no more white gloves - central plains...
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© 3
M 2
011.
All
Rig
hts
Res
erve
d.
NO
MO
RE
WH
ITE
GL
OV
ES
C
lean
ing
Mon
itorin
g in
Hea
lthca
re T
oday
© 3
M 2
010.
All
Rig
hts
Res
erve
d.
2
Gra
ce T
horn
hill,
Ph.
D.
3M In
fect
ion
Pre
vent
ion
Tec
hnic
al S
ervi
ce S
peci
alis
t
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
3 Up
on
Co
mp
leti
on
of
this
pro
gra
m, t
he
par
tici
pan
t
will
be
able
to
:
•D
escr
ibe
how
env
ironm
enta
l pat
hoge
ns a
re tr
ansm
itted
to p
atie
nts
and
heal
thca
re w
orke
rs.
•E
valu
ate
if an
env
ironm
enta
l sur
face
is a
t ris
k fo
r
envi
ronm
enta
l con
tam
inat
ion.
•D
escr
ibe
whi
ch M
DR
O’s
are
mos
t ofte
n fo
und
on
envi
ronm
enta
l sur
face
s.
•D
escr
ibe
the
curr
ent m
etho
ds u
sed
to m
onito
r
envi
ronm
enta
l cle
anin
g.
•D
escr
ibe
how
cle
anin
g m
onito
ring
can
be a
pplie
d to
ster
ile in
stru
men
t rep
roce
ssin
g
•E
valu
ate
if a
clea
ning
mon
itorin
g pr
ogra
m c
an b
e us
ed to
supp
ort a
n in
fect
ion
cont
rol p
rogr
am.
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
4
Ho
sp
ita
l A
cq
uir
ed
In
fec
tio
ns
(H
AI)
pe
rsis
t a
nd
are
co
stl
y
• 5%
-10%
of in
patients
acquire infe
ctions d
uring t
heir h
ospita
l sta
y*
• 2 m
illio
n infe
cte
d p
er
year
in t
he U
nite
d S
tate
s
• 90,0
00 d
eath
s a
ttribute
d to H
AI
• $5 ~
$50 b
illio
n a
dditi
onal cost to
HC
sys
tem
Cen
ter
for
Me
dic
aid
& M
ed
ica
re (
CM
S)
is p
us
hin
g t
o
cla
ssif
y H
AI
co
nd
itio
ns in
ord
er
to n
ot
reim
bu
rse
fo
r
“p
rev
en
tab
le” h
os
pit
al c
harg
es
New
la
ws
(s
tate
/fe
dera
l) a
re r
eq
uir
ing
gre
ate
r re
po
rtin
g o
f
HA
I
Res
earc
h i
s p
rov
idin
g m
ore
in
sig
ht
into
in
fec
tio
ns
an
d
the
ro
le o
f th
e e
nvir
on
me
nt
*Bu
rke
JP. In
fectio
n c
on
tro
l – a
pro
ble
m fo
r p
atie
nt sa
fety
. N
EJM
20
03
; 3
48
: 6
51
-656
Ho
sp
ita
l A
cq
uir
ed
In
fec
tio
ns
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
5
Iso
lati
on
of
Ca
rrie
rs
Ha
nd
Hy
gie
ne
De
tec
tio
n
of
Ca
rrie
rs
Dis
infe
cti
on
of
the
En
vir
on
me
nt
Ins
titu
te f
or
He
alt
hca
re I
mp
rov
em
en
t (I
HI)
Gu
ide
lin
es
fo
r C
om
ba
tin
g M
ult
i-D
rug
Res
ista
nt
Org
an
ism
s (
MD
RO
s)
Rec
om
me
nd
ed
in
terv
en
tio
ns u
sefu
l in
re
du
cin
g
tra
nsm
iss
ion
of
org
an
ism
s r
es
ista
nt
to m
ult
iple
dru
gs
htt
p:w
ww
.ih
i.org
.ih
i
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
6
Cle
anin
g –
Wh
y?
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
7
US
His
tori
ca
l P
ers
pe
cti
ve
on
th
e R
ole
of
the
En
vir
on
me
nt
in T
ran
sm
iss
ion
of
HA
Is
•R
outin
e cu
lturin
g of
sur
face
s an
d ai
r in
hos
pita
l
envi
ronm
ent w
as c
omm
on p
rior
to 1
970’
s
•U
S C
ente
r fo
r D
isea
se C
ontr
ol a
nd P
reve
ntio
n (C
DC
) an
d
Am
eric
an H
ospi
tal A
ssn
(AH
A)
reco
mm
ende
d
disc
ontin
uatio
n of
rou
tine
envi
ronm
enta
l cul
turin
g.
•La
bor
Inte
nsiv
e, L
acke
d se
nsiti
vity
•La
ck o
f rel
iabl
e da
ta fo
r ho
rizon
tal t
rans
mis
sion
from
cont
amin
ated
sur
face
s
•N
o st
anda
rds
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
8
Th
e P
ersp
ecti
ve is
Ch
ang
ing
•F
requ
ent r
ecov
ery
of e
mer
ging
MD
RO
’s fr
om e
nviro
nmen
tal
surf
aces
•
MR
SA
, VR
E, C
lost
ridiu
m d
iffic
ile, A
cine
toba
cter
bau
man
ii
•D
ata
show
ing
that
pat
hoge
n st
rain
s fr
om p
atie
nt a
nd th
e en
viro
nmen
t are
the
sam
e
•M
DR
O’s
can
sur
vive
bet
ter
in th
e en
viro
nmen
t w
hen
com
pare
d to
co
mm
on b
acte
ria
•G
row
ing
evid
ence
for
tran
smis
sion
of p
atho
gen
•E
nviro
nmen
t to
patie
nts
•E
nviro
nmen
t to
hand
s of
hea
lthca
re w
orke
r
•R
ecen
t stu
dies
sho
w t
hat r
educ
ing
envi
ronm
enta
l con
tam
inat
ion
redu
ces
infe
ctio
n in
pat
ient
s
•F
ocus
on
“hig
h-to
uch,
hig
h ris
k ar
eas/
obje
cts”
in p
atie
nt r
oom
s.
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
9 Wh
ere
do
yo
u f
ind
MD
RO
’s?
A. b
aum
anii
•
Str
etch
er
•S
ink
•B
loo
d p
ress
ure
cu
ffs
•D
oo
r h
and
le
•M
attr
ess
•C
urt
ain
s
•R
esp
irat
ory
car
e eq
uip
men
t
•P
aper
to
wel
dis
pen
ser
•S
hel
vin
g
•
Hay
den
MK
SH
EA
200
7
VR
E
•B
edsi
de
rails
•B
edsi
de
tab
les
•B
loo
d p
ress
ure
cu
ffs
•T
oile
ts, t
oile
t ra
ils
•T
V r
emo
tes
•F
loo
rs
•In
trav
eno
us
pu
mp
s
•B
ed c
on
tro
l bu
tto
ns
•N
urs
e ca
ll b
utt
on
s
•D
uck
ro A
N A
rch
Inte
rn
Med
200
5; 1
65:3
04
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
10 W
her
e d
o y
ou
fin
d M
DR
O’s
?
C. d
iffi
cile
•
Bed
sid
e ra
ils
•B
esid
e Ta
ble
s
•B
ed s
hee
ts
•C
all b
utt
on
s
•To
ilet
Sea
t
•B
ath
roo
m D
oo
r H
and
le
•W
ind
ow
sill
•C
om
mo
des
•R
oo
m F
loo
rs
•To
ilet
Flo
ors
S
amo
re M
H e
t al
Am
J M
ed 1
996;
100
:32
Fek
ety
R e
t al
Am
J M
ed 1
981;
70:
906
McF
arla
nd
L e
t al
NE
JM 1
989;
320
:204
Str
uel
ens
MJ
et a
l Am
J M
ed 1
991;
91
(S3B
):13
8S
McF
arla
nd
LJ
ICH
E 2
002;
23:
639
Du
bb
erke
ER
et
al A
JIC
200
7; 3
5:31
5
Ver
ity
P e
t al
J H
osp
Infe
ct 2
001;
49:
204
M
RS
A
•B
edsi
de
rails
•B
edsi
de
tab
les
•B
loo
d p
ress
ure
cu
ffs
•P
atie
nt
go
wn
s
•B
ed li
nen
•B
ath
roo
m D
oo
r H
and
le
B
oyc
e JM
et
al IC
HE
199
7; 1
8:62
2
Sex
ton
T e
t al
J H
osp
Infe
ct 2
006;
62:
187
Bo
yce
JM e
t al
ICH
E 2
007;
28:
1142
Bh
alla
A e
t al
ICH
E 2
004;
25:
164
Dan
cer
SJ
Lan
cet
Infe
ct D
is 2
008;
8:1
01
Bo
yce
JM e
t al
J H
osp
Infe
ct 2
007;
65(
S2)
:50
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
11
Su
rviv
al o
f P
ath
og
ens
in t
he
En
viro
nm
ent
MD
RO
D
ura
tio
n o
f S
urv
ival
Aci
neto
bact
er
Day
s to
5 m
onth
s
Clo
strid
ium
diff
icile
W
eeks
to 5
mon
ths
Ent
eroc
occu
s (V
RE
) D
ays
to 4
mon
ths
Sta
phyl
ococ
cus
aure
us (
MR
SA
) W
eeks
to m
onth
s
Hep
atiti
s B
viru
s 7
days
Nor
oviru
s 12
-14
days
Kra
me
r A
et
al.
B
MC
In
fec
t D
is 2
00
6, 6
:13
0
Ho
ta B
C
lin
In
fec
t D
is 2
00
4;
39
:11
82
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
12
VR
E T
ran
smis
sio
n R
edu
ced
by
Rem
ovi
ng
En
viro
nm
enta
l Co
nta
min
atio
n
•V
RE
ou
tbre
aks
wer
e co
ntr
olle
d b
y re
mo
val o
f co
nta
min
ated
el
ectr
on
ic r
ecta
l or
tym
pan
ic t
her
mo
met
ers
•V
RE
tra
nsm
issi
on
was
red
uce
d (
26 t
o 3
4%)
by
enh
ance
d
envi
ron
men
tal c
lean
ing
ove
r a
per
iod
•V
RE
ou
tbre
ak in
a b
urn
un
it w
as t
erm
inat
ed u
sin
g e
nh
ance
d
envi
ron
men
tal c
lean
ing
in c
om
bin
atio
n w
ith
oth
er c
on
tro
l m
easu
res
Liv
orn
ese
LL
et
al. A
nn
Inte
rn M
ed 1
992;
117
;112
Po
rwan
cher
R e
t al
. In
fect
Co
ntr
ol H
osp
Ep
idem
iol 1
997;
18:
771
Bro
oks
S e
t al
. In
fect
Co
ntr
ol H
osp
Ep
idem
iol 1
998;
19:
333
Fal
k P
S e
t al
. In
fect
Co
ntr
ol H
osp
Ep
idem
iol 2
000;
21:
575
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
13
Sta
nd
ard
s an
d G
uid
elin
es
•A
rea
l lac
k of
sta
ndar
ds a
nd g
uide
lines
for
Cle
anin
g
Mon
itorin
g fo
r E
nviro
nmen
tal S
urfa
ces
•E
nviro
nmen
tal c
lean
ing
regi
men
s ar
e no
t sta
ndar
dize
d or
regu
late
d an
d m
onito
ring
of c
lean
ing
effic
acy
is g
ener
ally
base
d on
vis
ual a
sses
smen
t.
•T
here
are
Gui
delin
es/R
ecom
men
datio
ns fr
om P
rofe
ssio
nal
Ass
ocia
tions
on
the
Ver
ifica
tion
of C
lean
ing
as p
art o
f the
Qua
lity
Pro
cess
es.
•N
o de
finiti
on o
f “C
lean
”
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
14
Rec
og
niz
ed N
eed
fo
r B
ette
r M
on
ito
rin
g o
f
En
viro
nm
enta
l Cle
anin
g P
ract
ices
•F
rom
CD
C “
Mo
nit
or
clea
nin
g p
erfo
rman
ce t
o e
nsu
re
con
sist
ent
clea
nin
g a
nd
dis
infe
ctio
n o
f su
rfac
es .
. .(1
)”
•C
DC
Too
lkit:
Opt
ions
for
Env
ironm
enta
l Cle
anin
g (2
).
•S
HE
A/ID
SA
rec
omm
ends
“A
sys
tem
fo
r m
on
ito
rin
g
adh
eren
ce t
o e
nvi
ron
men
tal c
lean
ing
an
d d
isin
fect
ion
pr
otoc
ols
is d
esira
ble.
” 1.
Man
agem
ent o
f Mul
ti-D
rug
Res
ista
nt O
rgan
ism
s in
Hea
lthca
re S
ettin
gs, 2
006.
HIC
PA
C g
uide
line
avai
labl
e at
:
ww
w.c
dc.g
ov/n
cido
d/dh
qp/p
df/a
r/m
droG
uide
line2
006.
2. h
ttp://
ww
w.c
dc.g
ov/H
AI/t
oolk
its/E
valu
atin
g-E
nviro
nmen
tal-C
lean
ing.
htm
l
**
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
15 CD
C T
oo
lkit
: O
pti
on
s fo
r E
nvi
ron
men
tal C
lean
ing
.
•“I
n vi
ew o
f the
evi
denc
e th
at tr
ansm
issi
on o
f m
any
heal
thca
re a
cqui
red
path
ogen
s (H
AP
s)
is r
elat
ed to
con
tam
inat
ion
of n
ear-
patie
nt
surf
aces
and
equ
ipm
ent,
all h
ospi
tals
are
en
cour
aged
to d
evel
op p
rogr
ams
to o
ptim
ize
the
thor
ough
ness
of h
igh
touc
h su
rfac
e cl
eani
ng a
s pa
rt o
f ter
min
al r
oom
cle
anin
g at
th
e tim
e of
dis
char
ge o
r tr
ansf
er o
f pat
ient
s.”
•ht
tp://
ww
w.c
dc.g
ov/H
AI/t
oolk
its/E
valu
atin
g-E
nviro
nmen
tal-
Cle
anin
g.ht
ml
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
16
CD
C T
oo
lkit
: O
pti
on
s fo
r E
nvi
ron
men
tal C
lean
ing
T
he T
oolk
it of
fers
rec
omm
enda
tions
on
how
to
impl
emen
t a p
rogr
am to
opt
imiz
e te
rmin
al r
oom
cl
eani
ng.
•Le
vel I
& II
pro
gram
s –
impl
emen
tatio
n &
ed
ucat
ion
reco
mm
enda
tions
• R
evie
w o
f cur
rent
mon
itorin
g te
chno
logi
es –
V
isua
l, M
icro
bial
, Flu
ores
cent
mar
kers
, A
TP
bi
olum
ines
cenc
e
•H
igh-
Tou
ch p
oint
che
cklis
t
•W
orks
heet
– D
ata
colle
ctio
n/an
alys
is to
ol
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
17 Mo
nit
ori
ng
mea
ns:
Ch
eck,
su
per
vise
, wat
ch, k
eep
tra
ck o
f….
How
do
we
mon
itor
envi
ronm
enta
l cle
anin
g?
•V
isua
l Ins
pect
ion
•A
erob
ic C
olon
y C
ount
s (A
CC
)
•F
luor
esce
nt D
yes/
Pow
ders
/Gel
•A
TP
Bio
lum
ines
cenc
e
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
18
Cu
rren
t S
tan
dar
d P
ract
ice:
Vis
ual
Exa
min
atio
n
•V
isua
l ass
essm
ent i
s no
t an
accu
rate
mea
sure
of s
urfa
ce c
lean
lines
s no
r of
mic
robi
al c
onta
min
atio
n. I
t can
be
a
mis
lead
ing
mea
sure
of c
lean
ing
effic
acy.
B
oyc
e e
t a
l. M
on
ito
rin
g th
e E
ffe
ctive
ness o
f H
osp
ita
l Cle
an
ing P
ractices b
y U
se
of
an
Ad
en
osin
e T
rip
ho
sp
hate
Bio
lum
inesce
nce A
ssa
y In
fectio
n C
on
trol a
nd
Hosp
ita
l Ep
ide
mio
logy.
Ju
ly 2
00
9, 3
0: 6
78
-68
4.
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
19 Ju
st b
ecau
se it
loo
ks c
lean
….
do
es n
ot
mea
n it
is c
lean
.
•Yo
u c
an’t s
ee
bio
film
or
mic
rob
es
•Yo
u c
an
’t s
ee
bio
log
ica
l re
sid
ues
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
20
Flu
ore
scen
t P
ow
der
s/L
oti
on
s/G
els
•U
V fl
uore
scen
t mol
ecul
es a
re in
corp
orat
ed in
to w
ater
sol
uble
gels
, po
wde
rs o
r lo
tions
and
use
d to
mar
k an
env
ironm
enta
l
surf
ace.
•T
he s
urfa
ce is
cle
aned
and
then
re-
insp
ecte
d by
usi
ng a
UV
A
light
. T
he r
emov
al o
r pa
rtia
l rem
oval
of t
he fl
uore
scen
t mar
ker
indi
cate
s if
a su
rfac
e ha
s be
en w
iped
.
•G
ener
ate
Qua
litat
ive
Res
ults
: H
as th
e su
rfac
e be
en w
iped
?
Yes/
No
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
21
Aer
ob
ic C
olo
ny
Co
un
ts (
AC
C)
•E
nviro
nmen
tal s
urfa
ces
are
cultu
red
for
the
pres
ence
of
aero
bic
bact
eria
.
•S
wab
sur
face
and
cul
ture
on
nutr
ient
med
ia
•D
ip s
lides
or
RO
DA
C p
late
s –n
utrie
nt a
gar
is p
ress
ed
dire
ctly
ont
o th
e en
viro
nmen
tal s
urfa
ce
•R
esul
ts a
re q
uant
itativ
e: C
FU
/ are
a te
sted
•P
atho
gens
are
iden
tifie
d in
som
e ca
ses.
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
22
Ad
eno
sin
e T
ri-p
ho
sph
ate
(AT
P)
Bio
lum
ines
cen
ce
•A
TP
is p
rese
nt in
all
livin
g or
gani
sms
– an
imal
, pla
nt,
mic
roor
gani
sms,
hum
an s
ecre
tions
and
exc
retio
ns.
•C
onta
min
ated
sur
face
s sh
ow h
igh
leve
ls o
f AT
P, c
lean
surf
aces
sho
w lo
w A
TP
leve
ls.
•T
he s
urfa
ce is
sw
abbe
d an
d th
e A
TP
leve
ls m
easu
red
in a
lum
inom
eter
•R
esul
ts a
re q
uant
itativ
e: A
TP
bio
lum
ines
cenc
e
is
mea
sure
d in
Rel
ativ
e Li
ght U
nits
•B
ench
mar
k R
LU le
vels
use
d to
def
ine
“
clea
n”
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
23
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
24
Sim
ple
Rela
tio
nsh
ip
incre
ase in
org
an
ism
s a
nd
oth
er
bio
log
ical r
esid
ues
incre
ase in
AT
P levels
incre
ase in
lig
ht
(RL
U)
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
25
•H
ave
im
po
rta
nt
su
rfa
ce
s b
ee
n w
ipe
d?
•
Vis
ual I
nspection/C
heckl
ist
•F
luore
sce
nt pow
der/
lotio
n/g
el
•Is
th
e s
urf
ace
“cle
an”?
•
Aero
bic
co
lony c
ounts
•A
denosin
e triphosphate
(A
TP
) bio
lum
inesce
nce a
ssa
y
Ma
lik e
t a
l Am
J I
nf
Co
nt
20
03
;31
:18
1
Sh
erlo
ck e
t a
l J H
osp
In
f 2
00
9
Wh
ich
mo
nit
ori
ng
met
ho
d is
bes
t?
Dep
end
s o
n t
he
qu
esti
on
ask
ed.
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
26 A
dv
an
tag
es
an
d D
isa
dv
an
tag
es
of
Me
tho
ds
fo
r A
ss
es
sin
g C
lea
nin
g P
rac
tic
es
Meth
od
A
dvan
tag
es
D
isad
van
tag
es
Vis
ua
l in
sp
ec
tio
n
•Sim
ple
•N
ot
relia
ble
me
as
ure
o
f
cle
an
lin
es
s
Flu
ore
sc
en
t m
ark
er
sys
tem
•In
ex
pe
ns
ive
•Min
ima
l e
qu
ipm
en
t
ne
ed
ed
•Ca
n im
pro
ve
pra
cti
ce
s
•Mu
st
ma
rk s
urf
ac
es
be
fore
cle
an
ing
, a
nd
ch
ec
k t
he
m a
fte
r
cle
an
ing
•Do
es
no
t p
rovid
e
qu
an
tita
tive
me
as
ure
s
Ae
rob
ic c
olo
ny c
ou
nts
•R
ela
tive
ly s
imp
le
•De
tec
ts p
res
en
ce
of
pa
tho
ge
ns
•Mo
re e
xp
en
siv
e
•Re
su
lts
no
t a
va
ila
ble
for
48
hrs
la
ter
AT
P b
iolu
min
es
ce
nc
e
as
sa
y s
ys
tem
s
•Pro
vid
es
qu
an
tita
tive
me
as
ure
of
cle
an
lin
es
s
•Qu
ick
re
su
lts
•Ca
n im
pro
ve
pra
cti
ce
s
•Mo
re e
xp
en
siv
e
•Re
qu
ire
s s
pe
cia
l
eq
uip
me
nt
John
M.
Boy
ce, M
D, A
PIC
201
0 ,
Impr
ovin
g C
lean
ing
and
Dis
infe
ctio
n an
d H
ow to
Mon
itor
the
Effe
ctiv
enes
s of
Sur
face
Dis
infe
ctio
n.
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
27
Wh
ere
do
yo
u s
tart
?
Wh
at is
a h
igh
ris
k -
hig
h t
ou
ch s
urf
ace?
A Q
ua
nti
tati
ve
Ap
pro
ac
h t
o D
efi
nin
g
“H
igh
-To
uc
h” S
urf
ac
es
in
Ho
sp
ita
ls
Kir
k H
us
lag
e, R
N, B
SN
, M
SP
H;
William
A. R
uta
la, P
hD
, M
PH
;
Em
ily S
ickb
ert
-Be
nn
ett
, P
hD
; D
avid
J. W
eb
er,
MD
, M
PH
Fifty
inte
ractions b
etw
ee
n h
ealthcare
wo
rkers
and p
atients
we
re o
bserv
ed
to
obta
in a
quantifiable
definitio
n o
f “h
igh
-touch
” (ie, fr
eque
ntly
touched)
surf
aces b
ase
d o
n fre
quency o
f conta
ct. F
ive s
urf
aces
we
re d
efined a
s h
igh
-touch
su
rfaces: th
e b
ed r
ails
, th
e b
ed s
urf
ace, th
e
su
pply
ca
rt, th
e o
ver-
bed table
, and the in
travenous p
um
p.
Infe
ct C
ontr
ol H
osp
Epid
em
iol 2010
; 31(8
):850
-85
3
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
28
CD
C G
uid
elin
es f
or
Mu
ltip
le-D
rug
Res
ista
nt
Org
anis
ms
Mo
nit
ori
ng
V
.B.8
Enh
ance
d en
viro
nmen
tal m
easu
res
V
.B.8
.c. M
on
ito
r (i.
e., s
uper
vise
and
insp
ect)
cle
anin
g
per
form
ance
to e
nsur
e co
nsis
tent
cle
anin
g an
d di
sinf
ectio
n of
sur
face
s in
clo
se p
roxi
mity
to th
e pa
tient
an
d th
ose
likel
y to
be
touc
hed
by th
e pa
tient
and
HC
P
(e.g
. bed
rails
, car
ts, b
edsi
de c
omm
odes
, doo
rkno
bs,
fauc
et h
andl
es.)
Cat
egor
y 1B
Str
ongl
y re
com
men
ded
for
impl
emen
tatio
n an
d su
ppor
ted
by s
ome
expe
rimen
tal,
clin
ical
or
epi
dem
iolo
gic
stud
ies
and
stro
ng th
eore
tical
rat
iona
le.
ww
w.c
dc.g
ov.n
cido
d/dh
qp/g
l_en
viro
ninf
ectio
n.ht
ml
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
29
Mo
nit
ori
ng
th
e ef
fica
cy o
f en
viro
nm
enta
l
clea
nin
g in
hea
lth
care
fac
iliti
es:
A r
evie
w
of
two
stu
die
s.
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
30
Imp
rovi
ng
Cle
anin
g P
ract
ices
by
Usi
ng
Flu
ore
scen
t M
arke
r S
yste
m
Ca
rlin
g P
C e
t al. IC
HE
2008;2
9:1
035
•S
tudy
per
form
ed in
36
acu
te-c
are
hosp
itals
•F
luor
esce
nt m
arke
rs c
over
tly a
pplie
d
to e
nviro
nmen
tal s
urfa
ces
befo
re
term
inal
roo
m d
isin
fect
ion
•S
urfa
ces
chec
ked
with
UV
A li
ght
afte
r te
rmin
al c
lean
ing
•In
terv
entio
n in
clud
ed p
rovi
ding
hous
ekee
pers
with
per
form
ance
feed
back
•P
erce
nt o
f obj
ects
cle
aned
ü
Bef
ore
inte
rven
tion:
47%
ü
Afte
r in
terv
entio
ns:
76 -
92%
0
10
20
30
40
50
60
70
80
Percent of Objects
Cleaned
Baselin
eP
ost-
Inte
rven
tio
n
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
31
Mon
itorin
g D
aily
Cle
anin
g P
ract
ices
Usi
ng a
n A
TP
Bio
lum
ines
cenc
e A
ssay
B
oyce J
M e
t al. IC
HE
2009
;30:6
78
•O
bje
ctiv
e -
To
eval
uate
the
usef
ulne
ss o
f an
aden
osin
e
trip
hosp
hate
(A
TP
) bi
olum
ines
cenc
e as
say
for
asse
ssin
g
the
effic
acy
of d
aily
hos
pita
l cle
anin
g pr
actic
es.
•S
tud
y d
esig
n -
A 2
-pha
se p
rosp
ectiv
e in
terv
entio
n st
udy
at
a un
iver
sity
-affi
liate
d co
mm
unity
teac
hing
hos
pita
l.
•C
on
clu
sio
ns
- S
ubop
timal
cle
anin
g pr
actic
es w
ere
docu
men
ted
by d
eter
min
ing
aero
bic
colo
ny c
ount
s an
d by
use
of a
n A
TP
bio
lum
ines
cenc
e as
say.
AT
P r
ead
ing
s
pro
vid
ed q
uan
tita
tive
evi
den
ce o
f im
pro
ved
cle
anlin
ess
of
hig
h-t
ou
ch s
urf
aces
aft
er t
he
imp
lem
enta
tio
n o
f an
inte
rven
tio
n p
rog
ram
.
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
32
Stu
dy D
esig
n
•P
has
e 1
Go
als
•A
sses
s th
e th
orou
ghne
ss o
f dai
ly c
lean
ing
proc
edur
es b
y de
term
inin
g ae
robi
c
colo
ny c
ount
s an
d by
use
of a
n A
TP
bio
lum
ines
cenc
e as
say
•In
terv
enti
on
•In
-ser
vice
edu
catio
nal s
essi
ons
for
hous
ekee
ping
. D
ata
from
Pha
se 1
revi
ewed
to s
tres
s im
port
ance
of c
lean
ing
proc
edur
es a
nd p
erfo
rman
ce
feed
back
.
•P
has
e 2
Go
als
• E
stab
lish
with
gre
ater
cer
tain
ty th
e ra
nge
of A
TP
rea
ding
s to
be
expe
cted
on
high
-tou
ch s
urfa
ces
in p
atie
nt r
oom
s be
fore
and
afte
r da
ily c
lean
ing.
•D
eter
min
e w
heth
er a
lert
ing
hous
ekee
pers
that
cle
anin
g pr
oced
ures
wer
e be
ing
mon
itore
d w
ould
res
ult i
n im
prov
ed c
lean
ing
prac
tices
, as
refle
cted
in th
e A
TP
read
ings
.
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
33
Me
dia
n R
ela
tiv
e L
igh
t U
nit
Rea
din
gs,
Aft
er
Da
ily C
lea
nin
g, P
has
es I
an
d I
I
0
10
0
20
0
30
0
40
0
50
0
60
0
70
0
80
0
Relative Light Units
Be
dra
ilO
ve
rbe
d
Ta
ble
TV
Re
mo
te
Gra
b b
ar
To
ile
t
Se
at
Ph
as
e I
Ph
as
e II
P <
.0
01
<
0
.00
1
.0
2
.0
02
.8
7
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
34
Mon
itorin
g C
lean
ing
Effe
ctiv
enes
s
How
can
this
be
used
in y
our
hosp
ital?
•Im
prov
ing
clea
ning
/dis
infe
ctio
n pr
actic
es in
hos
pita
ls
•Y
ou n
eed
a pl
an
•D
evel
opin
g de
taile
d pr
otoc
ols,
edu
catin
g ho
usek
eepe
rs
•M
onito
ring
clea
ning
, pr
ovid
ing
feed
back
to
hous
ekee
pers
•D
ecid
e w
hich
met
hod
best
ans
wer
s yo
ur m
ost i
mpo
rtan
t que
stio
ns:
•H
as a
sur
face
bee
n w
iped
? V
isua
l ass
essm
ent,
fluor
esce
nt
mar
kers
•Is
the
surf
ace
clea
n? A
TP
bio
lum
ines
cenc
e as
say
syst
ems
aero
bic
colo
ny c
ount
s,
•Q
uant
itativ
e M
onito
ring
clea
ning
pra
ctic
es c
an h
elp
esta
blis
h th
e ef
fect
iven
ess
of n
ew te
chno
logi
es f
or “
area
dec
onta
min
atio
n”
© 3
M 2
010.
All
Rig
hts
Res
erve
d.
35
Sur
gica
l Ins
trum
ent
Dec
onta
min
atio
n
Usi
ng A
TP
Bio
lum
ines
cenc
e to
Mon
itor
the
Sur
gica
l
Inst
rum
ent D
econ
tam
inat
ion
Pro
cess
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
36
Cu
rren
t M
eth
od
fo
r V
erif
icat
ion
of
Cle
anin
g
Eff
icac
y is
Vis
ual
Insp
ecti
on
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
37
Mo
nit
ori
ng
met
ho
ds
for
Su
rgic
al In
stru
men
ts
•V
isua
l – m
ost c
omm
on m
etho
d in
use
•M
icro
biol
ogic
al –
not
use
d ro
utin
ely.
May
be
used
by
inst
rum
ent m
anuf
actu
rer
to v
alid
ate
clea
ning
inst
ruct
ions
.
•F
luor
esce
nt g
el te
chno
logy
– n
ot c
urre
ntly
app
licab
le
•A
TP
bio
lum
ines
cenc
e –
is c
urre
ntly
bei
ng u
sed,
gai
ning
wid
er a
ccep
tanc
e
•P
rote
in te
st –
cur
rent
ly u
sed
in U
K d
ue to
prio
n co
ncer
ns.
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
38 Cle
anin
g…
..
•“C
lean
ing
is th
e re
mov
al o
f for
eign
mat
eria
l (e.
g., s
oil,
and
orga
nic
mat
eria
l) fr
om o
bjec
ts a
nd is
nor
mal
ly
acco
mpl
ishe
d us
ing
wat
er w
ith d
eter
gent
s or
enz
ymat
ic
prod
ucts
. Tho
roug
h cl
eani
ng is
req
uire
d be
fore
hig
h-le
vel
disi
nfec
tion
and
ster
iliza
tion
beca
use
inor
gani
c an
d or
gani
c
mat
eria
ls th
at r
emai
n on
the
surf
aces
of i
nstr
umen
ts
inte
rfer
e w
ith th
e ef
fect
iven
ess
of th
ese
proc
esse
s.”
C
DC
: Gui
delin
e fo
r D
isin
fect
ion
and
Ste
riliz
atio
n in
Hea
lthca
re F
acili
ties
2008
. W
. Rut
ala,
D. W
eber
and
HIC
PA
C. p
.36-
37
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
39
CD
C T
oo
lkit
•“I
n vi
ew o
f the
evi
denc
e th
at tr
ansm
issi
on o
f man
y he
alth
care
acq
uire
d pa
thog
ens
(HA
Ps)
is r
elat
ed to
co
ntam
inat
ion
of n
ear-
patie
nt s
urfa
ces
and
equi
pmen
t, al
l ho
spita
ls a
re e
ncou
rage
d to
dev
elop
pro
gram
s to
opt
imiz
e th
e th
orou
ghne
ss o
f hig
h to
uch
surf
ace
clea
ning
as
part
of
term
inal
roo
m c
lean
ing
at th
e tim
e of
dis
char
ge o
r tr
ansf
er
of p
atie
nts.
”
•T
oolk
it of
fers
rec
omm
enda
tions
on
how
to im
plem
ent
a pr
ogra
m to
opt
imiz
e te
rmin
al r
oom
cle
anin
g.
•Le
vel I
& II
pro
gram
s –
impl
emen
tatio
n, e
duca
tion
• R
evie
w o
f cur
rent
mon
itorin
g te
chno
logi
es
•H
igh-
Tou
ch p
oint
che
cklis
t an
d a
Wor
kshe
et
• h
ttp://
ww
w.c
dc.g
ov/H
AI/t
oolk
its/E
valu
atin
g-E
nviro
nmen
tal-
Cle
anin
g.ht
ml
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
40
Gu
idel
ines
an
d R
eco
mm
end
atio
ns
AO
RN
: C
lean
ing
Ver
ific
atio
n.
Eva
luat
e m
anu
al c
lean
ing
:
Whe
n ne
w in
stru
men
ts a
re r
epro
cess
ed a
nd p
erio
dica
lly, a
t
inte
rval
s de
term
ined
by
the
heal
thca
re o
rgan
izat
ion
AA
MI
ST
79:2
006.
Co
mp
reh
ensi
ve g
uid
e to
ste
am
ster
iliza
tio
n a
nd
ste
rilit
y as
sura
nce
in h
ealt
h c
are
faci
litie
s. A
nn
ex D
– U
ser
veri
fica
tio
n o
f cl
ean
ing
pro
cess
es
List
s m
etho
ds fo
r ve
rific
atio
n of
cle
anin
g pr
oces
s, A
TP
Bio
lum
ines
cenc
e is
incl
uded
in th
is li
st.
ISO
158
83-1
– W
ash
er D
isin
fect
or
Rec
omm
ends
pro
tein
as
mar
ker
for
valid
atio
n, b
ut le
aves
room
for
othe
r m
arke
rs to
be
used
for
rout
ine
clea
ning
verif
icat
ion.
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
41
Th
e C
DC
has
a w
ish
….
“A
lthou
gh th
e ef
fect
iven
ess
of h
igh-
leve
l dis
infe
ctio
n an
d
ster
iliza
tion
man
date
s ef
fect
ive
clea
ning
, no
“rea
l-tim
e”
test
s ex
ist t
hat c
an b
e em
ploy
ed in
a c
linic
al s
ettin
g to
verif
y cl
eani
ng. I
f suc
h te
sts
wer
e co
mm
erci
ally
ava
ilabl
e
they
cou
ld b
e us
ed to
ens
ure
an a
dequ
ate
leve
l of
clea
ning
.”
C
DC
: Gui
delin
e fo
r D
isin
fect
ion
and
Ste
riliz
atio
n in
Hea
lthca
re F
acili
ties
2008
. W
.
Rut
ala,
D. W
eber
and
HIC
PA
C. p
.36-
37
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
42
3M™
Cle
an-T
race
™
Ho
spit
al S
tud
ies
•H
ospi
tal S
PD
Stu
dies
•
Vis
it 3
hosp
ital S
PD
s to
tria
l Cle
an-T
race
pro
cedu
res
•H
ospi
tals
cho
sen
for
base
line
stud
y ar
e co
nsid
ered
to
be
prem
ier
hosp
itals
with
ver
y pr
ofic
ient
SP
Ds
•O
bjec
tive
was
to d
emon
stra
te a
pplic
abili
ty
•C
hose
inst
rum
ent s
ets
sugg
este
d by
hos
pita
l pe
rson
nel a
s ha
rd to
cle
an
•C
hose
inst
rum
ent s
ubse
ts b
ased
on
diffi
culty
to
clea
n an
d am
ount
of v
isib
le (
heav
y to
ligh
t soi
l le
vels
)
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
43
Data
: H
osp
ital 1
*No
te:
the
sc
rew
dri
ve
r a
nd
bro
ac
h a
pp
ea
red
vis
ibly
cle
an
aft
er
the
en
zym
e/h
an
d w
as
hin
g s
tep
; h
ow
eve
r, C
lea
n-T
rac
e r
es
ult
s i
nd
ica
ted
th
at
the
se
ite
ms
ma
y s
till
be
dir
ty u
sin
g a
n R
LU
cu
t-o
ff o
f 2
50
RL
U
*
1
10
100
10
00
10000
10
00
00
10
00
00
0
Pre
cle
an
ing
RL
U
En
zym
e C
lea
nin
g/ H
an
d
wa
sh
ing
RL
U
Wa
sh
er-
Dis
infe
cto
r R
LU
*
Ba
ckg
rou
nd
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
44
Data
: H
osp
ital 2
1
10
10
0
10
00
10
00
0
10
00
00
10
00
00
0
Pre
cle
an
ing
RL
U
En
zym
e C
lea
nin
g/ H
an
d
wa
sh
ing
RL
U
Wa
she
r-D
isin
fect
or
RL
U
Ba
ckg
rou
nd
*No
te:
wo
rker
sk
ipp
ed
th
e h
an
d w
ash
of
the h
am
mer
an
d L
-
sh
ap
ed
sp
rea
de
r; C
lean
-Tra
ce™
was a
ble
to
dete
ct
the
mis
sed
ste
p.
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
45
Dat
a: H
osp
ital
3
1
10
100
1,0
00
10,0
00
100,0
00
1,0
00,0
00
10,0
00,0
00
Pre
cle
anin
g R
LU
En
zym
e C
lean
ing
/Han
dw
ash
ing
R
LU
So
nic
atio
n R
LU
Was
he
r-D
isin
fect
or R
LU
Ba
ckg
rou
nd
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
46
Co
mp
iled
dat
a fr
om
Ho
spit
al T
rial
s
•All
step
s of
was
h an
d di
sinf
ectio
n
proc
ess
are
clea
rly s
epar
ated
•Red
uctio
n af
ter
man
ual w
ash
is
near
ly 3
logs
(bl
ue)
•Was
her-
disi
nfec
tion
show
s
addi
tiona
l 1.5
log
redu
ctio
n (r
ed)
to
near
bac
kgro
und
leve
ls (
gree
n)
•Ins
trum
ents
that
sho
w th
e hi
ghes
t
RLU
val
ues
afte
r au
tom
ated
was
h
and
disi
nfec
tion
are
also
the
sam
e
inst
rum
ents
that
sho
w e
leva
ted
RLU
valu
e af
ter
hand
was
hing
.(ci
rcle
d
data
poi
nts)
0
1020
0.51.01.52.02.53.03.54.04.55.05.56.06.5
Log(RLUs) (a.u.)
Swab
Num
ber
Han
d-Was
h A
fter W
ash-D
isinfe
ction
Pre-
Was
h
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
47
Ste
riliz
atio
n
Hig
h-L
evel
Dis
infe
ctio
n
Rea
mer
Mo
squ
ito
Cla
mp
Ro
ng
eur
Rea
mer
Mo
squ
ito
Cla
mp
Ro
ng
eur
Rea
mer
Mo
squ
ito
Cla
mp
Ro
ng
eur
On
e D
eco
nta
min
atio
n C
ycle
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n
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
48
Key
Lea
rnin
gs
•In
itial
hos
pita
l tria
ls d
emon
stra
te a
pplic
abili
ty o
f the
Cle
an-
Tra
ce a
s a
clea
n m
onito
r in
CS
SD
•D
ata
was
rep
eata
ble
with
in s
ite a
nd a
ppea
red
cons
iste
nt
site
-to-
site
•C
lean
-Tra
ce™
dem
onst
rate
d th
e ef
fect
iven
ess
of th
e m
anua
l was
h pr
oces
s an
d w
as a
ble
to d
etec
t ski
ps in
cl
eani
ng p
roce
dure
s.
© 3
M 2
011.
All
Rig
hts
Res
erve
d.
49
Su
mm
ary
– E
nvi
ron
men
tal S
urf
aces
•M
DR
O p
atho
gens
sur
vive
in th
e en
viro
nmen
t le
adin
g to
incr
ease
d en
viro
nmen
tal c
onta
min
atio
n
•E
nviro
nmen
tal c
onta
min
atio
n m
ay le
ad to
dire
ct tr
ansm
issi
on o
f M
DR
O to
pat
ient
s an
d H
CW
s
•T
rans
mis
sion
of p
atho
gens
can
be
redu
ced
by in
crea
sed
clea
ning
.
•C
urre
nt r
ecom
men
ded
prac
tices
des
crib
e cl
eani
ng m
onito
ring
as
part
of a
qua
lity
cont
rol p
rogr
am
•T
he s
tand
ard
prac
tice
of v
isua
l ass
essm
ent i
s no
long
er a
dequ
ate
for
the
mon
itorin
g of
cle
anin
g ef
ficac
y
•V
isua
l ass
essm
ent,
fluor
esce
nt p
owde
rs/lo
tions
/gel
s, a
erob
ic
colo
ny c
ount
s an
d A
TP
bio
lum
ines
cenc
e ar
e al
l cur
rent
ly u
sed
to
mon
itor
clea
ning
pro
toco
ls.
•T
oget
her
with
edu
catio
nal i
nter
vent
ions
, m
onito
ring
tech
nolo
gies
ca
n be
use
d to
incr
ease
the
effi
cacy
of a
nd c
ompl
ianc
e w
ith
clea
ning
pro
toco
ls.
© 3
M 2
010.
All
Rig
hts
Res
erve
d.
50
Que
stio
ns?
© 3
M 2
011.
for
com
plet
ing
the
3MT
M
Ste
rile
U s
emin
ar:
No
Mo
re W
hit
e G
love
s: C
lean
ing
Mo
nit
ori
ng
in H
ealt
hca
re T
od
ay (1
.0 C
E)
Inse
rvic
e ap
prov
ed b
y C
BS
PD
for
1.0
Con
tact
Hou
r, A
ppro
val C
ode
# 22
686W
CO
R11
IAH
CS
MM
has
aw
arde
d 1.
0 C
onta
ct H
our,
App
rova
l Cod
e #
0003
2612
Cer
tifi
cate
of A
tten
dan
ce
Mar
y K
undu
s, R
N, B
SN
, MP
H, C
IC
Dat
e
Loca
tion
3M H
ealth
Car
e P
rovi
der A
ppro
ved
by th
e C
alifo
rnia
Boa
rd o
f Reg
iste
red
Nur
sing
Pro
vide
r N
umbe
r C
EP
577
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r 1.
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onta
ct H
our
Thi
s ce
rtifi
cate
mus
t be
reta
ined
by
the
licen
see
for
a pe
riod
of fo
ur y
ears
afte
r th
e co
urse
end
s.
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