Improving Cleaning of the Environment Surrounding Patients in 36 Acute Care Hospitals

Philip C. Carling, MD; Michael M. Parry, MD; Mark E. Rupp, MD; John L. Po, Ph.D.; Brian Dick, MS, CIC; Sandra Von Beheren, RN, BSN, MS, CIC; for the Healthcare Environmental Hygiene Study Group



The prevalence of serious infections caused by multi-drug-resistant pathogens transmitted in hospitals has reached alarming levels despite increased interventions. A multi-hospital project to evaluate and improve current cleaning practices was implemented in conjunction with the mandates requiring that hospitals comply with procedures for disinfecting surfaces in the area surrounding the patient.


Prospective somewhat experimental before and after study.


Thirty-six acute hospitals in the United States ranging in size from 25 to 721 beds.


A fluorescent targeting method was used to objectively evaluate the thoroughness of terminal room disinfection cleaning before and after structured educational and procedural interventions.


Of 20,646 standardized environmental surfaces (14 types of objects), only 9,910 (48%) underwent baseline cleaning (95% confidence interval, 43.4-51.8). Thorough cleaning at this level only correlated with hospital expenses for environmental services personnel (P = .02). After implementing interventions and providing objective performance feedback to the environmental services staff, it was determined that 7,287 (77%) of 9,464 standardized environmental surfaces were cleaned (P < .001). Improvement was unrelated to any demographic, fiscal or staffing parameter. It was, however, related to the degree to which cleaning was suboptimal (P < .001).


Significant improvements in disinfection cleaning can be achieved in most hospitals without a substantial added financial commitment. This can be done by using a structured approach that incorporates a simple, highly objective surface targeting method, repeated performance feedback to environmental services personnel and administrative interventions. Administrative leadership and institutional flexibility are necessary, however, to achieve success. An ongoing programmatic commitment from each institution also is required for sustainability.


From the Infectious Diseases Section, Caritas Carney Hospital (P.C.C.), Boston University School of Medicine (P.C.C., J.L.P.), and the Department of Infectious Diseases, Boston Medical Center (J.L.P.), Boston, Massachusetts; the Department of Infectious Diseases, Stamford Hospital, Stamford, Connecticut (M.M.P.); Columbia College of Physicians and Surgeons, Columbia University of New York, New York (M.M.P.); the Department of Infectious Diseases, Nebraska Medical Center and University of Nebraska, Omaha, Nebraska (M.E.R.); the Department of Hospital Epidemiology, The Toledo Hospital, Toledo, Ohio (B.D.); the Department of Hospital Epidemiology, University of Iowa Hospitals and Clinics, Iowa, City, Iowa (S.V.B.). Participating members of the Healthcare Environmental Hygiene Study Group are listed at the end of the text.

Received May 12, 2008; accepted July 11, 2008; electronically published October 13, 2008.

ã 2008 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2008/2911-0006$15.00. DOI: 10.1086/591940



Improving Cleaning of the Environment Surrounding Patients in 36 Acute Care Hospitals:  Created on April 19th, 2010.  Last Modified on June 16th, 2010


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· 11 years ago

The process differs from ATP measurement as "fluorescent targeting" involves marking key surfaces with a fluorescent solution, then checking those surfaces (after room cleaning) using a black light to see if they have been cleaned.

Dr. Carling owns a patent for the florescent targeting evaluation system described in the manuscript.

Address correspondence to Philip C. Carling, MD, director of Hospital Epidemiology, Carney Hospital, 2100 Dorchester Ave, Boston, MA 02124.
[email protected]

June 16th, 2010 | 10:20am Reply
· 11 years ago

What type of "fluorescent targeting method" was used for this study? We are using the Hygiena System Sure Plus to swab surfaces.

June 16th, 2010 | 9:05am Reply

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