Department of Medicine (PCC), Boston University School of Medicine, Boston, MA, USA.
Crit Care Med. 2010 Apr;38(4):1054-9. doi: 10.1097/CCM.0b013e3181cdf705.
To determine the thoroughness of terminal disinfection and cleaning of patient rooms in hospital intensive care units and to assess the value of a structured intervention program to improve the quality of cleaning as a means of reducing environmental transmission of multidrug-resistant organisms within the intensive care unit.
Prospective, multicenter, and pre- and postinterventional study.
Intensive care unit rooms in 27 acute care hospitals. Hospitals ranged in size from 25 beds to 709 beds (mean, 206 beds).
A fluorescent targeting method was used to objectively evaluate the thoroughness of terminal room cleaning before and after structured educational, procedural, and administrative interventions. Systematic covert monitoring was performed by infection control personnel to assure accuracy and lack of bias.
In total, 3532 environmental surfaces (14 standardized objects) were assessed after terminal cleaning in 260 intensive care unit rooms. Only 49.5% (1748) of surfaces were cleaned at baseline (95% confidence interval, 42% to 57%). Thoroughness of cleaning at baseline did not correlate with hospital size, patient volume, case mix index, geographic location, or teaching status. After intervention and multiple cycles of objective performance feedback to environmental services staff, thoroughness of cleaning improved to 82% (95% confidence interval, 78% to 86%).
Significant improvements in intensive care unit room cleaning can be achieved in most hospitals by using a structured approach that incorporates a simple, highly objective surface targeting method and repeated performance feedback to environmental services personnel. Given the documented environmental transmission of a wide range of multidrug-resistant pathogens, our findings identify a substantial opportunity to enhance patient safety by improving the thoroughness of intensive care unit environmental hygiene.
确定医院重症监护病房患者房间终末消毒和清洁的彻底性，并评估结构化干预方案在提高清洁质量方面的价值，以此作为减少重症监护室内多药耐药菌环境传播的手段。
前瞻性、多中心、干预前后研究。
27 家急性护理医院的重症监护病房房间。医院规模从 25 张床位到 709 张床位不等（平均 206 张床位）。
采用荧光标记靶向方法，在结构化教育、程序和行政干预前后客观评估终末房间清洁的彻底性。感染控制人员进行系统的秘密监测，以确保准确性和消除偏见。
共评估了 260 个重症监护病房房间终末清洁后 3532 个环境表面（14 个标准化物体）。仅 49.5%（1748 个）表面在基线时得到清洁（95%置信区间，42%至 57%）。基线时清洁的彻底性与医院规模、患者量、病例组合指数、地理位置或教学地位无关。在干预和对环境服务人员进行多次客观绩效反馈后，清洁的彻底性提高到 82%（95%置信区间，78%至 86%）。
通过使用简单、高度客观的表面靶向方法，并对环境服务人员进行重复的绩效反馈，大多数医院都可以显著提高重症监护病房房间清洁度。鉴于广泛的多药耐药病原体的环境传播已有记录，我们的发现确定了通过提高重症监护室环境卫生的彻底性来增强患者安全的重大机会。
