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

Abstract

Objectives: To evaluate the adequacy of discharge room cleaning and the impact of a cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) on environmental surfaces in intensive care unit (ICU) rooms.

Design: Prospective environmental study.

Setting and sample: Convenience sample of ICU rooms in an academic hospital. METHODS AND INTERVENTION: The intervention consisted of (1) a change from the use of pour bottles to bucket immersion for applying disinfectant to cleaning cloths, (2) an educational campaign, and (3) feedback regarding adequacy of discharge cleaning. Cleaning of 15 surfaces was evaluated by inspecting for removal of a preapplied mark, visible only with an ultraviolet lamp ("black light"). Six surfaces were cultured for MRSA or VRE contamination. Outcomes of mark removal and culture positivity were evaluated by chi(2) testing and generalized linear mixed models, clustering by room.

Results: The black-light mark was removed from 44% of surfaces at baseline, compared with 71% during the intervention (P < .001). The intervention increased the likelihood of removal of black-light marks after discharge cleaning (odds ratio, 4.4; P < .001), controlling for ICU type (medical vs surgical) and type of surface. The intervention reduced the likelihood of an environmental culture positive for MRSA or VRE (proportion of cultures positive, 45% at baseline vs 27% during the intervention; adjusted odds ratio, 0.4; P = .02). Broad, flat surfaces were more likely to be cleaned than were doorknobs and sink or toilet handles.

Conclusions: Increasing the volume of disinfectant applied to environmental surfaces, providing education for Environmental Services staff, and instituting feedback with a black-light marker improved cleaning and reduced the frequency of MRSA and VRE contamination.

Conflict of interest statement

Potential conflicts of interest. R.P. has received research grants from Sanofi-Aventis, GlaxoSmithKline, Pfizer, and TAP Pharmaceuticals in the past 2 years. D.S.Y. has received research support from Sage Products. All other authors report no conflicts of interest relevant to this article.

Figures

FIGURE 1

Impact of the intervention on the removal of a black-light mark on 15 high-touch surfaces. A total of 41 rooms (545 surfaces) were evaluated during the baseline period, and a total of 44 rooms (576 surfaces) were evaluated during the intervention. The bed rail was evaluated only in medical intensive care units, with a n = 19; intervention, n = 14.