How do we assess hospital cleaning? A proposal for microbiological standards for surface hygiene in hospitals

• Published in: The Journal of hospital infection Vol. 56; no. 1; pp. 10 - 15
• Main Author: Dancer, S.J
• Format: Journal Article
• Language: English
• Published: Kent Elsevier Ltd 01.01.2004; Elsevier; The Hospital Infection Society. Published by Elsevier Ltd
• Subjects: Bacterial diseases; Biological and medical sciences; Clostridium difficile; Colony Count, Microbial - standards; Decontamination - standards; For Discussion; Hospital cleaning; Hospitals - standards; Human bacterial diseases; Humans; Hygiene - standards; Infection Control - standards; Infectious diseases; Mcrobiological standards; Medical sciences; Sanitation - standards; Staphylococcal infections, streptococcal infections, pneumococcal infections; Staphylococcus aureus; Surface hygiene; Surface hygiene; Hospital cleaning; Mcrobiological standards; Nosocomial infection; Clostridiales; Check; Evidence-based medicine; Surface; Prevention; Food industry; Bacteria; Micrococcales; Micrococcaceae; Hospital; Staphylococcus aureus; Quantitative analysis; Gram negative bacteria; Enterococcus; Use; Clostridium difficile; Cleaning; Hand; Indicator; Standards; Infection; Streptococcaceae; Clostridiaceae; Risk factor; Bacteriosis; Environment; Staphylococcal infection; Hygiene
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1016/j.jhin.2003.09.017

Increasing numbers of hospital-acquired infections have generated much attention over the last decade. The public has linked the so-called ‘superbugs’ with their experience of dirty hospitals, but the precise role of cleaning in the control of these organisms in unknown. Hence the importance of a clean environment is likely to remain speculative unless it becomes an evidence-based science. This proposal is a call for bacteriological standards with which to assess clinical surface hygiene in hospitals, based on those used by the food industry. The first standard concerns any finding of a specific ‘indicator’ organism, the presence of which suggests a requirement for increased cleaning. Indicators would include Staphylococcus aureus, including methicillin-resistant S. aureus, Clostridium difficile, vancomycin-resistant enterococci and various Gram-negative bacilli. The second standard concerns a quantitative aerobic colony count of <5 cfu/cm 2 on frequent hand touch surfaces in hospitals. The principle relates to modern risk management systems such as HACCP, and reflects the fact that pathogens of concern are widespread. Further work is required to evaluate and refine these standards and define the infection risk from the hospital environment.