Comparative efficacy of environmental cleaning and disinfection by nursing assistants and environmental services staff in ICUs: A multiyear analysis of multidrug-resistant organisms contamination risk.

OBJECTIVES

To compare the environmental disinfection efficacy of nursing assistants vs environmental services staff in intensive care units (ICUs).

METHODS

This retrospective study analyzed 22,828 environmental surface samples from ICUs (2021-2024) for multidrug-resistant organisms (MDROs). A binomial generalized linear model was used to assess the association between cleaning staff role (nursing assistants vs environmental services staff) and MDRO detection rates, controlling for surface type, department, strain type, and sampling time. Sensitivity analyses using a probit model and exclusion of pediatric departments were conducted to evaluate the robustness. Time trend and spatial distribution of contamination were visualized via stacked area charts and heat maps.

RESULTS

The overall MDRO positivity rate was 0.68%. Surfaces cleaned by nursing assistants showed a 56.61% lower MDRO positivity rate than those cleaned by environmental services staff. Carbapenem-resistant Acinetobacter baumannii was the most prevalent pathogen, with odds of contamination 22.40 times higher than methicillin-resistant Staphylococcus aureus. Contamination risk increased over the sampling period and was 74.31% lower in public areas compared to bed rails.

CONCLUSION

Nursing assistants demonstrated superior environmental cleaning outcomes. These findings underscore the need to reevaluate cleaning responsibilities and strengthen training for environmental services staff.