Hospital cleaning: past, present, and future

The effects of a novel, continuous disinfectant technology on methicillin-resistant Staphylococcus aureus (MRSA), fungi, and aerobic bacteria in 2 separate intensive care units in 2 different states: An experimental design with observed impact on health care associated infections (HAIs)

BACKGROUND

Hospitals are exposed to abundant contamination sources with limited remediation strategies. Without new countermeasures or treatments, the risk of health care-associated infections will remain high. This study explored the impact of advanced photohydrolysis continuous disinfection technology on hospital environmental bioburden.

METHODS

Two acute care intensive care units in different locations (ie, Kentucky, Louisiana) during different time periods were sampled every 4 weeks for 4 months for colony-forming units (CFUs) of methicillin-resistant Staphylococcus aureus (MRSA) and fungi on surfaces and floors and fungi and aerobic bacteria in the air.

RESULTS

At both sites, surface testing showed greater than 98% reduction in mean fungi and MRSA CFUs. Floor results had reductions by more than 96% for fungi and MRSA at both sites. Aerobic bacterial air and fungal CFUs had reductions up to 72% and 89%, respectively. HAIs declined 70% when postactivation data were compared to preactivation data.

DISCUSSION

The continuous nature of advanced photohydrolysis decontamination, its ability to be used in occupied rooms, and its independence of human resources provide an innovative intervention for complex health care environments.

CONCLUSIONS

This study is on the pioneering edge of demonstrating that continuous decontamination can reduce surface, floor, and air contamination and thereby reduce the acquisition of HAIs.

Assessing the impact of a cleaning programme on environmental hygiene in labour and neonatal wards: an exploratory study in The Gambia

BACKGROUND

Effective surface cleaning in hospitals is crucial to prevent the transmission of pathogens. However, hospitals in low- and middle-income countries face cleaning challenges due to limited resources and inadequate training.

METHODS

We assessed the effectiveness of a modified TEACH CLEAN programme for trainers in reducing surface microbiological contamination in the newborn unit of a tertiary referral hospital in The Gambia. We utilised a quasi-experimental design and compared data against those from the labour ward. Direct observations of cleaning practices and key informant interviews were also conducted to clarify the programme's impact.

RESULTS

Between July and September 2021 (pre-intervention) and October and December 2021 (post-intervention), weekly surface sampling was performed in the newborn unit and labour ward. The training package was delivered in October 2021, after which their surface microbiological contamination deteriorated in both clinical settings. While some cleaning standards improved, critical aspects such as using fresh cleaning cloths and the one-swipe method did not. Interviews with senior departmental and hospital management staff revealed ongoing challenges in the health system that hindered the ability to improve cleaning practices, including COVID-19, understaffing, disruptions to water supply and shortages of cleaning materials.

CONCLUSIONS

Keeping a hospital clean is fundamental to good care, but training hospital cleaning staff in this low-income country neonatal unit failed to reduce surface contamination levels. Further qualitative investigation revealed multiple external factors that challenged any possible impact of the cleaning programme. Further work is needed to address barriers to hospital cleaning in low-income hospitals.