Efficiency of cleaning and disinfection of surfaces: correlation between assessment methods

Frota, Oleci Pereira; Ferreira, Adriano Menis; Guerra, Odanir Garcia; Rigotti, Marcelo Alessandro; Andrade, Denise de; Borges, Najla Moreira Amaral; Almeida, Margarete Teresa Gottardo de

doi:10.1590/0034-7167-2016-0608

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Revista Brasileira de Enfermagem

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RESEARCH • Rev. Bras. Enferm. 70 (6) • Nov-Dec 2017 • https://doi.org/10.1590/0034-7167-2016-0608 copy

Efficiency of cleaning and disinfection of surfaces: correlation between assessment methods

Eficiencia de la limpieza y desinfección de superficies: correlación entre métodos de evaluación

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to assess the correlation among the ATP-bioluminescence assay, visual inspection and microbiological culture in monitoring the efficiency of cleaning and disinfection (C&D) of high-touch clinical surfaces (HTCS) in a walk-in emergency care unit.

Method:

a prospective and comparative study was carried out from March to June 2015, in which five HTCS were sampled before and after C&D by means of the three methods. The HTCS were considered dirty when dust, waste, humidity and stains were detected in visual inspection; when ≥2.5 colony forming units per cm² were found in culture; when ≥5 relative light units per cm² were found at the ATP-bioluminescence assay.

Results:

720 analyses were performed, 240 per method. The overall rates of clean surfaces per visual inspection, culture and ATP-bioluminescence assay were 8.3%, 20.8% and 44.2% before C&D, and 92.5%, 50% and 84.2% after C&D, respectively (p<0.001). There were only occasional statistically significant relationships between methods.

Conclusion:

the methods did not present a good correlation, neither quantitative nor qualitatively.

Descriptors:
Equipment Contamination; Housekeeping; Nursing Audit; Health Facility Environment; Infectious Disease Transmission

Time / surfaces	Visual	ATP^* * ATP-bioluminescence; (RLU/cm²)		ACC (CFU/cm²)		p value^† † Test for two proportions;
Time / surfaces	Disapproval n (%)	Median (variation)	Disapproval n (%)	Median (variation)	Disapproval n (%)	ATP vs visual	ATP vs ACC	ACC vs visual
Before C&D
Med Prep 1	23 (95.8)	6.9 (1.2-209.7)	15 (62.5)	3.1 (0.1-74.6)	13 (54.2)	0.010	0.770^‡ ‡ p ≥0.05, indicating a correlation between methods; ATP – adenosine triphosphate; RLU – relative light units; ACC – aerobic colony count; CFU – colony forming units; C&D – cleaning and disinfection.	<0.001
Heart Monitor	16 (66.7)	8.1 (2-1148.7)	15 (62.5)	1.4 (0.9-11)	8 (33.3)	1.000^‡ ‡ p ≥0.05, indicating a correlation between methods; ATP – adenosine triphosphate; RLU – relative light units; ACC – aerobic colony count; CFU – colony forming units; C&D – cleaning and disinfection.	0.082^‡ ‡ p ≥0.05, indicating a correlation between methods; ATP – adenosine triphosphate; RLU – relative light units; ACC – aerobic colony count; CFU – colony forming units; C&D – cleaning and disinfection.	0.022
Med Prep 2	23 (95.8)	11.2 (3.3-37.5)	22 (91.7)	2.9 (0.1-67.7)	13 (54.2)	1.000^‡ ‡ p ≥0.05, indicating a correlation between methods; ATP – adenosine triphosphate; RLU – relative light units; ACC – aerobic colony count; CFU – colony forming units; C&D – cleaning and disinfection.	0.008	<0.001
Dressing trolley	24 (100)	14 (4.1-2920.3)	23 (95.8)	3.5 (0.4-69)	16 (66.7)	1.000^‡ ‡ p ≥0.05, indicating a correlation between methods; ATP – adenosine triphosphate; RLU – relative light units; ACC – aerobic colony count; CFU – colony forming units; C&D – cleaning and disinfection.	0.023	0.001
Mattress	24 (100)	15.3 (1.9-221.2)	20 (83.3)	2.9 (0.5-82)	13 (54.2)	0.109^‡ ‡ p ≥0.05, indicating a correlation between methods; ATP – adenosine triphosphate; RLU – relative light units; ACC – aerobic colony count; CFU – colony forming units; C&D – cleaning and disinfection.	0.060^‡ ‡ p ≥0.05, indicating a correlation between methods; ATP – adenosine triphosphate; RLU – relative light units; ACC – aerobic colony count; CFU – colony forming units; C&D – cleaning and disinfection.	<0.001
All	110 (91.7)	11.2 (1.2-2920.3)	95 (87.1)	2.7 (0.1-81.9)	67 (61.4)	0.010	<0.001	<0.001
After C&D
Med Prep 1	1 (4.2)	4.2 (0.4-18.5)	10 (41.7)	0.9 (0-18.8)	2 (8.3)	0.004	0.017	1.000^‡ ‡ p ≥0.05, indicating a correlation between methods; ATP – adenosine triphosphate; RLU – relative light units; ACC – aerobic colony count; CFU – colony forming units; C&D – cleaning and disinfection.
Heart Monitor	0 (0)	1.4 (0.5-3.7)	0 (0)	0.2 (0-10.5)	3 (12.5)	1.000^‡ ‡ p ≥0.05, indicating a correlation between methods; ATP – adenosine triphosphate; RLU – relative light units; ACC – aerobic colony count; CFU – colony forming units; C&D – cleaning and disinfection.	0.234^‡ ‡ p ≥0.05, indicating a correlation between methods; ATP – adenosine triphosphate; RLU – relative light units; ACC – aerobic colony count; CFU – colony forming units; C&D – cleaning and disinfection.	0.234^‡ ‡ p ≥0.05, indicating a correlation between methods; ATP – adenosine triphosphate; RLU – relative light units; ACC – aerobic colony count; CFU – colony forming units; C&D – cleaning and disinfection.
Med Prep 2	1 (4.2)	7.5 (0.7-56.7)	16 (66.7)	0.4 (0.1-8)	3 (12.5)	<0.001	<0.001	<0.001
Dressing trolley	9 (37.5)	7.1 (0.5-21.5)	18 (75)	0.1 (0-68.5)	4 (16.7)	0.534^‡ ‡ p ≥0.05, indicating a correlation between methods; ATP – adenosine triphosphate; RLU – relative light units; ACC – aerobic colony count; CFU – colony forming units; C&D – cleaning and disinfection.	0.724^‡ ‡ p ≥0.05, indicating a correlation between methods; ATP – adenosine triphosphate; RLU – relative light units; ACC – aerobic colony count; CFU – colony forming units; C&D – cleaning and disinfection.	0.193^‡ ‡ p ≥0.05, indicating a correlation between methods; ATP – adenosine triphosphate; RLU – relative light units; ACC – aerobic colony count; CFU – colony forming units; C&D – cleaning and disinfection.
Mattress	1 (4.2)	5.9 (1.4-271)	14 (58.3)	0.8 (0.1-5.4)	2 (8.3)	<0.001	0.001	1.000^‡ ‡ p ≥0.05, indicating a correlation between methods; ATP – adenosine triphosphate; RLU – relative light units; ACC – aerobic colony count; CFU – colony forming units; C&D – cleaning and disinfection.
All	12 (10.0)	4.9 (04-270.9)	58 (48.3)	0.2 (0-68.5)	14 (11.7)	<0.001	<0.001	0.684^‡ ‡ p ≥0.05, indicating a correlation between methods; ATP – adenosine triphosphate; RLU – relative light units; ACC – aerobic colony count; CFU – colony forming units; C&D – cleaning and disinfection.

Method	Characteristics of the test to define a surface as dirty (%)
Method	Sensitivity	Specificity	PPV^† † positive predictive value;	NPV^‡ ‡ negative predictive value.	Accuracy
Visual inspection	83.1	64.4	52.5	89	70.4
ATP^* * ATP-bioluminescence; (< 5 RLU/cm²)	78	42.9	39.2	80.5	54.1
ATP^* * ATP-bioluminescence; (< 8 RLU/cm²)	62.3	61.4	43.2	77.5	61.7

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[1] CORRESPONDING AUTHOR Oleci Pereira Frota E-mail: olecifrota@gmail.com