Intensive care unit environmental cleaning: an evaluation in sixteen hospitals using a novel assessment tool.

Despite isolation precautions and enhanced hand hygiene product use, the transmission of healthcare-associated pathogens remains a major problem. Recent studies have confirmed that microbial contamination of the environment in intensive care units (ICUs) can lead to colonisation and infection of patients. Although environmental disinfectants have been used to minimise the spread of microbial pathogens, suboptimal cleaning may limit the effectiveness of such activities. In order to evaluate the thoroughness of cleaning near-patient surfaces, a transparent, easily cleanable and environmentally stable solution was developed that fluoresces when exposed to UV light. The solution was used to mark a standardised group of frequently touched objects in ICU patient rooms following discharge cleaning. These sites were then evaluated after at least two patients had occupied the room and at least two terminal cleanings had been completed. Evaluation of 2320 objects in 197 patient areas disclosed that 57.1% of the standardised sites were cleaned following discharge of the room's occupant in the 16 ICUs studied. Although high rates of cleaning (>80%) were found for toilet seats, sinks and tray tables, consistently low rates of cleaning (<30%) were documented for several objects at high risk of becoming contaminated with nosocomial pathogens, including bedpan cleaners, toilet area handholds, doorknobs and light switches.