Manual cleaning of hospital mattresses: an observational study comparing high and low resource settings.
BACKGROUND Hospital associated infections (HAIs) are more frequently encountered in low than in high resource settings. There is a need to identify and implement feasible and sustainable approaches to strengthen HAI prevention in low resource settings. AIM To evaluate the biological contamination of routinely cleaned mattresses in both high and low resource settings. METHODS In this two stage observational study, routine manual bed cleaning was evaluated at two university hospitals using adenosine triphosphate (ATP) Standardized training of cleaning personnel was achieved in both high and low resource settings. Qualitative analysis of the cleaning process was performed to identify predictors of cleaning outcome in low resource settings. FINDINGS Mattresses in low resource settings were highly contaminated prior to cleaning. Cleaning significantly reduced biological contamination of mattresses in low resource settings (P 0.0001) After training, the contamination observed after cleaning in both the high and low resource settings seemed comparable. Cleaning with appropriate type of cleaning materials reduced the contamination of mattresses adequately. Predictors for mattresses that remained contaminated in a low resource setting included: type of product used, type of ward, training, and the level of contamination prior to cleaning. CONCLUSION In low resource settings mattresses were highly contaminated as noted by ATP levels. Routine manual cleaning by trained staff can be as effective in a low resource setting as in a high resource setting. We recommend a multi modal cleaning strategy that consists of training of domestic services staff, availability of adequate time to clean beds between patients, and application of the correct type of cleaning products.
The Journal of hospital infection