Ensuring effective cleaning and disinfection (C/D) of operating room (OR) surfaces is essential for patient safety, yet available monitoring methods vary in performance and interpretation. This study aimed to assess changes associated with a multimodal intervention on C/D quality, compare the performance of four monitoring methods, and identify predictors of post-cleaning outcomes. A quasi-experimental pre–post study was conducted during 40 surgical procedures, totaling 1400 assessments across five high-touch surfaces. Monitoring included visual inspection, adenosine triphosphate (ATP) bioluminescence, microbiological culture (reference method), and a fluorescent marker. Sensitivity, specificity, and accuracy were calculated, and multivariable models were used to evaluate predictors of post-cleaning ATP levels. The methods showed distinct performance profiles: ATP demonstrated high specificity (93.9% and 86.7%) and accuracy (92.0% and 85.0%) but low sensitivity; visual inspection showed intermediate accuracy (62.0% and 44.0%); and the fluorescent marker demonstrated high sensitivity (100% in the first collection) but low specificity. The intervention period was associated with increased cleaning time and reduced post-cleaning ATP levels. Pre-cleaning ATP was the main predictor of post-cleaning ATP (p < 0.001), while surgical duration (p = 0.038) and surface type (p = 0.035) were associated in the second phase. These findings suggest that multimethod monitoring captures complementary dimensions of environmental hygiene and may support continuous quality improvement in surgical settings.
Carneiro et al. (Thu,) studied this question.
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