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Bernardes LDO, dos Santos FR, Angeloni NLN, Ribeiro Furlan MC, Barcelos LDS, Ferreira AM, Lopes de Sousa AF, de Andrade D, Valim MD, Batista OMA, Lapão LV, dos Santos Junior AG, Lima HDP. Monitoring of surface cleaning and disinfection in a Brazilian pediatric unit. Ther Adv Infect Dis 2023; 10:20499361221148007. [PMID: 36654871 PMCID: PMC9841839 DOI: 10.1177/20499361221148007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 12/06/2022] [Indexed: 01/12/2023] Open
Abstract
Background Understanding the correlation between the methods of monitoring surface cleaning and disinfection (SCD) is fundamental for better infection control. Purpose This study aims to correlate the SCD monitoring methods in a Brazilian pediatric unit. This is an exploratory, longitudinal, and correlational study. Methods The study was conducted in a pediatric hospitalization unit of a medium-sized hospital from December 2020 to March 2021. Four high-contact surfaces were analyzed before and after the cleaning and disinfection process by means of visual inspection, quantification of adenosine triphosphate (ATP), and colony-forming unit (CFU) count. The study consisted of three stages: stage I involving situational diagnosis of the SCD process; stage II referring to the implementation of the Surface Cleaning and Disinfection Standardization Program (SCDSP); and stage III involving long-term assessment after implementing the program. A total of 192 assessments were performed in each stage, totaling 576 in the three study stages. Conclusions A significant correlation was found between the ATP quantification methods and microbial count in the bed railing (p = 0.009) and companion's armchair (p = 0.018) surfaces. In both cases, Spearman's correlation coefficients were positive, indicating a positive correlation between ATP and microbial count scores, that is, the higher the ATP values (in RLUs), the greater the microbial counts (in CFUs/cm2). The analysis of the ROC curves suggests that the surfaces presenting ATP below 108 RLUs can be considered approved. The ATP method yielded 78.6% sensitivity; in turn, microbial count presented a sensitivity of 85.7%. It is important to use different methods to monitor the cleaning and disinfection of surfaces, as each one has different sensitivity and specificity.
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Affiliation(s)
| | | | | | | | | | | | | | - Denise de Andrade
- Human Exposome and Infectious Diseases Network (HEID), Ribeirão Preto College of Nursing, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Luís Velez Lapão
- Federal University of Mato Grosso do Sul, Três Lagoas Campus, Três Lagoas, Brazil
| | | | - Helder de Pádua Lima
- Master’s Program in Nursing, Federal University of Mato Grosso do Sul, Três Lagoas Campus, Três Lagoas, Brazil
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Christenson EC, Cronk R, Atkinson H, Bhatt A, Berdiel E, Cawley M, Cho G, Coleman CK, Harrington C, Heilferty K, Fejfar D, Grant EJ, Grigg K, Joshi T, Mohan S, Pelak G, Shu Y, Bartram J. Evidence Map and Systematic Review of Disinfection Efficacy on Environmental Surfaces in Healthcare Facilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11100. [PMID: 34769620 PMCID: PMC8582915 DOI: 10.3390/ijerph182111100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 01/23/2023]
Abstract
Healthcare-associated infections (HAIs) contribute to patient morbidity and mortality with an estimated 1.7 million infections and 99,000 deaths costing USD $28-34 billion annually in the United States alone. There is little understanding as to if current environmental surface disinfection practices reduce pathogen load, and subsequently HAIs, in critical care settings. This evidence map includes a systematic review on the efficacy of disinfecting environmental surfaces in healthcare facilities. We screened 17,064 abstracts, 635 full texts, and included 181 articles for data extraction and study quality assessment. We reviewed ten disinfectant types and compared disinfectants with respect to study design, outcome organism, and fourteen indictors of study quality. We found important areas for improvement and gaps in the research related to study design, implementation, and analysis. Implementation of disinfection, a determinant of disinfection outcomes, was not measured in most studies and few studies assessed fungi or viruses. Assessing and comparing disinfection efficacy was impeded by study heterogeneity; however, we catalogued the outcomes and results for each disinfection type. We concluded that guidelines for disinfectant use are primarily based on laboratory data rather than a systematic review of in situ disinfection efficacy. It is critically important for practitioners and researchers to consider system-level efficacy and not just the efficacy of the disinfectant.
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Affiliation(s)
- Elizabeth C. Christenson
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Ryan Cronk
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
- ICF, Durham, NC 27713, USA
| | - Helen Atkinson
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Aayush Bhatt
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Emilio Berdiel
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Michelle Cawley
- Health Sciences Library, University of North Carolina, Chapel Hill, NC 27599, USA; (M.C.); (K.G.); (G.P.)
| | - Grace Cho
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Collin Knox Coleman
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Cailee Harrington
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Kylie Heilferty
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Don Fejfar
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Emily J. Grant
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Karen Grigg
- Health Sciences Library, University of North Carolina, Chapel Hill, NC 27599, USA; (M.C.); (K.G.); (G.P.)
| | - Tanmay Joshi
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Suniti Mohan
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Grace Pelak
- Health Sciences Library, University of North Carolina, Chapel Hill, NC 27599, USA; (M.C.); (K.G.); (G.P.)
| | - Yuhong Shu
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Jamie Bartram
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
- School of Civil Engineering, University of Leeds, Leeds LS2 9DY, UK
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dos Santos Oliveira BA, Rigonato EM, de Sousa AFL, Ferreira AM, da Silva Barcelos L, Furlan MCR, Rigotti MA, Schneider G, de Andrade D, Lapão LV, dos Santos Junior AG. Correlation Between Surface Cleaning and Disinfection Methods in an Emergency Room. Open Nurs J 2021. [DOI: 10.2174/1874434602115010103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective:
To evaluate the correlation between microbiological culture, ATP tests by bioluminescence and visual inspection for monitoring the surface cleaning and disinfection in an emergency room.
Methods:
This is a prospective, analytical study with a quantitative approach. Data analysis was guided by the following tests: Spearman’s correlation, Fisher ‘s exact test and receiver operating characteristic (ROC) curve.
Results:
There was a correlation between ATP quantification methods and microbial count for the women’s bathroom door handle (ρ = 0.526; p= 0.008). In this study, considering the ROC curve, the ATP value below 20 RLU is suggested to classify surfaces as approved in the emergency room.
Conclusion:
Using different methods of monitoring the cleaning and disinfection process is essential, considering that each method has a different purpose.
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Oliveira BADS, Bernardes LDO, Ferreira AM, Pessalacia JDR, Furlan MCR, de Sousa ÁFL, de Andrade D, Barbosa DA, Lapão LV, dos Santos Junior AG. Impact of Educational Intervention on Cleaning and Disinfection of an Emergency Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093313. [PMID: 32397527 PMCID: PMC7246614 DOI: 10.3390/ijerph17093313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 11/16/2022]
Abstract
We aimed to evaluate the impact of an educational intervention on the surface cleaning and disinfection of an emergency room. This is an interventional, prospective, longitudinal, analytical and comparative study. Data collection consisted of three stages (Stage 1-baseline, Stage 2-intervention and immediate assessment, Stage 3-long term assessment). For the statistical analysis, we used a significance level of α = 0.05. The Wilcoxon and the Mann-Whitney test tests were applied. We performed 192 assessments in each stage totaling 576 evaluations. Considering the ATP method, the percentage of approval increased after the educational intervention, as the approval rate for ATP was 25% (Stage 1), immediately after the intervention it went to 100% of the approval (Stage 2), and in the long run, 75% of the areas have been fully approved. Stage 1 showed the existence of significant differences between the relative light units (RLU) scores on only two surfaces assessed: dressing cart (p = 0.021) and women's toilet flush handle (p = 0.014); Stage 2 presented three results with significant differences for ATP: dressing cart (p = 0.014), women's restroom door handle (p = 0.014) and women's toilet flush handle (p = 0.014); in step III, there was no significant difference for the ATP method. Therefore, conclusively, the educational intervention had a positive result in the short term for ATP; however, the same rates are not observed with the colony-forming units (CFU), due to their high sensitivity and the visual inspection method since four surfaces had defects in their structure.
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Affiliation(s)
- Bruna Andrade dos Santos Oliveira
- Campus Três Lagoas, University of Mato Grosso do Sul, Três Lagoas 79600-080, Brazil; (B.A.d.S.O.); (L.d.O.B.); (A.M.F.); (J.D.R.P.); (M.C.R.F.); (A.G.d.S.J.)
| | - Lucas de Oliveira Bernardes
- Campus Três Lagoas, University of Mato Grosso do Sul, Três Lagoas 79600-080, Brazil; (B.A.d.S.O.); (L.d.O.B.); (A.M.F.); (J.D.R.P.); (M.C.R.F.); (A.G.d.S.J.)
| | - Adriano Menis Ferreira
- Campus Três Lagoas, University of Mato Grosso do Sul, Três Lagoas 79600-080, Brazil; (B.A.d.S.O.); (L.d.O.B.); (A.M.F.); (J.D.R.P.); (M.C.R.F.); (A.G.d.S.J.)
| | - Juliana Dias Reis Pessalacia
- Campus Três Lagoas, University of Mato Grosso do Sul, Três Lagoas 79600-080, Brazil; (B.A.d.S.O.); (L.d.O.B.); (A.M.F.); (J.D.R.P.); (M.C.R.F.); (A.G.d.S.J.)
| | - Mara Cristina Ribeiro Furlan
- Campus Três Lagoas, University of Mato Grosso do Sul, Três Lagoas 79600-080, Brazil; (B.A.d.S.O.); (L.d.O.B.); (A.M.F.); (J.D.R.P.); (M.C.R.F.); (A.G.d.S.J.)
| | - Álvaro Francisco Lopes de Sousa
- Network in Exposome Human and Infectious Diseases (NEHID), School of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-902, Brazil;
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, 1349-008 Lisbon, Portugal;
- Correspondence:
| | - Denise de Andrade
- Network in Exposome Human and Infectious Diseases (NEHID), School of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-902, Brazil;
| | | | - Luis Velez Lapão
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, 1349-008 Lisbon, Portugal;
| | - Aires Garcia dos Santos Junior
- Campus Três Lagoas, University of Mato Grosso do Sul, Três Lagoas 79600-080, Brazil; (B.A.d.S.O.); (L.d.O.B.); (A.M.F.); (J.D.R.P.); (M.C.R.F.); (A.G.d.S.J.)
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