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      Educational Intervention on Cleaning and Sanitation of Surfaces in a Pediatric Hospitalization Unit

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          Abstract

          Introduction

          Environmental surfaces may serve as a reservoir for various microorganisms and consequently, they represent a potential risk for the spread of healthcare-associated infections.

          Objective

          This study aimed to assess the cleaning and sanitation of surfaces (CSS) before and after implementing a Standardization Program for Cleaning and Sanitation of Surfaces (SPCSS).

          Methods

          An analytical, comparative, and intervention study was conducted from 2020 to 2021 in a pediatric hospitalization unit in Midwest Brazil. Four frequently touched surfaces were monitored before and after the cleaning and sanitation process using the following methods: Adenosine Triphosphate (ATP) quantification, Colony-Forming Unit (CFU) count, and visual inspection. The study consisted of three stages: stage I (situational diagnosis of the CSS process), stage II (implementation of the SPCSS), and stage III (assessment 60 days after implementing the program). A total of 576 assessments were performed in all three study stages.

          Results

          The CSS process was effective in all three study stages by using the ATP and CFU methods. In stage I, statistically significant results were obtained for four surfaces using the ATP method, and two by the CFU count. In stages II and III, all surfaces presented lower ATP and CFU results ( p<0.05). In the visual inspection, only the bathroom door handle (stage I: p=0.041; stage III: p=0.007) and toilet flush handle (stage I: p=0.026; stage III: p=0.007) passed the test.

          Implications for Nursing

          This study presents subsidies to evaluate the cleaning and disinfection process carried out by the nursing and hygiene team.

          Conclusion

          The SPCSS exerted a positive impact on the CSS process.

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          Most cited references46

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          The role of environmental cleaning in the control of hospital-acquired infection.

          S.J Dancer (2009)
          Increasing numbers of hospital-acquired infections have generated much attention over the last decade. The public has linked the so-called 'superbugs' with their experience of dirty hospitals but the precise role of environmental cleaning in the control of these organisms remains unknown. Until cleaning becomes an evidence-based science, with established methods for assessment, the importance of a clean environment is likely to remain speculative. This review will examine the links between the hospital environment and various pathogens, including meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, norovirus, Clostridium difficile and acinetobacter. These organisms may be able to survive in healthcare environments but there is evidence to support their vulnerability to the cleaning process. Removal with, or without, disinfectants, appears to be associated with reduced infection rates for patients. Unfortunately, cleaning is often delivered as part of an overall infection control package in response to an outbreak and the importance of cleaning as a single intervention remains controversial. Recent work has shown that hand-touch sites are habitually contaminated by hospital pathogens, which are then delivered to patients on hands. It is possible that prioritising the cleaning of these sites might offer a useful adjunct to the current preoccupation with hand hygiene, since hand-touch sites comprise the less well-studied side of the hand-touch site equation. In addition, using proposed standards for hospital hygiene could provide further evidence that cleaning is a cost-effective intervention for controlling hospital-acquired infection.
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            The role of environmental factors to transmission of SARS-CoV-2 (COVID-19)

            The current outbreak of the novel coronavirus disease 2019 (COVID-19) in more than 250 countries has become a serious threat to the health of people around the world. Human-to-human transmission of the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurs most often when people are in the incubation stage of the disease or are carriers and have no symptoms. Therefore, in this study, was discussed the role of environmental factors and conditions such as temperature, humidity, wind speed as well as food, water and sewage, air, insects, inanimate surfaces, and hands in COVID-19 transmission. The results of studies on the stability of the SARS-CoV-2 on different levels showed that the resistance of this virus on smooth surfaces was higher than others. Temperature increase and sunlight can facilitate the destruction of SARS-COV-2 and the stability of it on surfaces. When the minimum ambient air temperature increases by 1 °C, the cumulative number of cases decreases by 0.86%. According to the latest evidence, the presence of coronavirus in the sewer has been confirmed, but there is no evidence that it is transmitted through sewage or contaminated drinking water. Also, SARS-COV-2 transmission through food, food packages, and food handlers has not been identified as a risk factor for the disease. According to the latest studies, the possibility of transmitting SARS-COV-2 bioaerosol through the air has been reported in the internal environment of ophthalmology. The results additionally show that infectious bio-aerosols can move up to 6 feet. There have been no reports of SARS-COV-2 transmission by blood-feeding arthropods such as mosquitoes.
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              How do we assess hospital cleaning? A proposal for microbiological standards for surface hygiene in hospitals

              S.J Dancer (2003)
              Increasing numbers of hospital-acquired infections have generated much attention over the last decade. The public has linked the so-called ‘superbugs’ with their experience of dirty hospitals, but the precise role of cleaning in the control of these organisms in unknown. Hence the importance of a clean environment is likely to remain speculative unless it becomes an evidence-based science. This proposal is a call for bacteriological standards with which to assess clinical surface hygiene in hospitals, based on those used by the food industry. The first standard concerns any finding of a specific ‘indicator’ organism, the presence of which suggests a requirement for increased cleaning. Indicators would include Staphylococcus aureus, including methicillin-resistant S. aureus, Clostridium difficile, vancomycin-resistant enterococci and various Gram-negative bacilli. The second standard concerns a quantitative aerobic colony count of <5 cfu/cm2 on frequent hand touch surfaces in hospitals. The principle relates to modern risk management systems such as HACCP, and reflects the fact that pathogens of concern are widespread. Further work is required to evaluate and refine these standards and define the infection risk from the hospital environment.
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                Author and article information

                Journal
                TONURSJ
                Open Nurs J
                The Open Nursing Journal
                Open Nurs. J.
                Bentham Science Publishers
                1874-4346
                03 November 2023
                2023
                : 17
                : e18744346228139
                Affiliations
                [1 ]Department of Nursing, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazi
                [2 ]Federal University of Mato Grosso do Sul, Três Lagoas, Brazil
                [3 ]Postgraduate Program in Health and Development in the Midwest Region, Faculdade de Medicina, Fundação Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
                [4 ]Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Brazil
                [5 ]Fundamental Nursing Program from the University of São Paulo, Ribeirão Preto, SP, Brazil
                Author notes
                [* ]Address correspondence to this author at the Postgraduate Program in Health and Development in the Midwest Region, Faculdade de Medicina, Fundação Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil; Tel: +55 67 9201-1107; E-mail: aires.junior@ 123456ufms.br
                Article
                e18744346228139
                10.2174/0118744346228139231102051053
                26213798-3c9f-4a85-863a-7f467162fb1b
                © 2023 The Author(s). Published by Bentham Open.

                This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 21 September 2022
                : 18 January 2023
                : 15 February 2023
                Categories
                Health Care

                Medicine,Chemistry,Life sciences
                Cleaning service,Sanitation,Pediatrics,Contamination in equipment,Patient safety,Continuing education

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