Infection Control & Hospital Epidemiology (2019), 40, 100–102 doi:10.1017/ice.2018.287
Concise Communication
Evaluation of environmental cleaning of patient rooms: Impact of different fluorescent gel markers
Clare Rock MD, MS1,2,3, Anping Xie PhD2, Jennifer Andonian MPH, CIC3, Yea-Jen Hsu PhD4, Patience Osei MSE2, Sara C. Keller MD, MPH1, Ayse P. Gurses PhD, MS, MPH2, Polly Trexler MS, CIC3, Lisa L Maragakis MD, MPH1,2,3
and Sara E. Cosgrove MD, MS1,2,3 for the CDC Prevention Epicenters Program 1Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, 2Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland, 3Department of Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital, Baltimore, Maryland and 4Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
Abstract
In this systematic evaluation of fluorescent gel markers (FGM) applied to high-touch surfaces with a metered applicator (MA) made for the purpose versus a generic cotton swab (CS), removal rates were 60.5% (476 of 787) for the MA and 64.3% (506 of 787) for the CS. MA-FGM removal interpretation was more consistent, 83% versus 50% not removed, possibly due to less varied application and more adhesive gel.
(Received 27 July 2018; accepted 11 October 2018; electronically published 13 November 2018)
Evaluation and performance improvement to enhance patient room cleaning is important for healthcare-associated infection prevention.1,2 The Centers for Disease Control and Prevention recommends fluorescent gel markers (FGMs) as a tool for the evaluation of environmental cleaning (EEC).3 However, the optimal FG formulation, method of application, and evaluation of removal remains to be determined. At the Johns Hopkins Hospital (JHH), a 1,020-bed aca-
demic hospital in Maryland, FGM has been a part of our EEC program since 2012. An FGM visible only with ultraviolet (UV) light is placed on high-touch surfaces (HTSs) in selected patient rooms and bathrooms. After a designated period, removal is assessed with UV light. Removed FGM (ie, no FGM is visible using a UV light) indicates a cleaned HTS, whereas remaining FGM indicates an uncleaned HTS. Since estab- lishing the program, we have evaluated multiple fluorescent markers with varied compositions and application methods (eg, fluorescent gel, paint, and pen marker). Many fluorescent markers were quickly eliminated because they were clearly visible to the naked eye or because they were not removed by expected best cleaning. However, 2 FGM types did not overtly appear to have these problems. Therefore, We evaluated 2 different FGM products: a metered applicator for FGM (MA-FGM) and a generic cotton swab dipped in FGM lotion (CS-FGM). We hypothesized that use of a purpose-made MA- FGM allowing for a more standardized application would be associated with (1) decreased FGM removal because it is less visible to the naked eye and (2) less variability in size of FGM at placement and more standardized interpretation of FGM removal.
Cite this article: Rock C, et al. (2019). Evaluation of environmental cleaning of patient
rooms: Impact of different fluorescent gel markers. Infection Control & Hospital Epidemiology 2019, 40, 100–102. doi: 10.1017/ice.2018.287
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
Methods Phase 1
Over a 2-day period at JHH, we randomly selected rooms from 9 hospital units via block randomization. We placed both MA-FGM (DAZO, Ecolab, St Paul, MN) and CS-FGM (GloGerm, GloGerm, Moab, UT) simultaneously on as many of 24 HTS as possible per room. For each room, we alternated the side of the HTS assessed by each method to account for handedness that might influence the likelihood of FGM removal. The location and types of FGM for each room were recorded, and the presence of each FGM was checked 1 day later. A discharge (ie, terminal) cleaning was deemed to have occurred if there was a new patient in the room at time of FGM assessment.
Phase 2
In the Johns Hopkins biocontainment unit in an unoccupied patient room used for training and simulations, 8 trained “markers” (ie, 3 research assistants, 2 infection control epide- miologists, 1 infectious diseases physician, 1 research coordi- nator, and 1 infection control assistant) placed dots 3 times with each product on a bedside table, using their usual practice. The FGM dot diameters were measured, and visibility to the naked eye was assessed. The FGM dried for 2.5 hours, after which an observer wiped each FGM with disinfectant using 2 strokes to mimic real-world cleaning, and FGM removal was assessed. The Cohen κ was used to measure agreement, and the
McNemar test was used to compare the removal rates between the 2 types of FGMs. We also used logistic regression models to compare removal rates across different HTSs for each type of FGM.
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