Effectiveness of various cleaning strategies in acute and long-term care facilities during novel corona virus 2019 disease pandemic-related staff shortages.
Effectiveness of various cleaning strategies in acute and long-term care facilities during novel corona virus 2019 disease pandemic-related staff shortages.
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BackgroundCleanliness of hospital surfaces helps prevent healthcare-associated infections, but comparative evaluations of various cleaning strategies during COVID-19 pandemic surges and worker shortages are scarce.Purpose and methodsTo evaluate the effectiveness of daily, enhanced terminal, and contingency-based cleaning strategies in an acute care hospital (ACH) and a long-term care facility (LTCF), using SARS-CoV-2 RT-PCR and adenosine triphosphate (ATP) assays.Daily cleaning involved light dusting and removal of visible debris while a patient is in the room.Enhanced terminal cleaning involved wet moping and surface wiping with disinfectants after a patient is permanently moved out of a room followed by ultraviolet light (UV-C), electrostatic spraying, or room fogging.Contingency-based strategies, performed only at the LTCF, involved cleaning by a commercial environmental remediation company with proprietary chemicals and room fogging.
Ambient surface contamination was also assessed randomly, without regard to cleaning times.Near-patient or high-touch stationary and non-stationary environmental surfaces were sampled with icon track bar f250 pre-moistened swabs in viral transport media.ResultsAt the ACH, SARS-CoV-2 RNA was detected on 66% of surfaces before cleaning and on 23% of those surfaces immediately after terminal cleaning, for a 65% post-cleaning reduction (p = 0.001).UV-C enhancement resulted in an 83% reduction (p = 0.
023), while enhancement with electrostatic bleach application resulted in a 50% reduction (p = 0.010).ATP levels on RNA positive surfaces were not significantly different from those of RNA negative surfaces.LTCF contamination rates differed between the dementia, rehabilitation, and residential units (p = 0.005).
67% of surfaces had RNA after room fogging without terminal-style wiping.Fogging with wiping led to a -11% change in the proportion of positive surfaces.At the LTCF, mean ATP levels were lower after terminal cleaning (p = 0.016).ConclusionAmbient surface contamination varied by type of unit and outbreak conditions, but not facility type.
Removal of SARS-CoV-2 RNA varied according to cleaning strategy.ImplicationsPrevious reports have shown time spent cleaning by hospital employed environmental services staff did not correlate with cleaning thoroughness.However, time spent cleaning by a commercial remediation company in this study was associated with canon imageclass mf227dw cleaning effectiveness.These findings may be useful for optimizing allocation of cleaning resources during staffing shortages.