Effectiveness of various cleaning strategies in acute and long-term care facilities during novel corona virus 2019 disease pandemic-related staff shortages

  1. Emil Lesho
  2. Donna Newhart
  3. Lisa Reno
  4. Scott Sleeper
  5. Julia Nary
  6. Jennifer Gutowski
  7. Stephanie Yu
  8. Edward Walsh
  9. Roberto Vargas
  10. Dawn Riedy
  11. Robert Mayo

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Abstract

Cleanliness of hospital surfaces helps prevent healthcare-associated infections, but comparative evaluations of various cleaning strategies during COVID-19 pandemic surges and worker shortages are scarce.

Purpose and methods

To evaluate the effectiveness of daily, enhanced terminal, and contingency-based cleaning strategies in an acute care hospital (ACH) and a long-term care facility (LTCF), using SARS-CoV-2 RT-PCR and adenosine triphosphate (ATP) assays. Daily cleaning involved light dusting and removal of visible debris while a patient is in the room. Enhanced terminal cleaning involved wet moping and surface wiping with disinfectants after a patient is permanently moved out of a room followed by ultraviolet light (UV-C), electrostatic spraying, or room fogging. Contingency-based strategies, performed only at the LTCF, involved cleaning by a commercial environmental remediation company with proprietary chemicals and room fogging. Ambient surface contamination was also assessed randomly, without regard to cleaning times. Near-patient or high-touch stationary and non-stationary environmental surfaces were sampled with pre-moistened swabs in viral transport media.

Results

At the ACH, SARS-CoV-2 RNA was detected on 66% of surfaces before cleaning and on 23% of those surfaces immediately after terminal cleaning, for a 65% post-cleaning reduction (p = 0.001). UV-C enhancement resulted in an 83% reduction (p = 0.023), while enhancement with electrostatic bleach application resulted in a 50% reduction (p = 0.010). ATP levels on RNA positive surfaces were not significantly different from those of RNA negative surfaces. LTCF contamination rates differed between the dementia, rehabilitation, and residential units (p = 0.005). 67% of surfaces had RNA after room fogging without terminal-style wiping. Fogging with wiping led to a -11% change in the proportion of positive surfaces. At the LTCF, mean ATP levels were lower after terminal cleaning (p = 0.016).

Conclusion

Ambient surface contamination varied by type of unit and outbreak conditions, but not facility type. Removal of SARS-CoV-2 RNA varied according to cleaning strategy.

Implications

Previous reports have shown time spent cleaning by hospital employed environmental services staff did not correlate with cleaning thoroughness. However, time spent cleaning by a commercial remediation company in this study was associated with cleaning effectiveness. These findings may be useful for optimizing allocation of cleaning resources during staffing shortages.

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  1. Version published to 10.1371/journal.pone.0261365
  2. ScreenIT

    SciScore for 10.1101/2021.04.13.21255427: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    RandomizationAt the ACH and the LTCF, for both random and controlled sampling, dedicated COVID-19 units were used as ‘positive control wards’, and wards which had zero COVID-19 patients identified were uses as ‘negative control wards’.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has several limitations. First, safety concerns and the lack of a BSL-3 level resources precluded the use of viral cultures to determine viability of virus, but nucleic acid of target pathogens can be consequential [19]. Furthermore, lack of culture-based assessments is not unique to our study [4-9]. Second, sponge sticks may be better at capturing pathogens from larger environmental surfaces such as floors and tray tables. These collection devices were unavailable and could not be used in automated PCR reaction tubes. Third, the commercial remediation service and EVS were not compared under identical conditions, but our main objective was not a direct head-to-head comparison of EVS vs contracted remediation service. Despite these limitations, this report is relevant to nursing homes and hospitals as the findings can assist in allocation of scarce cleaning and disinfection resources for maximum impact. Furthermore, studies of the survivability of the virus on fomites have been criticized as lacking real-life generalizability [22, 23]. Data in this report were obtained from a ‘typical’ general hospital and nursing home, representative of the type of settings (i.e. general/community/non-university-based hospitals) where much of health care is delivered. Studies for these settings may be underrepresented in research because most are carried out in large university-based hospitals. In summary, surface contamination with SARS-CoV-2 RNA significantly differed based on typ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.04.13.21255427v1 on medRxiv