Methods to evaluate environmental cleanliness in healthcare facilities
Mitchell, BG and Wilson, F and Dancer, SJ and McGregor, A, Methods to evaluate environmental cleanliness in healthcare facilities, Healthcare Infection, 18, (1) pp. 23-30. ISSN 1835-5617 (2013) [Refereed Article]
Copyright 2013 Australasian College for Infection Prevention and Control
Abstract. Background: The role of environment in infection prevention and control is being increasingly
acknowledged. However, gaps remain between what is promoted as best practice in the literature and what is occurring
in healthcare settings. In part, this is due to a lack of generally accepted scientific standards, further confounding the
ability to demonstrate an undisputed role for the healthcare environment in healthcare-acquired infections (HAIs).
Evaluating environmental cleanliness in a standardised format is required, in order to enable a framework for
performance management and provide a method by which interventions can be evaluated. Standardised assessment
would provide reliable data to support quality-improvement activities and to ensure that healthcare staff have relevant
and useful information to inform and adapt practice.
Methods: This integrative literature reviewdescribes approaches to assessing environmental cleanliness.A search
of the published literature was undertaken, in combination with a targeted review of the grey literature.
Results: Four methods for assessing environmental cleanliness were identified: visual inspection, fluorescent gel
marker, adenosine triphosphate (ATP) and microbial cultures. Advantages and disadvantages for each are explored.
Conclusion: Methods that evaluate cleaning performance are useful in assessing adherence to cleaning protocols,
whereas methods that sample bio-burden provide a more relevant indication of infection risk. Fast, reproducible, costeffective
and reliable methods are needed for routine environmental cleaning evaluation in order to predict timely