Table 1 Advantages and limitations of strategies for monitoring environmental hygiene
Method | Advantages | Limitations |
|---|---|---|
Possible in all facilities; does not require special equipment; requires less time than other methods; direct observation of and feedback to EVS personnel are possible | Cannot detect residual surface contamination | |
Can identify suboptimal technique; has contributed to reduction of MDRO transmission | Time consuming; not feasible in some circumstances | |
Fluorescent markers [46, 179, 181, 190, 230, 233,234,235, 238, 239] | Multiple studies support its use. Has been shown to improve cleaning compliance rates, reduce surface contamination, nosocomial transmission, and HAIs caused by MDROs. Can provide useful feedback to EVS staff | Complete marker removal does not assure elimination of MDROs from surface; EVS staff occasionally use black light to identify marked surfaces and prioritize those surfaces. Somewhat time-consuming, unless a representative sample of surfaces is selected |
Adenosine triphosphate (ATP) assays [179, 181, 233, 234, 236, 240,241,242,243] | Can provide immediate feedback to EVS staff and identify variations in cleaning practices. Associated with improved cleaning practices during CRE and CRAB outbreaks; may be useful in monitoring disinfection of CDI patient rooms. Associated with greater reduction of MDRO colonization/infection than fluorescent markers in a cluster-randomized trial | Detects both microorganisms and other organic material; poor correlation between ATP readings and level of microbial contamination; results may vary depending on microbe present. Some disinfectants may cause falsely low assay results. Relatively expensive |
Culturing surfaces [8, 28, 46, 54, 67, 181, 229, 233, 241, 244] | Can identify pathogens, including MDROs, on surfaces before and after routine disinfection. Swabs, sponges, contact plates and dip slides can be used to sample surfaces | Requires additional laboratory capabilities; results not available for 24–72 h; relatively expensive; requires the use of a neutralizer if surfaces have been disinfected with a product with residual activity |