Studies show that Clostridium difficile infections (CDIs) have been increasing in healthcare facilities, especially for high-risk patients such as the elderly or those receiving antibiotic therapy for other infections. Incidence rates are estimated to be 11 to 13 cases per 10,000 patient days, which translates into increased length in hospital stay ranging from 2 to 5 days per CDI.

The economic impact on healthcare facilities from these potentially non-reimbursed expenses can range from $2,500 to $7,000 per hospitalization. More importantly, multi-drug resistant strains are increasingly more difficult to treat, which results in an increased mortality rate.

Unfortunately, in many of today’s acute, ambulatory and continuing care facilities, if the room passes visual inspection it is considered clean.

However, it is generally accepted that only 50 percent of the surfaces are actually being disinfected during a terminal cleaning of a patient room. Building service contractors need to target high-touched surfaces and follow-up cleaning with ATP monitoring to ensure rooms are clean and safe for patients and other building occupants.

Important surfaces

Epidemiological studies have shown that surfaces play a definitive role in transmitting disease to patients and other building occupants. This is especially true in the case of organisms like C. diff that can persist and survive on surfaces for extended periods of time. It has been shown that occupying a room that had been previously occupied by a patient with C. diff significantly increases the risk of acquiring the same organism.

To control the transmission of these infections janitors need to adequately clean and disinfect the surfaces that patients and staff come into routine contact with — known as high-touch surfaces.

This concept has been further defined by the U.S. Centers for Disease Control and Prevention’s (CDC) updated guidance for cleaning high-touch surfaces in healthcare settings. A list of 17 surfaces were identified, including bed rails, bedside and tray tables, call boxes, telephones, patient chairs, IV poles and more.

The CDC’s list is a start, but an effective cleaning program will require that each facility evaluate patient areas and determine the individual, and possibly unique, list of high-touch surfaces.


Faster kill times as shown on the product labels do permit for faster overall cleaning processes. To ensure that all surfaces are being thoroughly and effectively cleaned and disinfected, BSCs can initiate an ATP monitoring system. Properly implemented, ATP measurements are quantifiable, reproducible and repeatable — three important criteria for any monitoring system.

ATP systems provide a rapid hygiene test for small surface areas. They utilize adenosine triphosphate (ATP) bioluminescense to measure organic matter on surfaces. All organic material contains ATP, which emits light when combined with compounds in the ATP swab.

Invisible to the eye, this light is easily measured by a Luminometer in relative light units (RLUs). The ranges of RLU’s indicating clean and soiled surfaces vary by manufacturer so base line data needs to be collected and related to the actual environmental conditions and cleaning process in the healthcare facility.

After swabbing any high-touch surface or object, the swab is then placed into the luminometer to measure the amount of ATP present. The measurement from the luminometer gives a reading in RLUs, which is then correlated to an estimated level of cleanliness for the test object or area.

ATP measurements can provide the base-line data needed to establish the critical limits necessary for developing the corrective actions that will ultimately be required to determine if the cleaning program is successful in these high-risk, healthcare facilities.  

John Thomas is the sales manager and HealthRite specialist for Philip Rosenau Co., Warminster, Pa. John is also a CIMS ISSA Certification Expert (ICE). He can be reached at

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