Comparative Effectiveness of Standard and Contingency-based Cleaning in Acute and Long-Term Care Facilities amidst Staff Shortages and a COVID-19 Surge

Lesho, E.; Newhart, D.; Reno, L.; Sleeper, S.; Nary, J.; Gutowski, J.; Yu, S.; Walsh, E.; Vargas, R.; Riedy, D.; Mayo, R.

Background: Cleanliness of hospital surfaces helps prevent healthcare-associated infections, but larger evaluations of the effectiveness of various cleaning strategies during SARS-CoV-2 surges and worker shortages are scarce. Methods: In an acute care hospital (ACH) and a long-term care facility (LTCF), 417 surfaces were tested for SARS-CoV-2 and adenosine triphosphate before and after various cleaning strategies, including ultraviolet light (UV-C), electrostatic spraying, and room fogging. Results: ACH surface contamination differed among outbreak and non-outbreak wards (p = 0.001). RNA was detected on 66% of surfaces before cleaning and on 23% of those surfaces immediately after terminal cleaning, for a 65% post-cleaning reduction (p = 0.001). UV-C resulted in an 87% reduction (p = 0.023), while spraying with electrostatic bleach resulted in a 47% reduction (p = 0.010). LTCF contamination rates differed between the dementia, rehabilitation, and the residential units (p = 0.005). 67% of surfaces had RNA after room fogging without terminal-style wiping. Fogging with wiping led to an 11% reduction in the proportion of positive surfaces. Discussion: Baseline contamination varied by type of unit and outbreak conditions, but not facility type. Removal of viral RNA varied according to strategy. Unlike previous reports, time spent cleaning was associated with cleaning thoroughness.