Exploring surface cleaning strategies in hospital to prevent contact transmission of methicillin-resistant Staphylococcu
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RESEARCH ARTICLE
Open Access
Exploring surface cleaning strategies in hospital to prevent contact transmission of methicillin-resistant Staphylococcus aureus Hao Lei1* , Rachael M. Jones2 and Yuguo Li1
Abstract Background: Cleaning of environmental surfaces in hospitals is important for the control of methicillin-resistant Staphylococcus aureus (MRSA) and other hospital-acquired infections transmitted by the contact route. Guidance regarding the best approaches for cleaning, however, is limited. Methods: In this study, a mathematical model based on ordinary differential equations was constructed to study MRSA concentration dynamics on high-touch and low-touch surfaces, and on the hands and noses of two patients (in two hospitals rooms) and a health care worker in a hypothetical hospital environment. Two cleaning interventions – whole room cleaning and wipe cleaning of touched surfaces – were considered. The performance of the cleaning interventions was indicated by a reduction in MRSA on the nose of a susceptible patient, relative to no intervention. Results: Whole room cleaning just before first patient care activities of the day was more effective than whole room cleaning at other times, but even with 100% efficiency, whole room cleaning only reduced the number of MRSA transmitted to the susceptible patient by 54%. Frequent wipe cleaning of touched surfaces was shown to be more effective that whole room cleaning because surfaces are rapidly re-contaminated with MRSA after cleaning. Wipe cleaning high-touch surfaces was more effective than wipe cleaning low-touch surfaces for the same frequency of cleaning. For low wipe cleaning frequency (≤3 times per hour), high-touch surfaces should be targeted, but for high wipe cleaning frequency (>3 times per hour), cleaning should target high- and low-touch surfaces in proportion to the surface touch frequency. This study reproduces the observations from a field study of room cleaning, which provides support for the validity of our findings. Conclusions: Daily whole room cleaning, even with 100% cleaning efficiency, provides limited reduction in the number of MRSA transmitted to susceptible patients via the contact route; and should be supplemented with frequent targeted cleaning of high-touch surfaces, such as by a wipe or cloth containing disinfectant. Keywords: Methicillin-resistant Staphylococcus aureus, Hospital, Surface cleaning, Mathematical model, High-touch surfaces
Background Methicillin-resistant Staphylococcus aureus (MRSA) has become an important cause of hospital-acquired infections (HAIs) worldwide [1]. MRSA can be transmitted by the contact route [2], which is consistent with the influence of MRSA-contaminated environmental surfaces, equipment, and hands of health care workers (HCWs) * Correspondence: [email protected] 1 Department of Mechanical Engineering, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China Full list of author information is available at the end of the article
on MRSA HAIs [3]. Cleaning and disinfection of environmental surface
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