(P36) Cleaning Assessment in LTCFs Using Observation, Microbiological, and Gel Sampling

Introduction/Objective: Environmental cleaning is a key feature of infection prevention (IP) in long term care facilities (LTCF), where residents reside for prolonged periods with many opportunities for bacterial shedding. While environmental sampling has not been extensively performed in LTCFs, preliminary data suggests that multidrug-resistant organism (MDRO) burden is higher in these settings than in acute care facilities. We sought to assess barriers to proper environmental cleaning through direct observations of environmental cleaning associates’ (EVCA) cleaning practices combined with environmental and fluorescent gel sampling across two LTCFs in Maryland.

Design/Methodology : EVCAs were observed through the patient room cleaning process with data recorded by two observers. Data recorded included use of hand hygiene, time to complete clean, order of activities, interruptions observed, and cleaning materials.

Environmental samples of high-touch surfaces (HTS) were collected over a 4-month period using a composite sampling technique that paired surface type and proximity to the patient. Composite samples were cultured using media selective for MDROs. Fluorescent gel dots were placed on HTSs in patient rooms, physical therapy gyms, and nursing stations, and removal of dots was assessed after 24 hours.

Results: 33% (318/975) of HTSs were cleaned across all observations (n=25). Hand hygiene upon both room entry and exit was observed in 32% (8/25) of cleans, with higher adherence to glove use at 72% (18/25). Major deviations from facility policies were cited in 64% of observations across both LTCFs. Commonly cited deviations included low-to-high/dirty-to-clean processes (40%, 10/25) and incorrect sequence of bathroom cleaning (40%, 10/25). Interruptions in the EVCA cleaning process occurred in 32% of observed cleans.

MDROs were detected on 58% (125/216) of all composite samples; patient rooms had the highest MDRO prevalence (62%, 111/180), followed by gyms (42%, 5/12), and nursing stations (38%, 9/24). 89% (111/125) of composites tested positive for MRSA, while ESBL-producing Enterobacteriaceae (19%), VRE (7%), and Carbapenamase producing Enterobacteriaceae (CRE) were detected at lower rates (6%, 8/125). Fluorescent gel sampling illustrated low removal rates overall, with a total removal rate of 33% of HTSs (mean of 5/14 dots removed/room, n= 269 rooms). Gyms had the lowest room-level removal rate at 11%, followed by patient rooms (33%) and nursing stations (48%).

Conclusion/Discussion : Observed EVCA workflow in LTCFs demonstrated gaps in “work as done” (procedures) compared to “work as imagined” (policies) that may account for the high burden of MDROs and low removal of fluorescent gel observed. Interventions to address MDRO burden and bolster IP strategies may include frequent training of clear, consistent policies on cleaning procedures and hand hygiene prior to glove use, implementation of fluorescent gel monitoring with feedback, and reducing interruptions to EVCA workflow.