Assessing and upgrading the cleanliness of the emergency department brief title: upgrading the emergency room's cleanliness.

Objective: To upgrade cleaning and disinfection of patient rooms in a crowded emergency department (ED).

Setting: Tertiary referral hospital.

Design: Prospective, 3-component, before-and-after intervention study.

Methods: Phase 1 consisted of a 4-week baseline determination of ED patient-room cleanliness, using two means: (1) the fluorescence spray, applied before cleaning and assessed subsequently with an ultraviolet lamp. Results are expressed as % of removed spots/all spots (≥7/10 cleaned spots/room was considered clean; (2) ATP swabs obtained after cleaning, which test for presence of residual organic material; readings <45 were considered clean. Phase 2 consisted of revision and reorganization of established cleaning practices. Phase 3 consisted of adding one cleaning person in afternoon/evening shifts, for 4-weeks, during which room cleanliness was assessed as previously described.

Results: Cleanliness of the 79 patient rooms, for which fluorescence tests were available from before and after cleaning for all three phases of the study, increased from a baseline of 50% ± 35 removed spots/all spots, to 61% ± 36 after the first intervention (CI95 -0.6 - 21, P = 0.54) and to 68% ± 35 after the second intervention (CI95 5 - 31, P = 0.004, as compared to the baseline). Subanalysis showed that evening shifts improved most remarkably, from 47% ± 32 (n = 45), to 60% ± 33 (n = 49) to 76%±29 (n = 29), respectively, from baseline through the second and third phase (P = 0.001). ATP testing appeared less sensitive for assessment of cleanliness but confirmed the assessment by fluorescence for overall cleanliness (CI95 1 - 14, P = 0.018).

Conclusions: Our data demonstrate that a two-step intervention significantly improves cleaning in a busy ED.