Explore - Summer 2013 - (Page 9)
THE CRUCIAL ROLE
OF THE ENVIRONMENT
Evidence-based strategies for improved environmental hygiene
PHOTO CREDIT: CDC/JANICE CARR
By Linda R. Greene, RN, MPS, CIC
This micrograph depicts Gram-positive
C. difficile bacteria from a stool sample
culture obtained using a .1µm filter. People can
become infected if they touch items or surfaces
that are contaminated with feces and then
touch their mouth or mucous membranes.
Healthcare workers can spread the bacteria
to other patients or contaminate surfaces
through hand contact.
t is widely accepted that environmental contamination plays an
important role in the transmission
of certain pathogens in the healthcare environment. As such, there
has been a revival of interest in the
role of environmental surfaces as potential vehicles for the transmission of several
healthcare pathogens. This interest underscores the importance of environmental
services in infection prevention programs
and the crucial need for understanding and
implementing evidence-based practices.
First and foremost, cleaning forms the
foundation for environmental hygiene.
The monitoring and evaluation of cleaning practices is an essential part of the
infection prevention program. However,
until recently, this evaluation consisted primarily of visual inspections. Clean looking
rooms and “shiny floors” were perceived
as a reflection of good cleaning practices.
Unfortunately, visual examination does not
address the issue of high-touch surfaces
and places undue importance on noncritical areas such as floors and walls.
To properly address environmental
hygiene, there are several key components
that must be combined to deliver improved
cleaning outcomes. These include such
processes as consistent delivery of the
correct disinfectant concentration, infection control practices to prevent cross
contamination, standardized processes to
consistently disinfect high-touch surfaces,
training on best practices, and objective
measures for enhanced monitoring.
These objective measures are referred
to as enhanced monitoring or EC. EC monitoring consists of repetitive monitoring of
actual findings based upon standardization and uniform definitions, and facilitates
program development based upon both
individual and system issues. In addition
to direct observation, the following measures are more objective measures for EC
• Swab cultures: Swab cultures identify
microorganisms and are very useful
in outbreak situations. This technique
may provide periodic information but is
limited in its ability to provide real-time
feedback on a consistent basis due to the
delay in analyzing results and its limited
feasibility for monitoring multiple surfaces in multiple rooms.
• Fluorescent markers: Fluorescent gel,
powder, and lotion have all been developed for the purpose of marking hightouch objects prior to room cleaning.
Fluorescent gel has an advantage in that
it dries transparent on surfaces and resists
abrasion. There are several studies demonstrating the accuracy of the system in
objectively evaluating cleaning practice.
Fluorescent gel is applied to high-touch
surfaces prior to cleaning and is then evaluated with a UV light to see if the mark
was removed. Because these fluorescent markers are all designed to indicate
physical removal of an applied substance,
surfaces that are effectively disinfected
but less effectively cleaned may be more
likely flagged as failing to meet a quality
standard using one of these markers than
with culture techniques.
• ATP bioluminescence (ATP): This technique has been used in the food industry
for many years. Before cleaning, a swab is
used to sample high-touch surfaces and
then is placed in a luminometer, which
analyzes the amount of ATP present.
Because ATP measures organic debris
as well as bacterial counts, the accuracy
of the readings has been challenged.
Despite limitations, however, the ATP
www.ahe.org I EXPLORE I Summer 2013 9
Table of Contents for the Digital Edition of Explore - Summer 2013
Managing the Engagement Driver
The Crucial Role of the Environment
HCAHPS: Ways to Improve on the Environment Question
AHE News & Updates
Explore - Summer 2013