Evaluation of different monitoring methods of surface cleanliness in operating rooms

Environmental cleaning and disinfection in the operating room: a systematic scoping review through a human factors and systems engineering lens

OBJECTIVE

To synthesize evidence and identify gaps in the literature on environmental cleaning and disinfection in the operating room based on a human factors and systems engineering approach guided by the Systems Engineering Initiative for Patient Safety (SEIPS) model.

DESIGN

A systematic scoping review.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched 4 databases (ie, PubMed, EMBASE, OVID, CINAHL) for empirical studies on operating-room cleaning and disinfection. Studies were categorized based on their objectives and designs and were coded using the SEIPS model. The quality of randomized controlled trials and quasi-experimental studies with a nonequivalent groups design was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials.

RESULTS

In total, 40 studies were reviewed and categorized into 3 groups: observational studies examining the effectiveness of operating-room cleaning and disinfections (11 studies), observational study assessing compliance with operating-room cleaning and disinfection (1 study), and interventional studies to improve operating-room cleaning and disinfection (28 studies). The SEIPS-based analysis only identified 3 observational studies examining individual work-system components influencing the effectiveness of operating-room cleaning and disinfection. Furthermore, most interventional studies addressed single work-system components, including tools and technologies (20 studies), tasks (3 studies), and organization (3 studies). Only 2 studies implemented interventions targeting multiple work-system components.

CONCLUSIONS

The existing literature shows suboptimal compliance and inconsistent effectiveness of operating-room cleaning and disinfection. Improvement efforts have been largely focused on cleaning and disinfection tools and technologies and staff monitoring and training. Future research is needed (1) to systematically examine work-system factors influencing operating-room cleaning and disinfection and (2) to redesign the entire work system to optimize operating-room cleaning and disinfection.

Impact of ATP Bioluminescence Cleaning Verification System on Rates of Infection and Fecal Colonization in a Burn Unit of Tertiary Care Hospital in Egypt

Contaminated surfaces increase the risk of hospital infections. Traditional hospital cleanliness monitoring has become insufficient. ATP bioluminescence is a developed monitoring tool with limited clinical data in healthcare settings. Therefore, the current work aims to study the impact of the ATP monitoring tool on wound infection rates and fecal colonization among burn patients. The study was designed over two phases. Phase I involved conventional cleaning monitoring by visual inspection, while phase II involved the ATP bioluminescence tool. In both phases, clinical and environmental swabs were collected for microbial culture and identification. Gram-negative bacteria were screened for carbapenem resistance. Among the five selected cases, MALDI-TOF and Vitek2 were utilized to test for phenotypic relatedness between common isolates from different clinical and environmental sources. The wound infection rate was significantly reduced from 23% in phase I to 8% in phase II (p-value <0.005). Fecal colonization by CR bacteria demonstrated 7% and 14% in phase I and phase II, respectively. Environmental culture demonstrated significantly decreased microbial isolation rates from 37% (phase I) to 10% (phase II) (p-value<0.001) with a non-significant decrease in CR bacteria. Total pass and failed cleaning rates for ATP bioluminescence were 70.9% and 6.08%, respectively. Common isolates in 3 cases exhibited a similarity of >65% by MALDI-TOF and the identical resistance phenotypes by Vitek2. The ATP bioluminescence cleaning verification system has been proven a rapid and objective tool that positively impacts microbial isolation rates from clinical and environmental samples.