Do beds stored on hospital corridors have an increased bacterial load than beds in use on acute hospital wards? Using ATP bioluminescence testing, is there evidence to suggest that unused beds need to be stored in a clean environment rather than busy hospital corridors.

Introduction

Space is at a premium in many NHS organisations. Corridors are magnets for unused items both in and outside of healthcare settings (Keyes 2015).  Many items of clinical and none clinical equipment migrate to corridors outside hospital wards due to a significant lack of storage within the clinical ward area (Keyes 2015). Keyes (2015) highlights this as a problem from a health and safety perspective, but Reboux et al (2014) outline the principle of hospital corridors being a significant risk of contamination from an infection control point of view, highlighting a much heightened risk of both bacterial and fungal contamination on equipment stored on corridors.

Within the Children’s Hospital trust in which I work there are many types of bed to cater for the various ages of children attending the hospital. These range from bassinet cots to cot beds and to standard size hospital beds. It is very difficult to predict which age of child will be admitted, so inevitably there are more beds in the building than bed spaces to put them in. Invariably corridors are used daily to store the varying types of bed until ward staff know the age of the patient to be admitted. These beds stored in corridors are regularly ‘touched’ by passers-by including visitors and staff alike.

Although questioned in its efficacy by Brown and Eder (2010), adenosine triphosphate (ATP) bioluminescence measurements have been used in healthcare and in food hygiene areas for many years and are used as a method to rapidly test an area or piece of equipment to assess level of cleanliness (Omidabakhsh et al, 2014).

 

Background/literature review

Using both internet search engines such as Google and Bing, I have extensively used library resources at the universities in both Dundee and Sheffield. Keyword searches included hospital corridors, hospital beds, cleaning, ATP testing and hand bacterial transmission.

There is a wealth of literature relating both to the bacterial contamination of hospital beds and their subsequent cleaning within hospital environments (Sjoberg et al 2013 and Attaway et al 2012) and also the contamination of hospital equipment whilst within ward areas (Havill et al 2011). Research has also been completed highlighting an increased risk of bacterial and fungal transmission whilst hospital environments undergo restoration or rebuilding (Rollins 2013) – the trust involved in this study is currently undergoing a large rebuild and renovation project.

I have been unable to find any piece of work than pertains directly to the issue that beds whilst being stored on hospital corridors gain an increased bioload due to a combination of bacterial shedding from passers-by and the increased risk that the beds themselves are used to hold on to and touched by varying staff and visitor groups whilst in situ.

My concern in this instance is that these beds are put straight back into use once a ward has confirmation of the age of a patient being admitted without an extra clean once being moved from corridor to ward.

 

Purpose/significance

Using the ATP system of bioluminescent monitoring, the aim of this research is to prove that beds on corridors do have a higher bioload than their equivalent counterparts within ward areas with the main research question being: Do beds stored on corridors in a Children’s NHS Hospital trust become more bacterially contaminated that those beds in use within the hospital’s ward environments?

All findings from this study will be used directly within the trust to amend or change practice with view to creating a clean bed store and instigate an adequate cleaning programme.

All findings/results will be disseminated to all relevant staff within the trust.

 

Description of proposed research

I am proposing to use an experimental type research model as I plan to find out an ‘objective reality’ as detailed by DePoy and Gitlin (1994). This has been chosen as the research type to use as the information gathered will be numeric values which can be used to hypothesise problems whilst the ATP numeric values obtained can represent a reality of the current state of bed ‘cleanliness’.

The study itself will involve using ATP monitors to get base line readings of all beds on corridors – without any prior cleaning. Once all readings have been obtained, the plan is to complete another set of readings on beds within each acute ward (there are 5 main wards within the hospital).

All data received with be collected and recorded appropriately and reports/graphs completed. All results will be reported to trust board members and I the infection control committee once provisional and final results have been obtained. All results will also be fed back to the hotel services team who manage domestic services.

All data will be used directly to address cleaning effectiveness and frequency within this busy children’s hospital.

Ethical considerations

This research project has already been discussed with the infection control team and Nurse Director and has been added to the agenda of the next Infection Control Committee meeting for ratification.

 

 

 

 

 

 

Reference List

 

ATTAWAY, H.H., et al, 2012. Intrinsic bacterial burden associated with intensive care unit hospital beds: Effects of disinfection on population recovery and mitigation of potential infection risk. American Journal of Infection Control. Vol. 40, pp 907-912

 

BROWN, E. et al, 2009. Do surface and cleaning chemistries interfere with ATP measurement systems for monitoring patient room hygiene? The Hospital Infection Society. Vol. 72, No. 2, pp 193-195

 

HAVILL, N.L., et al, 2011. Cleanliness of portable medical equipment disinfected by nursing staff. American Journal of Infection Control. Vol. 39, No. 7, pp 602-604

 

HOPMAN, J., et al, 2015. Mechanical vs manual cleaning of hospital beds: a prospective intervention study. Journal of Hospital Infection. Vol. 90, pp 142-146

 

KEYES, B., 2015. Confessions of a former life safety specialist: Corridor clutter in among common tour snags. Strategies for Nurse Managers. http://www.strategiesfornursemanagers.com/ce_detail/236414.cfm (accessed 05/09/15)

 

OMIDBAKHSH, N., et al, 2014. How reliable are ATP bioluminescence meters in assessing decontamination of environmental surfaces in healthcare settings? Plos One. Vol. 9, issue 6

 

REBOUX, G., et al, 2014. A 10 year survey of fungal aerocontamination in hospital corridors: a reliable sentinel to predict fungal exposure risk?     Journal of Hospital Infection. Vol. 87, pp 34-40

 

ROLLINS, M., 2013. Dirty Work in Clean Hospitals. European Medical Hygiene Magazine. http://emhmagazine.com/article.php?article_id=926 (accesses 04/09/15)

 

SJOBERG, M., et al, 2013. Transmission of Clostridium difficile spores in isolation room environments and through hospital beds. Acta Pathologica, Microbiologica et Immunologica Scandinavia. Vol. 122, pp 800-803

 

 

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