الفهرس 
INTRODUCTION AND AIM OF THE STUDYOnly 14 pages are availabe for public view
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Abstract
from the previous results, the following could be concluded:• Assessment of the knowledge of cleaning team in the study area ( ICU rooms A&B) showed that it was inadequate, and this was revealed through the results from the questionnaire.
• Assessment of the cleaning practice of the health care workers through the CDC checklist revealed that it was not enough to make the ICU environmental surfaces clean.
• Before applying the enhanced technique in cleaning and disinfection, the samples taken from the high touch areas in the ICU of the neurosurgery department (Rooms A and B), the routine cleaning reveals high values of TACC ( above 5 cfu/cm2 which is above the cut off of CDC).
• After applying the enhanced cleaning technique (Room A) using chlorine as disinfectant and training the health care workers on the proper way of cleaning according to the guidelines of the CDC, there was a significant reduction in TACC (GM 1.78-2.92 cfu/cm2) .
• There is a statistically significant difference as regards to GM of TACC before and after applying the enhanced techniques (p<0.001)
• There was a significant reduction in contamination with G -ve after applying the enhanced technique of disinfection to the high touch areas in the ICU rooms.
• The enhanced cleaning technique could have a part in decreasing the HAIs and this was registered through the hospital records.
5.2. Recommendations:
Based on the results of the present study, it can be recommended:
On individual level:
• All the health care workers should have infection control awareness and should have a basic level of education before working in the health care facility.
• All the health care workers should have training with supervision before getting to work in ICU.
On health care facility level:
• An infection control committee should be present in any health care facility and should have a well-defined plan for training the personnel working in the different departments.
• Providing sufficient number of competent workers at ICU to meet the high work load.
• Availability of enough equipment which needs a sufficient budget.
• Strict supervision of nursing staff for implementation the proper process of cleaning.
• Samples should be taken from hospital environmental surfaces to check the cleaning level standards according to the CDC.
For all environmental cleaning procedures, these are the best practices for environmental cleaning of surfaces:
• Use fresh cleaning cloths at the start of each cleaning session (e.g., routine daily cleaning in a general inpatient ward).
• Change cleaning cloths when they are no longer saturated with solution, for a new, wetted cloth. Soiled cloths should be stored for reprocessing.
• For higher-risk areas, change cleaning cloths between each patient zone (i.e., use a new cleaning cloth for each patient bed). For example, in a multi-bed intensive unit, use a fresh cloth for every bed/incubator.
• Ensure that there are enough cleaning cloths to complete the required cleaning session.
• Never double-dip cleaning cloths into portable containers (e.g., bottles, small buckets) used for storing environmental cleaning products (or solutions).
• Never shake mop heads and cleaning cloths—it disperses dust or droplets that could contain microorganisms.
• Never leave soiled mop heads and cleaning cloths soaking in buckets.
On national level:
• A national program should be documented and present to evaluate and progress the level of the awareness and practice inside the health care facilities.
• A well-established plan should be present concerning infection control practice using the enhanced cleaning and disinfection techniques to control health care acquired infections.
Further research:
• Further infection control studies should be done to correlate the health care acquired infections reduction with the implementation of enhanced cleaning for environmental surfaces in the ICU.
5.3. Summary
Hospital affords an excellent environment for the proliferation of pathogenic bacteria.it may constitute a risk to patients, residents, staff and visitors.
The highest risk of HAIs transmission exists near patients on high-touch surfaces. Microorganism contaminated surfaces can act as reservoirs for potential diseases. Although healthcare workers’ hands are the most common means of pathogen transfer from a colonised or infected patient to a susceptible patient, contaminated hospital surfaces and medical equipment (and less frequently water and air) can also play a direct or indirect role in the transmission pathways.
It is not an easy way to clean a hospital environment or to keep it clean, however cleaning is defined as removing visual and invisible dirt from the hospital environment. It is the process of physically removing dirt and debris with water, detergent, or both, until the area is clearly clean. To limit the danger of infection and cross-contamination, disinfection instead tries to eradicate most or all pathogenic microorganisms.
The determination of environmental cleaning procedures for individual patient care areas, including frequency and process, should be based on the risk of pathogen transmission.
There are two processes of cleaning hospitals, routine cleaning using detergents and water and enhanced cleaning with the use of water, detergent, and disinfectants.
The intensive care units of the neurosurgery department in Alexandria Main University Hospital were divided into two rooms (room A with enhanced cleaning and room B with routine cleaning).
The main objective of the study was to assess the impact of enhanced cleaning of the high touch areas of the environmental surfaces on the bacterial contamination of room A as the intervention area which contains a higher number of beds while room B continued to apply the routine cleaning at the intensive care units of the Neurosurgery Department in Alexandria Main University Hospital.
Appropriate statistical procedures were applied to handle the data and the following results were found:
1. There was statistically significant difference between the GM of TACC from the high touch areas around the beds before routine cleaning and after routine cleaning in room B (p≤ 0.001) with GM of TACC ranging from 12.77 ± 0.11 CFU/cm2 15.81± 0.17 CFU/cm2 in all the results.
2. There was statistically significant difference between the GM of TACC from the high touch areas around the beds before enhanced cleaning and after enhanced cleaning in room A (p≤ 0.001) with GM of TACC ranging from 1.78± 0.42 CFU/cm2to 2.92 ± 0.03 CFU/cm2.
3. After the enhanced cleaning in room A , all the geometric means from the high touch areas around the beds were below 3 CFU/cm2. (p≤ 0.001)
4. The percent reduction after the enhanced cleaning was 91.4% in room A, while it was only 47% after routine cleaning in room B. (p≤ 0.001)
5. The number of samples detected presence of Gram -ve bacteria isolated from the high touch areas around the beds in room B was 23 (44.2%) before routine cleaning while it was 21 (40.3%) after routine cleaning with no statistically significant difference between both of them. |(p=0.703)
6. The number of samples detected presence of Gram -ve bacteria isolated from the high touch areas around the beds in room A was 95 (45.6%) before the enhanced cleaning while it was 34 (16.3%) after the enhanced cleaning with statistically significant difference. (p <0.001).
7. The percentage of the ICU acquired infections rate was 30% before conducting the study and decreased to 23% after conducting the study in 6 months. (p=0.535)
Based on the results of the current study, it is concluded that:
• Before applying the enhanced technique in cleaning and disinfection, the samples taken from the high touch areas around the beds in the ICU of the neurosurgery department (Rooms A and B), the routine cleaning reveals high values of TACC ( above 5 cfu/cm2 which is above the cut off of CDC).
• There was a significant reduction in contamination with G -ve after applying the enhanced technique of disinfection to the high touch areas in room A of the ICU.
• The enhanced cleaning technique could have a part in decreasing the HAIs and this was registered through the hospital records.
In the light of the present study, it is recommended that:
• Providing sufficient number of competent workers at ICU to meet the high workload.
• Availability of enough equipment which needs a sufficient budget.
• Strict supervision of nursing staff for implementation the proper process of cleaning.