An assessment of high touch object cleaning thoroughness using a fluorescent marker in two Australian hospitals

Objective We needed to better understand the usefulness of different methods of monitoring and achieving sustained improvement in cleaning. Common elements of successful international approaches include a covert nature, the use of a method to visually identify and highlight deficiencies in the cleaning of high touch objects (HTOs) and the provision of feedback and education before re-evaluation. The specific purpose of this study was to evaluate fluorescent marking, education and feedback for assessing and improving HTO cleaning in a typical Australian inpatient hospital setting. Methods A three-phase, prospective study was conducted in two acute care hospitals over 17 weeks. For each phase, in a set of 37 specific single-inpatient rooms, seven predefined HTOs were marked with a liquid isopropyl alcohol and optical brightener formulation targeting material solution containing a fluorescent marker (FM), known as DAZO, designed specifically for the purpose of evaluating surface cleaning. In each hospital we targeted rooms located in the four wards with the greatest de novo multidrug resistant organism burden. Forty-eight hours after applying the FM we used a black-light to visualise the mark's presence or removal. In phase 1 only, HTOs were swabbed before marking. Also in the first phase only and immediately following the initial assessment, each HTO was cleaned, remarked and re-assessed at 48h. Between phases 1 and 2, investigators provided results to environmental services (EVS) leadership and staff. Education was provided to EVS staff after phase 1 only. Results A total of 986 marks were evaluated. The cleaning scores for individual HTOs in phases 1-3 ranged from 9.4 to 77.8%, 10.8 to 93% and 13.5 to 67.7% respectively. In phase 3, three HTOs scored lower than in phase 1. The mean overall cleaning scores for phases 13 were 34%, 53% and 41% respectively. Conclusions The FM was useful to assess HTO cleaning thoroughness. It facilitated relevant feedback and education and motivated staff to strive for continual improvements in environmental cleaning. Without on-going education, preliminary improvements were unsustained. However, investigators better understood flaws in cleaning and policy/procedure conflicts.