Skip to main content Accessibility help

Impact of an Environmental Cleaning Intervention on the Presence of Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococci on Surfaces in Intensive Care Unit Rooms

  • Eric R. Goodman (a1) (a2), Richard Piatt (a1) (a3), Richard Bass (a4), Andrew B. Onderdonk (a5), Deborah S. Yokoe (a1) and Susan S. Huang (a1) (a6)...



To evaluate the adequacy of discharge room cleaning and the impact of a cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) on environmental surfaces in intensive care unit (ICU) rooms.


Prospective environmental study.

Setting and sample.

Convenience sample of ICU rooms in an academic hospital.

Methods and intervention.

The intervention consisted of (1) a change from the use of pour bottles to bucket immersion for applying disinfectant to cleaning cloths, (2) an educational campaign, and (3) feedback regarding adequacy of discharge cleaning. Cleaning of 15 surfaces was evaluated by inspecting for removal of a preapplied mark, visible only with an ultraviolet lamp (“black light”). Six surfaces were cultured for MRSA or VRE contamination. Outcomes of mark removal and culture positivity were evaluated by X2 testing and generalized linear mixed models, clustering by room.


The black-light mark was removed from 44% of surfaces at baseline, compared with 71 % during the intervention (P < .001). The intervention increased the likelihood of removal of black-light marks after discharge cleaning (odds ratio, 4.4; P < .001), controlling for ICU type (medical vs surgical) and type of surface. The intervention reduced the likelihood of an environmental culture positive for MRSA or VRE (proportion of cultures positive, 45% at baseline vs 27% during the intervention; adjusted odds ratio, 0.4; P = .02). Broad, flat surfaces were more likely to be cleaned than were doorknobs and sink or toilet handles.


Increasing the volume of disinfectant applied to environmental surfaces, providing education for Environmental Services staff, and instituting feedback with a black-light marker improved cleaning and reduced the frequency of MRSA and VRE contamination.


Corresponding author

University of California-Irvine Medical Center, Division of Infectious Diseases, Building 53, Suite 215, 101 The City Dr., Orange, CA 92868 (


Hide All
1.Bures, S, Fishbain, JT, Uyehara, CF, Parker, JM, Berg, BW. Computer keyboards and faucet handles as reservoirs of nosocomial pathogens in the intensive care unit. Am J Infect Control 2000;28:465471.
2.Noskin, GA, Bednarz, P, Suriano, T, Reiner, S, Peterson, LR. Persistent contamination of fabric-covered furniture by vancomycin-resistant enterococci: implications for upholstery selection in hospitals. Am J Infect Control 2000;28:311313.
3.Zachary, KC, Bayne, PS, Morrison, VJ, Ford, DS, Silver, LC, Hooper, DC. Contamination of gowns, gloves, and stethoscopes with vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 2001;22:560564.
4.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L, Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings, 2006. Atlanta: Centers for Disease Control and Prevention, 2006.
5.Cosgrove, SE, Qi, Y, Kaye, KS, Harbarth, S, Karchmer, AW, Carmeli, Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26:166174.
6. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470485.
7.Patel, R. Clinical impact of vancomycin-resistant enterococci. J Antimicrob Chemother 2003;51(Suppl 3):iii1321.
8.Boyce, JM, Potter-Bynoe, G, Chenevert, C, King, T. Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications. Infect Control Hosp Epidemiol 1997;18:622627.
9.Ray, AJ, Hoyen, CK, Taub, TF, Eckstein, EC, Donskey, CJ. Nosocomial transmission of vancomycin-resistant enterococci from surfaces. JAMA 2002;287:14001401.
10.Bhalla, A, Pultz, NJ, Gries, DM, et al. Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients. Infect Control Hosp Epidemiol 2004;25:164167.
11.Sexton, T, Clarke, P, O'Neill, E, Dillane, T, Humphreys, H. Environmental reservoirs of methicillin-resistant Staphylococcus aureus in isolation rooms: correlation with patient isolates and implications for hospital hygiene. J Hosp Infect 2006;62:187194.
12.Hayden, MK, Bonten, MJ, Blom, DW, Lyle, EA, van de Vijver, DA, Weinstein, RA. Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis 2006;42:15521560.
13.Byers, KE, Durbin, LJ, Simonton, BM, Anglim, AM, Adal, KA, Farr, BM. Disinfection of hospital rooms contaminated with vancomycin-resistant Enterococcus faecium. Infect Control Hosp Epidemiol 1998;19:261264.
14.Bonten, MJ, Hayden, MK, Nathan, C, et al. Epidemiology of colonisation of patients and environment with vancomycin-resistant enterococci. Lancet 1996;348:16151619.
15.Rampling, A, Wiseman, S, Davis, L, et al. Evidence that hospital hygiene is important in the control of methicillin-resistant Staphylococcus aureus. J Hosp Infect 2001;49:109116.
16.Oie, S, Hosokawa, I, Kamiya, A. Contamination of room door handles by methicillin-sensitive/methicillin-resistant Staphylococcus aureus. J Hosp Infect 2002;51:140143.
17.French, GL, Otter, JA, Shannon, KP, Adams, NM, Watling, D, Parks, MJ. Tackling contamination of the hospital environment by methicillin-resistant Staphylococcus aureus (MRSA): a comparison between conventional terminal cleaning and hydrogen peroxide vapour decontamination. J Hosp Infect 2004;57:3137.
18.Huang, SS, Datta, R, Piatt, R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006;166:19451951.
19.Centers for Disease Control and Prevention. Guideline for Environmental Infection Control in Health-Care Facilities, 2003. Available at: Accessed May 13, 2008.
20.Carling, PC, Briggs, J, Hylander, D, Perkins, JAn evaluation of patient area cleaning in 3 hospitals using a novel targeting methodology. Am J Infect Control 2006;34:513519.
21.Carling, PC, Briggs, JL, Perkins, J, Highlander, D. Improved cleaning of patient rooms using a new targeting method. Clin Infect Dis 2006;42:385388.
22.Carling, PC, Parry, MF, Von Beheren, SM. Identifying opportunities to enhance environmental cleaning in 23 acute care hospitals. Infect Control Hosp Epidemiol 2008;29:17.
23.Carling, PC, Von Beheren, S, Kim, P, Woods, C, for The Healthcare Environmental Hygiene Study Group. Intensive care unit environmental cleaning: an evaluation in sixteen hospitals using a novel assessment tool. J Hosp Infect 2008;68:3944.
24.Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing: sixteenth informational supplement. M100S16. Wayne, Pennsylvania: CLSI, 2004.
25.Huang, SS, Hinrichsen, VL, Stulgis, L, et al. Methicillin-resistant Staphylococcus aureus infection in the year following detection of carriage. In: Program and abstracts of the 16th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; March 18–21, 2006; Chicago, IL. Abstract 157.
26.Eckstein, BC, Adams, DA, Eckstein, EC, et al. Reduction of Clostridium difficile and vancomycin-resistant enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods. BMC Infect Dis 2007;7:61.
27.Huang, SS, Rifas-Shiman, SL, Warren, DK, et al. Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units. J Infect Dis 2007;195:330338.
28.Huang, SS, Rifas-Shiman, SL, Pottinger, JM, et al. Improving the assessment of vancomycin-resistant enterococci by routine screening. J Infect Dis 2007;195:339346.
29.Duckro, AN, Blom, DW, Lyle, EA, et al. Transfer of vancomycin-resistant enterococci via health care worker hands. Arch Intern Med 2005;165:302307.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed