no more white gloves - central plains...
TRANSCRIPT
© 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
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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
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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
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ospi
tals
cho
sen
for
base
line
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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
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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
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zym
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an
d w
as
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; h
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lea
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nd
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se
ite
ms
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y s
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n R
LU
cu
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RL
U
*
1
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10000
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00
00
10
00
00
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Pre
cle
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ing
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zym
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an
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r R
LU
*
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ckg
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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
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Pre
cle
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RL
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Wa
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r-D
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fect
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RL
U
Ba
ckg
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nd
*No
te:
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rker
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ipp
ed
th
e h
an
d w
ash
of
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am
mer
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-
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
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00
Pre
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LU
En
zym
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ing
R
LU
So
nic
atio
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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)
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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)
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0.51.01.52.02.53.03.54.04.55.05.56.06.5
Log(RLUs) (a.u.)
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ber
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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
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© 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
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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
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by
the
licen
see
for
a pe
riod
of fo
ur y
ears
afte
r th
e co
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end
s.