Hospital Room Items Left Off Cleaning List May Contain Dangerous Bacteria


A new study suggests updating items included on terminal cleaning checklists to decrease bacteria in patient rooms and prevent further infection.

Terminal cleaning of hospital rooms between patients is pivotal in eliminating contamination. Checklists are used as standard guides for cleaning staff in most hospitals, and a presentation from the 45th Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC) suggests that the checklist is even more important than originally thought.

At Summit Health, a hospital in Pennsylvania, the environmental services team was provided with a 175-item checklist to use during terminal room cleaning. The list has been in use since 2012. Upon reviewing the checklist, infection prevention specialists found that although whiteboards were on the cleaning check-list, markers and erasers were not included on the list. The team wanted to know if the omission of these items meant they were not being cleaned, or if the environmental services team were cleaning them anyway.

“Markers and erasers are obviously high-touch, yet they were not included on the check-list for routine cleaning, which was surprising. We hypothesized that the concept of ‘out of sight, out of mind’ may come into play. If the visual reminder is absent from the checklist, the cleaning may not occur.” Ericka Kalp, PhD, MPH, CIC, FAPIC, lead study author and director of epidemiology and infection prevention at Summit Health, Chambersburg, Pennsylvania, told Contagion®.

In an inspection of 55 rooms that had been cleaned and set up for new patients, 39 markers and 52 erasers were tested for the presence of Adenosine triphosphate (ATP), which is an indicator for the presence of biological residue. All the markers tested positive for the presence of ATP while only 2 erasers tested positive. Conversely, 95% of the items listed on the checklist tested negative for ATP.

“Although they are just small writing instruments, both the markers and erasers tested at 40 times the threshold,” said Dr. Kalp in a statement. “Because these are a main communication tool for nurses, cleaning them properly is of great significance to improving infection prevention.”

The testing was conducted in the presence of environmental services staff. If an object tested positive for ATP, the infection preventionist conducting the test demonstrated how to properly clean the object, prior to retesting.

“Environmental cleaning is essential to preventing the spread of infection,” said 2018 APIC President Janet Haas, PhD, RN, CIC, FSHEA, FAPIC, in the statement. “This study emphasizes the importance of not only using a checklist as a reminder of what needs to be cleaned, but also making sure the list includes all frequently touched items.”

Since conducting this study, markers and erasers have been added to the terminal cleaning checklist.

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