TY - JOUR
T1 - Evaluation of daily environmental cleaning and disinfection practices in veterans affairs acute and long-term care facilities
T2 - A mixed methods study
AU - McKinley, L.
AU - Goedken, C. C.
AU - Balkenende, E.
AU - Clore, G.
AU - Hockett, Sherlock S.
AU - Bartel, R.
AU - Bradley, S.
AU - Judd, J.
AU - Lyons, Goedken
AU - Rock, C.
AU - Rubin, M.
AU - Shaughnessy, C.
AU - Reisinger, H. S.
AU - Perencevich, E.
AU - Safdar, N.
N1 - Funding Information:
The contents of this article do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. Thank you: We thank the patient and Veteran members of the UW – Madison and Madison VA Patient Engagement in Education and Research (PEER) Group for their partnership in our HAI prevention research. We thank the VA employees who participated in the interviews for their time and willingness to share their experiences. We thank Mr. Bernardino Guerrero, Sanitation Program Manager, VHA Environmental Programs Service and Ms. Trina Zabarsky, MSN, RN, CIC, FAPIC, Chair of VHA Environmental Programs Service Director's Advisory Board for their review of this manuscript. Funding: This work was supported by the VA-CDC Practice-Based Research Network, which was funded collaboratively by the VA Health Services Research & Development Service (HSR&D) service, the Centers for Disease Control & Prevention (CDC), and the Collaborative Research to Enhance and Advance Transformation and Excellence (CREATE) program (CRE 12-289, HSR) from the VA HSR&D.
Funding Information:
Funding: This work was supported by the VA-CDC Practice-Based Research Network, which was funded collaboratively by the VA Health Services Research & Development Service (HSR&D) service, the Centers for Disease Control & Prevention (CDC), and the Collaborative Research to Enhance and Advance Transformation and Excellence (CREATE) program (CRE 12-289, HSR) from the VA HSR&D.
Publisher Copyright:
© 2022
PY - 2023/2
Y1 - 2023/2
N2 - Objectives: To describe daily environmental cleaning and disinfection practices and their associations with cleaning rates while exploring contextual factors experienced by healthcare workers involved in the cleaning process. Methods: A convergent mixed methods approach using quantitative observations (ie, direct observation of environmental service staff performing environmental cleaning using a standardized observation form) and qualitative interviews (ie, semistructured interviews of key healthcare workers) across 3 Veterans Affairs acute and long-term care facilities. Results: Between December 2018 and May 2019 a total of sixty-two room observations (N = 3602 surfaces) were conducted. The average observed surface cleaning rate during daily cleaning in patient rooms was 33.6% for all environmental surfaces and 60.0% for high-touch surfaces (HTS). Higher cleaning rates were observed with bathroom surfaces (Odds Ratio OR = 3.23), HTSs (OR = 1.57), and reusable medical equipment (RME) (OR = 1.40). Lower cleaning rates were observed when cleaning semiprivate rooms (OR = 0.71) and rooms in AC (OR = 0.56). In analysis stratified by patient presence (ie, present, or absent) in the room during cleaning, patient absence was associated with higher cleaning rates for HTSs (OR = 1.71). In addition, the odds that bathroom surfaces being cleaned more frequently than bedroom surfaces decreased (OR = 1.97) as well as the odds that private rooms being cleaned more frequently than semi-private rooms also decreased (OR = 0.26; 0.07-0.93). Between January and June 2019 eighteen qualitative interviews were conducted and found key themes (ie, patient presence and semiprivate rooms) as potential barriers to cleaning; this supports findings from the quantitative analysis. Conclusion: Overall observed rates of daily cleaning of environmental surfaces in both acute and long-term care was low. Standardized environmental cleaning practices to address known barriers, specifically cleaning practices when patients are present in rooms and semi-private rooms are needed to achieve improvements in cleaning rates.
AB - Objectives: To describe daily environmental cleaning and disinfection practices and their associations with cleaning rates while exploring contextual factors experienced by healthcare workers involved in the cleaning process. Methods: A convergent mixed methods approach using quantitative observations (ie, direct observation of environmental service staff performing environmental cleaning using a standardized observation form) and qualitative interviews (ie, semistructured interviews of key healthcare workers) across 3 Veterans Affairs acute and long-term care facilities. Results: Between December 2018 and May 2019 a total of sixty-two room observations (N = 3602 surfaces) were conducted. The average observed surface cleaning rate during daily cleaning in patient rooms was 33.6% for all environmental surfaces and 60.0% for high-touch surfaces (HTS). Higher cleaning rates were observed with bathroom surfaces (Odds Ratio OR = 3.23), HTSs (OR = 1.57), and reusable medical equipment (RME) (OR = 1.40). Lower cleaning rates were observed when cleaning semiprivate rooms (OR = 0.71) and rooms in AC (OR = 0.56). In analysis stratified by patient presence (ie, present, or absent) in the room during cleaning, patient absence was associated with higher cleaning rates for HTSs (OR = 1.71). In addition, the odds that bathroom surfaces being cleaned more frequently than bedroom surfaces decreased (OR = 1.97) as well as the odds that private rooms being cleaned more frequently than semi-private rooms also decreased (OR = 0.26; 0.07-0.93). Between January and June 2019 eighteen qualitative interviews were conducted and found key themes (ie, patient presence and semiprivate rooms) as potential barriers to cleaning; this supports findings from the quantitative analysis. Conclusion: Overall observed rates of daily cleaning of environmental surfaces in both acute and long-term care was low. Standardized environmental cleaning practices to address known barriers, specifically cleaning practices when patients are present in rooms and semi-private rooms are needed to achieve improvements in cleaning rates.
KW - Audit and feedback
KW - Environment of care
KW - Healthcare-associated infections
KW - Qualitative research
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U2 - 10.1016/j.ajic.2022.05.014
DO - 10.1016/j.ajic.2022.05.014
M3 - Article
C2 - 35644297
AN - SCOPUS:85133362182
SN - 0196-6553
VL - 51
SP - 205
EP - 213
JO - American Journal of Infection Control
JF - American Journal of Infection Control
IS - 2
ER -