Levine Elisheva, Abo-Gush Samar, Ezagui Bath Sheva, David Ruth, Kopuit Puah, Bagrish Naama, Zalut Todd, Assous Marc V, Freier-Dror Yossi, Yinnon Amos M, Benenson Shmuel
Infection Control and Prevention Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel.
Infect Control Hosp Epidemiol. 2024 Dec 26;46(2):1-6. doi: 10.1017/ice.2024.177.
To upgrade cleaning and disinfection of patient rooms in a crowded emergency department (ED).
Tertiary referral hospital.
Prospective, 3-component, before-and-after intervention study.
Phase 1 consisted of a 4-week baseline determination of ED patient-room cleanliness, using two means: (1) the fluorescence spray, applied before cleaning and assessed subsequently with an ultraviolet lamp. Results are expressed as % of removed spots/all spots (≥7/10 cleaned spots/room was considered clean; (2) ATP swabs obtained after cleaning, which test for presence of residual organic material; readings <45 were considered clean. Phase 2 consisted of revision and reorganization of established cleaning practices. Phase 3 consisted of adding one cleaning person in afternoon/evening shifts, for 4-weeks, during which room cleanliness was assessed as previously described.
Cleanliness of the 79 patient rooms, for which fluorescence tests were available from before and after cleaning for all three phases of the study, increased from a baseline of 50% ± 35 removed spots/all spots, to 61% ± 36 after the first intervention (CI95 -0.6 - 21, = 0.54) and to 68% ± 35 after the second intervention (CI95 5 - 31, = 0.004, as compared to the baseline). Subanalysis showed that evening shifts improved most remarkably, from 47% ± 32 (n = 45), to 60% ± 33 (n = 49) to 76%±29 (n = 29), respectively, from baseline through the second and third phase ( = 0.001). ATP testing appeared less sensitive for assessment of cleanliness but confirmed the assessment by fluorescence for overall cleanliness (CI95 1 - 14, = 0.018).
Our data demonstrate that a two-step intervention significantly improves cleaning in a busy ED.
提升拥挤急诊科病房的清洁与消毒水平。
三级转诊医院。
前瞻性、三部分、干预前后对照研究。
第一阶段为期4周，通过两种方法确定急诊科病房的清洁基线：（1）荧光喷雾法，清洁前喷洒，随后用紫外线灯评估。结果以清除斑点数/总斑点数的百分比表示（每间病房≥7/10的清洁斑点数视为清洁；（2）清洁后进行ATP拭子检测，用于检测残留有机物质的存在；读数<45视为清洁。第二阶段包括修订和重新组织既定的清洁流程。第三阶段包括在下午/晚上班次增加一名清洁人员，为期4周，在此期间按照之前描述的方法评估病房清洁度。
在研究的三个阶段中，对79间有清洁前后荧光测试数据的病房进行分析，清洁度从基线时的清除斑点数/总斑点数50%±35%，在第一次干预后提高到61%±36%（CI95 -0.6 - 21，P = 0.54），在第二次干预后提高到68%±35%（CI95 5 - 31，P = 0.004，与基线相比）。亚分析显示，晚班的改善最为显著，从基线时的47%±32%（n = 45），到第二阶段的60%±33%（n = 49），再到第三阶段的76%±29%（n = 29）（P = 0.001）。ATP检测在评估清洁度方面似乎不太敏感，但证实了荧光检测对整体清洁度的评估（CI95 1 - 14，P = 0.018）。
我们的数据表明，两步干预措施能显著改善繁忙急诊科的清洁状况。
