Currently there are 5 systems or types of cleaning auditing being used. These are: Direct Observation (Visual Inspections), Indirect Observation (Patient/Resident Satisfaction Surveys), Environmental Marking, ATP Bioluminescence and Environmental Cultures.
Observation Audits are one of the most common yet crude practices in Canada. Quite simply, an inspector visually scans the surfaces to see if they look cleaned. It is subjective from person to person, as one person’s view of clean may be different from another. If the surface receives a pass of clean it does not guarantee the surface was effectively cleaned of less visible soils including germs, exposing building occupants to illness i.e. you can’t see the harmful microbes.
The other type of Observation Audit is that of direct observation during cleaning. While more effective than a regular observation audit, it creates an atmosphere of mistrust in the cleaner’s value, as well as duplication in cost in manpower for the observer and cleaner.
Patient, Resident, and Client Surveys also known as Indirect Observation were created to obtain an indication of how people see the services that are provided. They are too very subjective as every individual has different standards and perceptions of the environment around them. The general health of the patron is also at risk with no measurement that cleaning and disinfection has occurred. It poses the question “Is it clean enough?” instead of asking the question “Has it been cleaned and disinfected? The surface may look clean but may be a breading ground for illness.
Bioluminescence Environmental Marking measures that thoroughness of cleaning using a marking system. It involves the use of a colourless marker applied by pen solution or by powder to objects before cleaning. After the cleaning has taken place, a UV light is used to detect any residual of the colourless marker. However, the solutions used can stain or are difficult to remove on porous or damages surfaces and can lead to false positive results. There is also a high potential for cross contamination when a patient touches the detector and then touches another surface.
ATP is a small lettered-auditing tool that also comes with a large price tag. The hardware comes as a significant cost, along with the testing supplies. The testing supplies may require refrigeration. The hardware and swabs measure ATP, which is a chemical substance present in all living cells. If ATP is detected on a surface it indicates that organic material is still present and has not been effectively cleaned. However, false positives are quite common as the disinfectant product used such as products containing bleach may dramatically impact the results.
Environmental Cultures are more accurate but they come at a cost and take time. During their culturing process, a patron may be exposed to germs or viruses that have not yet been detected on a surface until the culture has grown. This system is costly and requires experienced knowledge to differentiate findings, a set of specific equipment and a growing environment that may not be possible in many facilities. For these reasons this type of system is rarely used.
Despite the positive and negatives of the above auditing tools, what is important is that cleaning auditing is actually being done…. and frequently. That is a measurable auditing system for cleaning is employed which will provide important documented feedback on the state of clean. The importance of measuring clean can prevent illness, outbreaks, secure cleaning clientele, and protect surfaces from wear, amongst a whole list of valuable benefits.