Impact of an Environmental Cleaning Intervention MRSA VRE in ICU

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Impact of an Environmental Cleaning Intervention on the Presence of MRSA VRE in ICU

Infect Control Hosp Epidemiol. 2008 July ; 29(7): 593–599. doi:10.1086/588566.

OBJECTIVES—To evaluate the adequacy of discharge room cleaning and the impact of a cleaning
intervention on the presence of methicillin-resistant Staphylococcus aureus (MRSA) and
vancomycin-resistant enterococci (VRE) on environmental surfaces in intensive care unit (ICU)
rooms.
DESIGN—Prospective environmental study.
SETTING AND SAMPLE—Convenience sample of ICU rooms in an academic hospital.
METHODS AND INTERVENTION—The intervention consisted of (1) a change from the use of
pour bottles to bucket immersion for applying disinfectant to cleaning cloths, (2) an educational
campaign, and (3) feedback regarding adequacy of discharge cleaning. Cleaning of 15 surfaces was
evaluated by inspecting for removal of a preapplied mark, visible only with an ultraviolet lamp
(“black light”). Six surfaces were cultured for MRSA or VRE contamination. Outcomes of mark
removal and culture positivity were evaluated by χ2 testing and generalized linear mixed models,
clustering by room.
RESULTS—The black-light mark was removed from 44% of surfaces at baseline, compared with
71% during the intervention (P <.001). The intervention increased the likelihood of removal of blacklight
marks after discharge cleaning (odds ratio, 4.4; P < .001), controlling for ICU type (medical vs
surgical) and type of surface. The intervention reduced the likelihood of an environmental culture
positive for MRSA or VRE (proportion of cultures positive, 45% at baseline vs 27% during the
intervention; adjusted odds ratio, 0.4; P = .02). Broad, flat surfaces were more likely to be cleaned
than were doorknobs and sink or toilet handles.
CONCLUSIONS—Increasing the volume of disinfectant applied to environmental surfaces,
providing education for Environmental Services staff, and instituting feedback with a black-light
marker improved cleaning and reduced the frequency of MRSA and VRE contamination.