Cleanliness audit of clinical surfaces and equipment: who cleans what?

Current guidelines recommend regular cleaning of clinical equipment. We monitored items on a surgical ward for predominant user, hand-touch frequency, cleaning responsibilities and measurement of organic soil. Equipment was assessed in triplicate against a cleanliness benchmark of 100 relative light units (RLU) using the Hygiena® ATP system. There were 44 items, of which 21 were cleaned by clinical support workers (CSWs), five by domestic staff; three by nurses, three by doctors, and 12 with no designated cleaning responsibility. Geometric mean RLUs ranged from 60 to 550/100 cm² for small items such as hand-gel containers, bed control, blood pressure cuff and clinical notes; with similar values of 80-540/100 cm² RLU for larger items such as electrocardiogram machine, defibrillator, trolleys and tables. Overall geometric mean was 249/100 cm² RLU for all surfaces, with 84% (37 of 44) items exceeding the 100RLU benchmark. Of 27 items cleaned by clinical staff, 24 (89%) failed the benchmark. Of 12 sites with no cleaning specification, 11 (92%) failed the benchmark. Three of seven 'clean' sites (<100/100 cm² RLU) were cleaned by domestic staff. Average log(10) RLU of surfaces cleaned by domestics were 64% lower compared with surfaces cleaned by CSWs (95% confidence interval: 35%, 80%; P=0.019). In conclusion, clinical equipment frequently demonstrates high levels of organic soil, whether or not items have assigned cleaning responsibility. These findings suggest that cleaning practices for clinical equipment may require review, along with education of staff with specific cleaning responsibilities.