uk webcite
• [9]NHMRC: Australian Guidelines for the Prevention and Control of Infection in Healthcare. Commonwealth of Australia; 2010. http://www.ag.gov.au/cca webcite, ISBN Online: 1864965223
• [10]Rutala WA, Weber DJ, The Healthcare Infection Control Practices Advisory Committee (HICPAC): Guideline for disinfection and sterilization in healthcare facilities, 2008. U.S.: Centers for Disease Control and Prevention; 2008.
• [11]Moore G, Smyth D, Singleton J, Wilson P: The use of adenosine triphosphate bioluminescence to assess the efficacy of a modified cleaning program implemented within an intensive care setting. Am J Infect Control 2010, 38:617-622.
• [12]Boyce JM, Havill NL, Dumigan DG, Golebiewski M, Balogun O, Rizvani R: Monitoring the effectiveness of hospital cleaning practices by use of an adenosine triphosphate bioluminescence assay. Infect Control Hosp Epidemiol 2009, 30:678-684.
• [13]Andersen BM, Rasch M, Kvist J, Tollefsen T, Lukkassen R, Sandvik L, Welo A: Floor cleaning: effect on bacteria and organic materials in hospital rooms. J Hosp Infect 2009, 71:57-65.
• [14]Malik RE, Cooper RA, Griffith CJ: Use of audit tools to evaluate the efficacy of cleaning systems in hospitals. Am J Infect Control 2003, 31:181-187.
• [15]Griffith CJ, Cooper RA, Gilmore J, Davies C, Lewis M: An evaluation of hospital cleaning regimes and standards. J Hosp Infect 2000, 45:19-28.
• [16]Dolan A, Bartlett M, McEntee B, Creamer E, Humphreys H: Evaluation of different methods to recover meticillin-resistant Staphylococcus aureus from hospital environmental surfaces. J Hosp Infect 2011, 79:227-230.
• [17]Cheng KL, Boost MV, Chung JW: Study on the effectiveness of disinfection with wipes against methicillin-resistant Staphylococcus aureus and implications for hospital hygiene. Am J Infect Control 2011, 39:577-580.
• [18]Nandalal P, Somashekar RK: Prevalence of Staphylococcus aureus and Pseudomonas aeruginosa in indoor air flora of a district hospital, Mandya, Karnataka. J Environ Biol 2007, 28:197-200.
• [19]OECD Health Data 2012. http://www.oecd.org/health/healthpoliciesanddata/oecdhealthdata2012.htm webcite
• [20]Mulvey D, Redding P, Robertson C, Woodall C, Kingsmore P, Bedwell D, Dancer SJ: Finding a benchmark for monitoring hospital cleanliness. J Hosp Infect 2011, 77:25-30.
• [21]The Helsinki Declaration. http://www.wma.net/en/30publications/10policies/b3/index.html webcite
• [22]Dancer SJ: Hospital cleaning in the 21st century. Eur J Clin Microbiol Infect Dis 2011, 30:1473-1481.
• [23]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:S41-S50.
• [24]Goodman ER, Platt R, Bass R, Onderdonk AB, Yokoe DS, Huang SS: Impact of an environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in intensive care unit rooms. Infect Control Hosp Epidemiol 2008, 29:593-599.
• [25]Davies S: Hospital contract cleaning and infection control. London: UNISON; 2005.
• [26]Page K, Wilson M, Parkin IP: Antimicrobial surfaces and their potential in reducing the role of the inanimate environment in the incidence of hospital-acquired infections. J Mater Chem 2009, 19:3819-3831.
• [27]Brady MJ, Lisay CM, Yurkovetskiy AV, Sawan SP: Persistent silver disinfectant for the environmental control of pathogenic bacteria. Am J Infect Control 2003, 31:208-214.
• [28]De Muynck W, De Belie N, Verstraete W: Antimicrobial mortar surfaces for the improvement of hygienic conditions. J Appl Microbiol 2010, 108:62-72.
• [29]Aycicek H, Oguz U, Karci K: Comparison of results of ATP bioluminescence and traditional hygiene swabbing methods for the determination of surface cleanliness at a hospital kitchen. Int J Hyg Environ Health 2006, 209:203-206.
• [30]Lewis T, Griffith C, Gallo M, Weinbren M: A modified ATP benchmark for evaluating the cleaning of some hospital environmental surfaces. J Hosp Infect 2008, 69:156-163.