infection control & hospital epidemiology october 2017, vol. 38, no. 10 concise communication
National Survey of Environmental Cleaning and Disinfection in Hospitals in Thailand
Anucha Apisarnthanarak, MD;1 David J. Weber, MD, MPH;2 David Ratz, MS;3 Sanjay Saint, MD, MPH;3,4 Thana Khawcharoenporn,MD, MSc;1 M. Todd Greene, PhD,MPH3,4
More than 90% of Thai hospitals surveyed reported implementing environmental cleaning and disinfection (ECD) protocols. Hospital epidemiologist presence was associated with the existence of an ECD checklist (P= .01) and of ECD auditing (P=.001), while good and excellent hospital administrative support were associated with better adherence to ECD protocols (P<.001) and ECD checklists (P=.005).
Infect Control Hosp Epidemiol 2017;38:1250–1253
Contaminated environmental surfaces in patient rooms are a critical component in healthcare-associated infection (HAI) transmission1 and are a well-recognized cause of common- source nosocomial outbreaks.2,3 Decontaminating hospital- room surfaces has emerged as a key target area to prevent the spread of HAI,4,5 and it may help reduce the transmission of multidrug-resistant microorganisms (MDROs).6 In the Asia Pacific region, a multinational guideline recommends the best practices in routine environmental cleaning and disinfection (ECD).7 However, the extent to which the adoption of these practices to clean and disinfect the hospital environment as well as factors associated with adherence to ECD protocols in this region remain largely unknown. Therefore, we conducted a national survey to evaluate the ECD practices used among Thai hospitals, and we evaluated factors associated with implementing ECD policies and adherence to ECD practices.
methods
From January 1, 2014, to November 30, 2014, we surveyed all hospitals in Thailand that had an intensive care unit (ICU) and at least 250 hospitals beds (n=245). The list of included hospitals was obtained from Thai Ministry of Public Health. The survey instrument, first developed by Krein et al,8 was translated into the Thai language by an experienced hospital epidemiologist (A.A.). The survey assessed general hospital, personnel, and infection control program characteristics, as well as the practices used by Thai hospitals to routinely clean and disinfect the hospital environment, including ECD practices. The survey included questions regarding whether facilities implemented protocols for ECD of patient care areas, the existence of checklists to monitor ECD practices, the use of ECD auditing, and adherence to ECD checklists and protocols. The lead infection preventionist (IP) for each hospital was
interviewed to determine various hospital characteristics and to ascertain whether their hospital had implemented various ECD protocols. The level of adherence with ECD protocols was also assessed. Infection preventionists were asked how often the hospital complied with ECD practices (ie, 1 for 100% compliance to 6 for no monitoring compliance). Responses of 1 or 2 (ie, 75%–100% compliance) were coded as high compliance for all analyses. Hospital administration support was based on the response to the question, “How would you rank the overall support your infection control program receives from the hospital administrative leadership?” A Likert response scale was used: 1 for “poor” to 5 for “excellent.” Responses of 3 “good” to 5 “excellent” represented strong support for the infection control program. In-person interviews were administered by research nurses
who used the survey instrument to interview each lead infec- tion preventionist. In total, 3 training sessions were conducted to instruct the 5 research nurses on the survey and data collection procedures. The survey instrument was tested in a pilot study of 10 hospitals to ensure the validity, reliability, and acceptability of the survey results, and 100% agreement in the responses by the research nurses was observed in the pilot test. This study was approved by the Institutional Review Board of the Faculty of Medicine at Thammasat University. Descriptive statistics were calculated for all relevant survey questions. Multivariable logistic regression was used to deter- mine significant associations between hospital characteristics and regular use of each ECD practice. The hospital character- istics considered included type of ownership, number of intensive care unit beds, affiliation with a medical school, presence of hospitalists, involvement in a collaborative effort to reduce HAI, strong support of the infection control program by hospital leadership, presence of a hospital epidemiologist, total full-time equivalent of all infection pre- ventionists, the presence of an infectious diseases specialist, environmental cleaning services provided, existence of a facilities maintenance department, and presence of a micro- biology laboratory. All statistical analyses were performed using SAS version 9.4 software (SAS Institute, Cary, NC).
results
Overall, 212 of 245 eligible hospitals (86.5%) responded to our survey. Of these 212 hospitals, 192 (90.6%) reported imple- menting an ECD protocol, 117 (55.2%) had an ECD checklist, and 92 (43.4%) had a mechanism to audit ECD practices. Among hospitals implementing an ECD protocol, high adherence to implemented ECD practices and to ECD check- lists was documented in 109 of 192 hospitals (56.8%) and 67 of 117 hospitals (57.3%), respectively. Hospital characteristics, policies, and practices as well as barriers to implementing the ECD policy are summarized in Table 1.
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