Methods to evaluate environmental cleanliness in healthcare facilities

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 clinical risk.