BACKGROUND: Despite the important role that cleaning plays in reducing the risk of healthcare-associated infections no research has been done to quantify the time required to effectively clean and disinfect different pieces of shared medical equipment commonly used in hospitals. In this short report, we present results from a study that aims to quantify the time required to effectively clean common pieces of shared medical equipment.
METHODS: We conducted an observational time and motion study in a nursing simulation laboratory, to determine the time required to effectively clean and disinfect 12 pieces of shared medical equipment commonly used in hospital. After receiving training, participants cleaned and disinfected equipment with the time taken to clean recorded. Cleaning effectiveness was determined if ≥80% of ultraviolet fluorescent dots were removed during the cleaning process.
RESULTS: The time to effectively clean equipment ranged from 50 sec (blood glucose testing kit; 95%CI 0:40-1:00 (min:sec)) to 3 min 53 sec (medication trolley; 95%CI 3:36-4:11 (min:sec)). The intravenous stand was most effectively cleaned, with 100% of dots removed (n = 100 dots). Contrastingly, the bladder scanner was the most difficult to clean, with 12 attempts required to meet the 80% cleaned criteria.
CONCLUSIONS: This study will inform staffing and training requirements to effectively plan the cleaning and disinfect of shared medical equipment. Findings can also be used for business cases and in future cost-effectiveness evaluations of cleaning interventions that include shared medical equipment.

BACKGROUND: Effective infection prevention and control programs can positively influence quality of care, increase patient safety, and protect health care providers. Chlorine, a widely used and effective chemical disinfectant, is recommended for infection prevention and control in health care settings. However, lack of consistent chlorine availability limits its use. Electrolytic chlorine generators can address limited chlorine supply and stockouts by enabling onsite production of readily usable, high-quality chlorine cost-effectively. We report the feasibility (i.e., performance, acceptability, chlorine availability, and cost) of the electrolytic STREAM Disinfectant Generator (Aqua Research, New Mexico, USA) device for infection prevention and control in primary health care facilities in Uganda.
METHODS: We installed STREAM devices in 10 primary health care facilities in central and western Uganda. Commercial chlorine inventory records (stock cards) were reviewed in each facility to calculate average liters of chlorine received and used per month. These values were compared with actual STREAM chlorine production volumes over the study period to determine its impact on chlorine availability. We collected acceptability data from a purposive sample of device users (n = 16), hospital administrators (n = 10), and district health officers (n = 6) who had been directly involved in the operation or supervision of the STREAM device. We descriptively analyzed the acceptability data by user group and evaluated qualitative responses manually using a thematic approach. Cost data were normalized and modeled to determine a break-even and cost-savings analysis across a five-year period (the minimum expected lifespan of the STREAM device).
RESULTS: Chlorine was consistently available without any reported stockouts during the evaluation period. STREAM chlorine production resulted in a 36.9 percent cost-savings over a five-year period compared to commercial chlorine. User acceptability of the STREAM device was high among STREAM operators, hospital administrators, and district health officers, with all respondents reporting that STREAM moderately or significantly improved infection prevention and control practices in the health facility. Overall, 88 percent of device users and 100 percent of hospital administrators wished to continue using the STREAM device instead of commercial chlorine products.
CONCLUSIONS: The STREAM device has demonstrated significant potential to strengthen infection prevention and control practices in health care facilities in Uganda. Based on the preliminary results, the STREAM device should be considered a promising tool for district hospitals and large health centers facing infection prevention and control challenges in Uganda and elsewhere, provided water and electricity are available. Going forward, implementation of the STREAM device could also be considered in smaller health care facilities in Uganda and elsewhere.

BACKGROUND: Improving hospital environmental hygiene can reduce environmental contamination and cross-transmission risk, a precursor to healthcare associated infections (HAI). With poor cleaning practice a demonstrated problem, the process of converting evidence into practice requires investigation. The aim of this study was to assess the effectiveness of an environmental hygiene bundle in terms of changes to HAI rates, cleaning performance and environmental services workers (ESW) knowledge and attitudes.
METHODS: A multi-modal bundle was designed and implemented with ESW in eight wards, in a 400-bed metropolitan teaching hospital, using a prospective, before-and-after study design. This consisted of a three-month pre-intervention phase and six-month intervention phase. This research used an implementation science framework to guide the transition from evidence into practice, with data collected in the pre-intervention phase synthesised to design the implementation strategy.
RESULTS: There was no statistically significant change in infection rates in the six-month period. Significant improvements in cleaning performance were observed, with the average proportion of ultraviolet markers removed during cleaning across the wards increasing from 61.1% to 95.4%. Results also demonstrate improvements to both the knowledge and attitudes of ESW.
CONCLUSIONS: By combining infection prevention and implementation science, this bundle was an effective way to engage environmental services staff and improve hospital cleaning.

BACKGROUND: Effective surface cleaning in hospitals is crucial to prevent the transmission of pathogens. However, hospitals in low- and middle-income countries face cleaning challenges due to limited resources and inadequate training.
METHODS: We assessed the effectiveness of a modified TEACH CLEAN programme for trainers in reducing surface microbiological contamination in the newborn unit of a tertiary referral hospital in The Gambia. We utilised a quasi-experimental design and compared data against those from the labour ward. Direct observations of cleaning practices and key informant interviews were also conducted to clarify the programme\'s impact.
RESULTS: Between July and September 2021 (pre-intervention) and October and December 2021 (post-intervention), weekly surface sampling was performed in the newborn unit and labour ward. The training package was delivered in October 2021, after which their surface microbiological contamination deteriorated in both clinical settings. While some cleaning standards improved, critical aspects such as using fresh cleaning cloths and the one-swipe method did not. Interviews with senior departmental and hospital management staff revealed ongoing challenges in the health system that hindered the ability to improve cleaning practices, including COVID-19, understaffing, disruptions to water supply and shortages of cleaning materials.
CONCLUSIONS: Keeping a hospital clean is fundamental to good care, but training hospital cleaning staff in this low-income country neonatal unit failed to reduce surface contamination levels. Further qualitative investigation revealed multiple external factors that challenged any possible impact of the cleaning programme. Further work is needed to address barriers to hospital cleaning in low-income hospitals.

As population density increases, environmental hygiene and public health become increasingly severe. As the space where residents stay for the longest time and have the most profound impact on their physical and mental health, the quality of the environment in urban communities largely determines the degree to which residents engage in physical activity, bear the risk of pollution exposure, and obtain healthy food. Therefore, in order to ensure the physical and mental health of residents, this study proposes community planning guided by environmental hygiene and public health, and establishes an environmental health assessment system for this purpose. This system evaluates the community environment from four aspects: land use, service facilities, site convenience, and environmental quality. Established the diversity, density, road network connectivity and facilities accessibility nine criteria, as well as the land function of mix, plot ratio, food environment, network ring α and connected β index, pavement risk level, green configuration and neighborhood material environment disorder degree of 27 indicators of community built environmental evaluation index system. The data is collected through field survey, questionnaire distribution, resident interview and data mapping, and the established evaluation index system is used to evaluate the construction environment of the community. The experimental research data included population data, CAD plan, land use data, street data, POI point data, building data and bus station data, etc. 273 questionnaires were distributed, 264 were recovered, 8 invalid questionnaires were removed, and 256 valid questionnaires were obtained. These experiments confirm that land use, service facilities, site convenience, and environmental quality have a significant impact on the built environment of communities, with impact weights of 0.513, 0.227, 0.135, and 0.125, respectively. The above weights are calculated based on the index judgment matrix and the eigenvectors. The scores of land use, service facilities, site convenience, and environmental quality for the study subjects were 3.44, 1.46, 0.94, and 0.51, respectively, among them, the land use score is less than 3.85, the 1 service facility score is less than 1.71, the site convenience score is less than 1.01, and the environmental quality score is less than 0.94; indicating that the community has serious problems such as single land use types, pollution exposure, and difficulty in obtaining healthy food. Therefore, community planning and transformation based on land use, service facilities, venue convenience, and environmental quality can effectively improve the physical and mental health of residents. In the specific community transformation plan, artificial intelligence and data-driven methods can be used to optimize the land use plan, service facility configuration, site convenience transformation and environmental quality improvement, so as to formulate the optimal community transformation plan and improve the comfort and happiness of community residents. In the future, on the basis of the existing research, the selection of community types will be further enriched and the research cases will be expanded. And through the in-depth practical study of the case, the constructed evaluation index system is optimized and improved to make it more scientific. At the same time, as urban renewal and design have entered the era of stock planning, based on the more perfect evaluation index system, more specific and detailed system discussion of the built communities with public health problems, in order to provide more detailed services for the construction of a better and healthy living environment in the future.

暂无摘要。

BACKGROUND: Hospital-acquired infections pose an ongoing threat to patient safety due to the presence of multi-drug-resistant organisms (MDROs) and other pathogens such as Clostridioides difficile which are dependent on thorough and effective cleaning and disinfection by personnel.
METHODS: This study evaluated the influence of UV-C air treatment: the air in the room was sanitized by UV-C and redirected into the room. In addition, ozone was released into the room to treat actual surfaces in low-risk areas such as hospital gyms, and high- to medium-risk areas such as hospital rooms. To this aim, a portable device designed for treating the environment air was tested against nine bacterial strains including Aspergillus spp. and Clostridioides spp.
RESULTS: The use of UV-C air treatment during daily operations and ozone treatment achieved at least a 2-log10 pathogen reduction except for Clostridioides spp.
CONCLUSIONS: Effective prevention of C. difficile normally requires the use of combined approaches that include chemical compounds and disinfection agents whose toxicity can be harmful not only to patients but also to healthcare personnel. Thus, the proposed no-touch device may be evaluated in future research to assess the needed requirements for its possible and full implementation in hospitals.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is primarily transmitted from person to person through respiratory droplets and aerosols. It is also possible for the virus to be transmitted indirectly through environmental contamination. The likelihood of environmental transmission depends on several factors, including the survival time of the virus in respiratory secretions. However, the stability of SARS-CoV-2 in respiratory secretions has not been investigated. In this study, we compared the half-life of the SARS-CoV-2 antigen in respiratory secretion under different conditions. We applied respiratory secretion (5 µL) to glass slides, air-dried the slides for 1 h, and kept them at 24 °C or 4 °C for 10 days. Respiratory secretions were also placed in test tubes (sealed to preserve moisture) and in normal saline for 10 days. The concentration of SARS-CoV-2 antigen in all samples was simultaneously measured using colloidal gold immunochromatography, and the half-life of the antigen was calculated. The half-life of the antigen in the wet (sealed tube) and saline samples at room temperature was 5.0 and 2.92 days, respectively. The half-life of the antigen in the air-dried sample at room temperature and at 4 °C was 2.93 and 11.4 days, respectively. The half-life was longer in respiratory secretions than that in normal saline. The half-life was also longer in respiratory secretions, at a lower temperature, and under wet conditions. Therefore, environmental transmission can also play a significant role in the spread of the virus. Robust prevention and control strategies could be developed based on the half-life of the antigen in respiratory secretions.

UNASSIGNED: The impact of environmental hygiene on the occurrence of hospital-acquired infections (HAIs) remains a subject of debate. We determined the effect of three different surface-cleaning strategies on the incidence of HAIs.
UNASSIGNED: Between June 2017 and August 2018 we conducted a pragmatic, cluster-randomized controlled crossover trial at 18 non-ICU wards in the university hospital of Berlin, Germany. Surfaces in patient rooms on the study wards were routinely cleaned using one of three agents: Soap-based (reference), disinfectant and probiotic. Each strategy was used on each ward for four consecutive months (4m-4m-4m). There was a one-month wash-in period at the beginning of the study and after each change in strategy. The order of strategies used was randomized for each ward. Primary outcome was the incidence of HAIs. The trial was registered with the German Clinical Trials Register, DRKS00012675.
UNASSIGNED: 13,896 admitted patients met the inclusion criteria, including 4708 in the soap-based (reference) arm, 4535 in the disinfectant arm and 4653 in the probiotic arm. In the reference group, the incidence density of HAIs was 2.31 per 1000 exposure days. The incidence density was similar in the disinfectant arm 2.21 cases per 1000 exposure days (IRR 0.95; 95% CI 0.69-1.31; p = 0.953) and the probiotic arm 2.21 cases per 1000 exposure days (IRR 0.96; 95% CI 0.69-1.32; p = 0.955).
UNASSIGNED: In non-ICU wards, routine surface disinfection proved not superior to soap-based or probiotic cleaning in terms of HAI prevention. Thus, probiotic cleaning could be an interesting alternative, especially in terms of environmental protection.
UNASSIGNED: Federal Ministry of Education and Research of Germany (03Z0818C). Bill and Melinda Gates Foundation (INV-004308).

Healthcare environmental hygiene (HEH) has become recognized as being increasingly important for patient safety and the prevention of healthcare-associated infections. At the 2022 Healthcare Cleaning Forum at Interclean in Amsterdam, the academic lectures focused on a series of main areas of interest. These areas are indicative of some of the main trends and avenues for research in the coming years. Both industry and academia need to take steps to continue the momentum of HEH as we transition out of the acute phase of the Covid-19 pandemic. There is a need for new ways to facilitate collaboration between the academic and private sectors. The Clean Hospitals® network was presented in the context of the need for both cross-disciplinarity and evidence-based interventions in HEH. Governmental bodies have also become more involved in the field, and both the German DIN 13603 standard and the UK NHS Cleaning Standards were analyzed and compared. The challenge of environmental pathogens was explored through the example of how P. aeruginosa persists in the healthcare environment. New innovations in HEH were presented, from digitalization to tracking, and automated disinfection to antimicrobial surfaces. The need for sustainability in HEH was also explored, focusing on the burden of waste, the need for a circular economy, and trends towards increasingly local provision of goods and services. The continued focus on and expansion of these areas of HEH will result in safer patient care and contribute to better health systems.