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DOI: 10.1016/j.enfi.2021.02.002
Available online 1 June 2021
The efficiency of cleaning in intensive care units: A systematic review
Eficacia de la limpieza en las unidades de cuidados intensivos: revisión sistemática
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Z. Gülsoya,
Corresponding author
zuhalgulsoy@hotmail.com

Corresponding author.
, S. Karagozoglub
a Cumhuriyet University Research and Practice Hospital, Department of Anesthesia Intensive Care Unit, Sivas, Turkey
b Cumhuriyet University Faculty of Health Science, Division of Nursing, Department of Fundamentals of Nursing, Sivas, Turkey
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Table 1. Characteristics of the selected studies in the literature review.
Abstract
Objectives

This review aims to analyze the studies on cleaning practices and the efficiency of the cleaning carried out in environments that have a great risk of resistant microorganism infection, such as intensive care units.

Methods

In this study, a retrospective literature review was undertaken of the relevant publications between the years 2005 and 2020, using the keywords “Cross Infection, Infection Control, Multidrug-Resistant Bacteria, Intensive Care, Room Cleaning, Environmental Cleaning, Hospital-Associated Infection”; using the international databases Pubmed, CINAHL and EBSCO and domestic database ULAKBIM on search engines. Titles and abstracts of all relevant articles found on electronic searches were reviewed by the researchers independently. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guideline and Patient, Intervention, Comparison, Outcomes, Study design model were used in analysing the studies.

Results

The selected studies were reviewed in four main categories: Materials used in cleaning, the period between taking environmental samples, cleaning methods, and the efficiency of cleaning. Among the studies included herein, eight were randomized controlled trials, three were retrospective intervention studies, two were case-control studies and one was a retrospective cohort study.

Conclusions

Today, the assessment of cleaning in environments can be evaluated by different methods, but there are advantages and disadvantages of these methods. Therefore, in the relevant literature, it is suggested that cleaning must be evaluated by several methods, not only one. Also, training the staff that carries out the cleaning and rewarding correct behavior by giving feedback are important approaches to increase the efficiency of cleaning. It is suggested that cleaning must be carried out every day, regularly with effective methods and equipment; frequency of cleaning during epidemics must be increased, institutions must prepare cleaning manuals according to evidence-based guidelines that are recognized at an international level.

Keywords:
Cross infection
Infection control
Multidrug-resistant bacteria
Intensive care
Room cleaning
Environmental cleaning
Hospital-associated infection
Resumen
Objetivos

El objetivo de esta revisión es analizar los estudios sobre la práctica y la eficacia de la limpieza realizada en entornos con alto riesgo de infección por microorganismos resistentes, tales como las unidades de cuidados intensivos.

Métodos

En este estudio se realizó una revisión retrospectiva de la literatura dentro de las publicaciones relacionadas entre los años 2005 y 2020, utilizando palabras clave tales como cross infection, infection control, multidrug-resistant bacteria, intensive care, room cleaning, environmental cleaning, hospital-associated infection (infección cruzada, control de infecciones, bacterias multirresistenes a los fármacos, cuidados intensivos, limpieza de habitaciones, limpieza ambiental, infección adquirida en los hospitales), utilizando bases de datos internacionales tales como Pubmed, CINAHL y EBSCO, y la base de datos nacional ULAKBIM en los motores de búsqueda. Los títulos y resúmenes de todos los artículos relacionados seleccionados en las búsquedas electrónicas fueron revisados por investigadores de manera independiente. Se utilizaron las directrices de The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols y el modelo del diseño Patient, Intervention, Comparison, Outcomes, Study para analizar los estudios.

Resultados

Se revisaron los estudios seleccionados en 4 categorías principales: materiales utilizados en la limpieza, periodo transcurrido entre las tomas de muestras ambientales, métodos de limpieza y eficacia de la limpieza. Entre los estudios incluidos en la revisión 8 eran ensayos controlados aleatorizados, 3 eran estudios retrospectivos de intervención, 2 eran estudios de control de casos y uno era un estudio retrospectivo de cohorte.

Conclusiones

Hoy en día la evaluación de la limpieza en los entornos puede evaluarse mediante métodos diferentes, aunque existen dichos métodos tienen ventajas y desventajas. Por tanto, en la literatura relevante se sugiere que la limpieza debe ser evaluada por diversos métodos, y no solo por uno. De igual modo, formar al personal a cargo de la limpieza y apreciar el comportamiento correcto mediante la aportación de comentarios son metodologías importantes para incrementar la eficacia de la limpieza. Se sugiere que la limpieza debe llevarse a cabo cada día, de manera regular, y con métodos y equipos efectivos. Debe incrementarse la frecuencia de la limpieza durante las pandemias, quedando a cargo de las instituciones el deber de preparar manuales de limpieza acordes a las directrices basadas en la evidencia a nivel internacional.

Palabras clave:
Infección cruzada
Control de infecciones
Bacterias multirresistentes a los fármacos
Cuidados intensivos
Limpieza de habitaciones
Limpieza ambiental
Infección adquirida en los hospitales

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