Reiniging en desinfectie van ruimten Module 1b Evidence-tabel

Diab-Elschahawi (2010)

Type of study: experiment

Funding and conflicts of interest: “Supported by the research fund of the Division of Hospital Hygiene,

Medical University of Vienna.”

Test surface/area: Standardized ceramic tiles measuring 5x5 cm

Microorganism: Staphylococcus aureus (ATCC 6538) and Escherichia coli (ATCC 8739), 5x10⁷ colony-forming units (CFU) per ml, 0.1 ml per tile; left to dry for 1 hour

Describe intervention (treatment/procedure/test):

Cleaning with 5x5 cm microfiber cleaning cloth, cotton cloth, sponge cloth

Wiping: meander-like pattern, starting left upper corner, turning 4 times, ending right lower corner

Dry and wet (with distilled water)

Microfiber cloths, cotton cloths, and sponge cloths were reprocessed in a washer disinfector and a laundry dryer (90°C for 5 minutes) up to 20 times

Describe control (treatment/procedure/test):

Cleaning with disposable paper towels

Wiping: meander-like pattern, starting left upper corner, turning 4 times, ending right lower corner

Dry and wet (with distilled water)

Outcome measures and effect size (include 95%CI and p-value if available):

CFUs: microbial load from a surface / decontamination: tested by shaking the tiles in a petri dish with glass pearls, and then incubated on agar.

New microfiber better than new cotton (P=.0012; regression coefficient = 1.0766), new sponge (P=.001; regression coefficient = 1.0971), and disposable paper towels (P=.0001; regression coefficient = 1.5455).

After processing, no difference between main effect of cloths. Cotton cloths better than microfiber cloths (S. aureus P=.0334; regression coefficient = 20.4332; E coli P=.0014; regression coefficient = 20.7847). Sponge better than microfiber (S. aureus P=.0263; regression

Coefficient = 20.4531).

Conclusions: decontamination capacity higher when used wet versus dry (for all cloths)

No difference in decontamination efficacy between cloths.

Hron (2019)

Type of study: experiment

Funding and conflicts of interest: “The author(s) received no financial support for the research, authorship, and/or publication of this article.”

Test surface/area:

Stainless steel plate

Microorganism:

2 experiments:

- protein contaminant: 500 μl of 5% fetal bovine serum in phosphate buffered saline, left to dry overnight

- hydrophobic residue: paraffin wax bead 50 ± 2 mg, melted and dried for 30 min

Describe intervention (treatment/procedure/test):

Cleaning with 10 in-house nonwoven fabrics (energy of hydroentanglement 4.8 MJ/kg):

2. 100% rayon
3. 100% polyester
4. 100% greige cotton (6.8 MJ/kg)
5. 100% greige cotton (8.9 MJ/kg)
6. 100% greige cotton (10.1 MJ/kg)
7. 100% greige cotton scoured and bleached
8. 80% polyester/20% greige cotton
9. 20% polyester/80% greige cotton
10. 80% rayon/20% greige cotton
11. 20% rayon/80% greige cotton

Protein contaminant:

Dry and wet (1 mL of ultrapure water)

Wiping: by machine, 16 movements, 71.3r/min, 9 kPa

Hydrophobic residue:

Dry

Wiping: by machine, 16 movements, 71.3r/min, 12 kPa

Describe control (treatment/procedure/test):

Cleaning with

1. single use wipes (50% rayon/50% polyester)

Protein contaminant:

Dry and wet (1 mL of ultrapure water)

Wiping: by machine, 16 movements, 71.3r/min, 9 kPa

Hydrophobic residue:

Dry

Wiping: by machine, 16 movements, 71.3r/min, 12 kPa

Outcome measures and effect size (include 95%CI and p-value if available):

Protein contamination:

After wiping, wipes were put in saline and incubated. Then they performed protein analysis.

Dry wipes

Wipes 3, 5, 8, and 10 had significantly lower protein (mg/ml) uptake, compared to wipe 1 (single use wipes).

Wipe 4 had significantly higher protein (mg/ml) uptake, compared to wipe 1.

Wet wipes

Wipes 3, 4, 6, 8, and 9 had significantly lower protein (mg/ml) uptake, compared to wipe 1 (single use wipes).

Hydrophobic residue:

Removal of wax was measured by placing the sample on a scale

Dry wipes

Wipe 3 had significantly lower paraffin (mg) uptake, compared to wipe 1.

Wipes 4, 6, and 9 had significantly higher paraffin (mg) uptake, compared to wipe 1.

No numbers are given. Only descriptions of results and boxplots.

Trajtman (2015)

Type of study: experiment

Funding and conflicts of interest: none to report

Test surface/area:

On ceramic tiles (2.2x2.2 cm)

On microfiber cloths

On cotton cloths

Microorganism:

Clostridium difficile 765, 2.3x10⁶

spores/mL; 100 mL/site to provide 2.3x10⁴ spores/site (CFUs), dried overnight

Describe intervention (treatment/procedure/test):

Cleaning with microfiber cloths (16 cm²)

Wiping: done by machine: 1.5-1.77 N and 10 rotations

Before assessing the outcome, tiles were sprayed with either phosphate buffer saline (PBS) or with a hydrogen peroxide 0.01% cleaning agent.

Describe control (treatment/procedure/test):

Cleaning with cotton cloths (16 cm²)

Wiping: done by machine: 1.5-1.77 N and 10 rotations

Before assessing the outcome, tiles were sprayed with either phosphate buffer saline (PBS) or with a hydrogen peroxide 0.01% cleaning agent.

Outcome measures and effect size (include 95%CI and p-value if available):

CFUs: tiles and wipes were placed in liquid, this was then incubated on agar. CFUs were counted, and expressed as log¹⁰ (cfu/cm²)

Cotton cloths transfer significantly more spores than microfiber cloths between wet ceramic surfaces regardless of using a detergent (P = .0261 and P = .0001).

Trajtman used cleaning agents in the study with the purpose of disinfecting, leading to somewhat indirect results. However, due to the small contribution of the study to the final results, it was decided downgrading is not needed.

Wiemken (2014)

Type of study: experiment

Funding and conflicts of interest: “Supported by Clorox Healthcare, which did not play a role in data collection, analysis, writing, or critical review of the study data or manuscript.

Conflicts of interest: None to report.”

Test surface/area: 6 pre-specified areas in a patient room

Microorganism:

Fluorescent marker

Describe intervention (treatment/procedure/test):

Cleaning with towel and bucket with sodium hypochlorite cleaner/disinfectant solutions

Wiping: by randomized participant

Describe control (treatment/procedure/test):

Cleaning with ready-to-use (RTU) wipes with sodium hypochlorite cleaner/disinfectant solutions

Outcome measures and effect size (include 95%CI and p-value if available):

Compliance: residual fluorescent marker viewable under an ultraviolet light (0 point = complete miss of area; 1 point = partial miss; 2 points = completely removing fluorescent marker). A total of 12 points could be rewarded.

Mean (SD) compliance, RTU versus bucket

Sink countertop
1.8 (0.67) 
1.1 (0.78)

Bedside table
1.9 (0.33) 
1.8 (0.44)

In-room dresser
2 (0) 1.3 (0.71)

Medicine cabinet
1.8 (0.67)
1.6 (0.73)

Wall-mounted cabinet
1.9 (0.33) 
1.3 (0.87)

Toilet
1.2 (0.97) 
1(0.87)

Average compliance points:

RTU: 10.6
(SD 1.3)

Bucket 8.1
(SD 2.4)

P =.017

Time of cleaning and disinfecting:

RTU: 178.1 seconds (SD 98.2)

Bucket: 230.9 seconds (SD 96.0)

P=0.003

Time-related cost savings for using RTU wipes: (15 rooms per day, 20 min per room, $10 per hour): $38.58 (95%CI: $34.07-$41.08) per employee per day

Wren (2008)

Type of study: experiment

Funding and conflicts of interest:

Test surface/area:

100 cm² of:

- a rough tile
- a smooth tile
- laminated worktops (new and worn (aged >10 years, taken from a ward in the closed Middlesex Hospital, London)
- stainless steel surfaces

Microorganism:

- meticillin- resistant Staphylococcus aureus (MRSA meticilline-resistente Staphylococcus aureus (meticilline-resistente Staphylococcus aureus ))
- Acinetobacter calcoaceticus var. baumannii (ACCB)
- Klebsiella oxytoca (K. oxytoca) in logarithmic phase growth
- spores of Clostridium difficile

All in PBS, 100 ul on area, dried for 2 hours

Describe intervention (treatment/procedure/test):

Cleaning with ultramicrofibre (UMF)-woven cloths (80% polyamide/ 20% polyester fibre)

Wet: deionized water

Wiping: as prescribed by manufacturer.

Describe control (treatment/procedure/test):

Cleaning with conventional cloths (JC)

Wet: deionized water

Wiping: as prescribed by manufacturer.

Outcome measures and effect size (include 95%CI and p-value if available):

CFUs: contact plates on areas were incubated

RLUs: by ATP Adenosinetrifosfaat (Adenosinetrifosfaat ) swabbing of surface

Laminated worktop (new): CFUs

In 28 of 36 experiments, ultra-microfiber cloths were able to completely remove all bacteria of bacterial spores (MRSA, ACCB, K. oxytoca, and C. difficile Clostridioides difficile (Clostridioides difficile )) from surfaces (new and old laminated surfaces, and steel tiles). Whereas conventional cloths were only able to remove all bacteria of bacterial spores in two of 36 experiments. When bacteria (MRSA, ACCB, and K. oxytoca) were suspended in 7% bovine serum albumin, ultra-microfiber cloths were able to completely remove all bacteria 20 of 24 experiments, and conventional cloths were not able to remove all bacteria from surfaces (smooth tile, rough tile, new laminated worktop, steel tile