Use of audit tools to evaluate the efficacy of cleaning systems in hospitals
Use of audit tools to evaluate the efficacy of cleaning systems in hospitals
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DOI：
10.1067/mic.2003.34
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发表时间：
2003-05-01
影响因子：
4.9
通讯作者：
Griffith, CJ
中科院分区：
文献类型：
--
作者：
Malik, RE;Cooper, RA;Griffith, CJ
背景资料：最近的宣传强调了医院清洁的不足和英国医院耐甲氧西林金黄色葡萄球菌感染的高水平。“环境清洁标准”（SEC）是1999年4月由感染控制护士协会和家庭经理协会制定的一份清单，用于评估清洁服务，无论谁是提供者。最近，国家卫生服务计划（2000年7月）试图通过国家卫生服务病人环境审计迅速改善医院的清洁和整洁。在食品工业中使用的模型的基础上，管理清洁的做法具有成本效益，基于风险的审计清单，包括快速卫生监测，以评估医院的清洁计划和标准的充分性。在4家医院应用该检查表（清洁功效审计或ACE）以及SEC和PEA方法，并比较环境微生物表面计数。SEC和PEA依赖于视觉评估，而ACE的方法是更全面的，包括更具体的问题，有关的管理和监测的清洁以及标准的基础上，快速卫生monitoring.Methods：两个病房在每个4家医院进行了访问后，立即清洁完成3个不同的场合。对选定的环境场所进行目视评估、三磷酸腺苷生物发光和微生物取样，以评价清洁的有效性。在最终医院访视期间完成了3次稽查。目视评估表明，90%的部位令人满意，而三磷酸腺苷生物发光显示100%，微生物采样显示90%的部位不符合基准值。SEC和PEA审计之间没有显著差异（P = 0.311），使用目视评估，结果表明它们在通过微生物基准值过高的表面方面相似。然而，ACE审核结果与SEC和PEA审核结果相比存在显著差异（P = < .001），并且没有通过微生物基准值过高的表面。ACE审计，其中包括快速卫生测试，显示出更强的关联与微生物计数，这是不明显的SEC和PEA audits.Conclusion：数据表明，视觉评估是一个贫穷的指标清洁效果和ACE审计提供了更好的评估清洁程序相比，其他2审计方法在微生物表面计数。建议医院清洁。应设计制度，以确保表面得到充分清洁，并通过内部审计和快速卫生测试评估功效。
Background: Recent publicity has highlighted both the inadequacies of hospital cleaning and high levels of methicillin-resistant Staphylococcus aureus infections in UK hospitals. "Standards for Environmental Cleanliness" (SEC) was a checklist developed in April 1999 by the Infection Control Nurses Association and the Association of Domestic Managers to evaluate cleaning services regardless of who is the provider. More recently the National Health Service plan (July 2000) was an attempt to generate a rapid improvement in the cleanliness and tidiness of hospitals via a National Health Service patient environment audit (PEA). On the basis of models used in the food industry to manage cleaning practices cost-effectively, a risk-based audit checklist incorporating rapid hygiene monitoring was developed to assess the adequacy of cleaning programs and standards in hospitals. This checklist (Audit for Cleaning Efficacy, or ACE) as well as the SEC and PEA approaches were applied at 4 hospitals, and environmental microbial surface counts were compared. SEC and PEA rely on visual assessment, whereas the ACE approach is more comprehensive and included more specific questions relating to the management and monitoring of cleaning as well as standards on the basis of rapid hygiene monitoring.Methods: Two wards in each of the 4 hospitals were visited on 3 separate occasions immediately after cleaning was completed. Visual assessment, adenosine triphosphate bioluminescence, and microbiologic sampling of selected environmental sites were performed to evaluate the effectiveness of cleaning. The 3 audits were completed during the final hospital visit.Results. Visual assessment indicated that 90 % of sites were satisfactory, whereas adenosine triphosphate bioluminescence showed that 100 % and microbiologic sampling showed that 90 % of sites did not meet benchmark values. There was no significant difference between the SEC and PEA audits (P = .311), which used visual assessment, and the results suggest that they both are similar in passing surfaces that have microbiologic benchmark values that are too high. However, the ACE audit showed a significant difference (P = < .001) in results compared with the SEC and the PEA audits and did not pass surfaces with microbiologic benchmark values that were too high. The ACE audit, which incorporates rapid hygiene testing, showed a much stronger association with the microbial counts; this was not-apparent with the SEC and the PEA audits.Conclusion: The data suggest that visual assessment is a poor indicator of cleaning efficacy and that the ACE audit gives a better assessment of cleaning programs compared with the other 2 audit methods in relation to microbial surface counts. It is recommended that hospital cleaning. regimes be designed to ensure that surfaces are cleaned adequately and that efficacy is assessed with use of internal auditing and rapid hygiene testing.