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. 2018 Jul 17:13:Doc06.
doi: 10.3205/dgkh000312. eCollection 2018.

Cleaning and disinfection of surfaces in hospitals. Improvement in quality of structure, process and outcome in the hospitals in Frankfurt/Main, Germany, in 2016 compared to 2014

Angelika Hausemann  1 , Miriam Grünewald  1 , Ulla Otto  1 , Ursel Heudorf  1
Affiliations

Cleaning and disinfection of surfaces in hospitals. Improvement in quality of structure, process and outcome in the hospitals in Frankfurt/Main, Germany, in 2016 compared to 2014

Angelika Hausemann et al. GMS Hyg Infect Control. .

Abstract
in English, German

The cleaning and disinfection of surfaces in hospitals is becoming increasingly important in the multi-barrier approach for preventing infection, in addition to hand hygiene and proper reprocessing of medical devices. Therefore, in 2014, the quality of structure, process and outcome of surface preparation was checked in all hospitals in Frankfurt/Main, Germany. Because of great need for improvements, this monitoring was repeated in 2016. The data are presented in comparison to those in 2014. Methods: All 16 hospitals provided information on the quality of structure. Data on quality of process was obtained through direct observation during cleaning and disinfection of rooms and their bathrooms. Data on quality of result was acquired using the fluorescence method, i.e., marking surfaces with a fluorescent liquid and testing whether this mark has been sufficiently removed by cleaning. The results are compared to those of the 17 hospitals monitored in 2014, before the closing of one of the hospitals.Results: Quality of structure [data from 2014]: In all hospitals, the employees were trained regularly. In 14 (88%) [12; 71%] of those, the foremen had the required qualifications. In 1 (6%) [6; 35%] hospitals, some uncertainty remained concerning the interface of the cleaning and nursing care services. A complete cleaning was reported to take place in 12 (75%) [12; 70%] hospitals on Saturdays and in 4 (25%) [2; 11%] hospitals on Sundays. Quality of process: During process monitoring, the different surfaces with frequent hand or skin contact were prepared to different extents (91-100%) [70-100%]. Quality of result: 88% [75%] of fluorescent marks were appropriately removed. Conclusion: Compared to 2014, a clear improvement were seen in 2016, especially in the qualification of the foremen and in terms of clearly defining the interface between cleaning and care services as well as the quality of process and outcome. Nevertheless, regarding the growing importance of proper reprocessing of hospital surfaces for prevention of infections and/or colonizations, further improvements are mandatory, including a program for better education of the cleaning staff.

Neben der Händehygiene und der Instrumentenaufbereitung kommt der Flächenreinigung und -desinfektion in Kliniken eine wichtige Bedeutung in der Verhinderung von Erregerübertragungen und damit auch Infektionen zu. Nachdem bei einer umfassenden, standardisierten Erhebung der Struktur-, Prozess- und Ergebnisqualität der Flächenaufbereitung der Frankfurter Kliniken im Jahr 2014 deutlicher Verbesserungsbedarf gefunden wurde, wurde diese Erhebung im Jahr 2016 mit identischer Methode wiederholt. Methoden: Wie in 2014 wurden auch in 2016 alle Krankenhäuser im Hinblick auf die Strukturqualität (incl. Verträge mit Reinigungsfirmen, Qualitätsanforderungen, vereinbarte Zeitkontingente etc.) und die Prozess- und Ergebnisqualität überwacht. Da inzwischen ein Haus geschlossen hat, betraf dies jetzt insgesamt 16 Häuser (2014: 17). Vor Ort wurde die Reinigung in jeweils mindestens 5 Zweibettzimmern pro Krankenhaus beobachtet und die Ergebnisqualität an jeweils 15 vorab standardisiert angebrachten fluoreszierenden Markierungen (Glow-Check) erhoben. Ergebnisse: Strukturqualität [Werte aus 2014]: In 14 (88%) Kliniken hatten die Vorarbeiter die geforderte Qualifikation [2014: 12; 71%]. In 15 (94%) Kliniken gab es Schnittstellenpläne, d.h. genaue Angaben für den Reinigungs- und Pflegedienst [11; 65%]. Eine „volle Reinigungsleistung“ an Samstagen wurde in 12 (75%) Kliniken [12; 71%], an Sonntagen in 4 (25%) Kliniken angegeben [2; 12%]. Die vertraglich vorgegebene Reinigungsleistung (beobachtete Leistung in Klammern) lag im Mittel bei 168 m2/h (155 m2/h) pro Patientenzimmer [178 und 148 m2/h] und bei 63 m2/h (34 m2/h) pro Nasszelle [69 und 33 m2/h]. Bei der Beobachtung der Prozessqualität wurden die verschiedenen Handkontaktflächen im Jahr 2016 besser aufbereitet. Bei der Prüfung der Ergebnisqualität: wurden 88% der erreichbaren Punkte erreicht [2014: 75%]. Schlussfolgerung: Im Vergleich zu 2014 zeigte sich 2016 eine deutliche Verbesserung, insbesondere in den Häusern bzw. in den Bereichen, bei welchen zuvor ein höherer Verbesserungsbedarf festgestellt worden war. Die Häuser haben teilweise erhebliche Anstrengungen unternommen – u.a. bei der Schulung des Personals und der Kontrolle der Reinigung. Gleichwohl werden immer wieder teilweise auch erhebliche Fehler beobachtet und es erreichen uns Patientenbeschwerden wegen Reinigungsmängeln, d.h. weitere Verbesserungen sind erforderlich.

Keywords: hospital hygiene; infection control visits; public health department; surface cleaning; surface disinfection.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Table 1
Table 1. Structural quality for the cleaning and disinfection of surfaces in hospitals in Frankfurt/Main, 2016 vs 2014
Table 2
Table 2. Time for cleaning and disinfection of patient rooms and bathrooms – recommendation of the RAL, questionnaire survey of the German Society for Hospital Hygiene (DGKH) 2013, and the data of Frankfurt hospitals 2014 and 2016
Table 3
Table 3. Effect of hospital cleaning as assessed by the glow-check method. Results from the hospitals in Frankfurt 2014 and 2016 compared to published data from other studies (only completely removed marks taken into account)
Figure 1
Figure 1. Time commissioned and time needed for the reprocessing of patients’ rooms and bathrooms in the hospitals in Frankfurt/Main – 2016 vs 2014
Figure 2
Figure 2. Monitoring quality of process of the cleaning and disinfection in hospitals in Frankfurt/Main, 2014 and 2016, by visual observation according to the different sites – percent of properly cleaned sites
Figure 3
Figure 3. Monitoring the outcome quality of cleaning and disinfection in hospitals in Frankfurt/Main, 2014 and 2016, by the glow-check method according to the different sites – percent compliance in different hospitals
Figure 4
Figure 4. Monitoring the effect of the cleaning and disinfection in hospitals in Frankfurt/Main, 2014 and 2016, by the glow-check method on different sites – percent of properly cleaned sites
See this image and copyright information in PMC

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