There is increasing evidence that the hospital surface environment contributes to the spread of pathogens. However, evidence on how best to sample these surfaces is inconsistent and there is no guidance or legislation in place on how to do this. The aim of this review was to assess current literature on surface sampling methodologies, including the devices used, processing methods, and the environmental and biological factors that might influence results. Studies published prior to March 2019 were selected using relevant keywords from ScienceDirect, Web of Science, and PubMed. Abstracts were reviewed and all data-based studies in peer-reviewed journals in the English language were included. Microbiological air and water sampling in the hospital environment were not included. Although the numbers of cells or virions recovered from hospital surface environments were generally low, the majority of surfaces sampled were microbiologically contaminated. Of the organisms detected, multidrug-resistant organisms and clinically significant pathogens were frequently isolated and could, therefore, present a risk to vulnerable patients. Great variation was found between methods and the available data were incomplete and incomparable. Available literature on sampling methods demonstrated deficits with potential improvements for future research. Many of the studies included in the review were laboratory-based and not undertaken in the real hospital environment where sampling recoveries could be affected by the many variables present in a clinical environment. It was therefore difficult to draw overall conclusions; however, some recommendations for the design of routine protocols for surface sampling of healthcare environments can be made.

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Summary Background Cleaning is a critical tool for infection prevention and control, and is a key intervention for preventing healthcare associated infections (HCAIs) and controlling intermediate transmission routes between patient and environment. This study sought to identify potential areas of weakness in clinical surface cleaning, and assess the effectiveness of a staff group specific training intervention. Observations One-hundred hours of audit observations in a paediatric cardiac intensive care unit (CICU) assessed surface cleaning technique of healthcare staff within bedspaces. Cleaning was assessed with a 5-component bundle, with each cleaning opportunity scored out of five. Training Intervention Fifty hours of audit observations before and after a training intervention tested the efficacy of a staff group specific education intervention. The intervention was developed and implemented for 69% of nurses and 100% of cleaners. Results One hundred and eighteen cleaning opportunities were observed before training, and scored an average of 2.4. One hundred and twenty-one cleaning opportunities were observed after training and scored an average 3.0. On average, before training, each cleaning opportunity by nurses and cleaners fulfilled 2.4 and 2.5, respectively, of the 5 bundle components. Following training, this improved to 3.3 and 2.9 respectively. There was a statistically significant improvement in bundle scores for nurses (P=.004) and cleaners (P=.0003). Conclusions Surface wipe methods were inconsistent between all staff groups. The education based intervention resulted in a small improvement in most of the cleaning components. This study has identified how a small but targeted cleaning training intervention can have a significant (P= <.0001) impact on cleaning bundle compliance for both nurses and cleaners.

To assess the number of organisms present on different surfaces within a clinical environment before and after cleaning has taken place, and to identify the impact of cleaning. Design and Setting Extensive 2-week microbiological environmental monitoring of an entire ward before and after cleaning, within a pediatric hematology-oncology ward comprised of a day unit and outpatients ward. Methods Tryptone soya agar (TSA) contact plates were used to take a total of 1,160 surface samples before and after cleaning from 55 predetermined sites. Samples were taken from representative surfaces throughout the ward, including different materials, surfaces with varying heights, different functions, distance from patients, and both high-touch and infrequently touched surfaces. Results. Surface cleaning has been undertaken within the ward and there is a significant difference between CFU recovered before and after cleaning (P<0.0001). Cleaning produced an average reduction of 68% throughout the ward environment. The corridor was the most contaminated area within the ward. There is a difference in CFU between the different areas within the ward, and these were cleaned with varying efficiency. Surface material, who interacts with the surface, levels of initial contamination, perceived risk and perceived cleanability were all found to have a varying impact on how well cleaning was undertaken. Conclusions. To the authors current knowledge, this is the only study assessing cleaning within a pediatric ward taking samples directly before and after cleaning. The standard of 3 cleaning undertaken within the ward is open for discussion, and these data highlight the need for an improved cleaning intervention, and can provide insight into the multitude of factors that must be considered when designing an effective training protocol.

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