Semiquantitative Evaluation of Concurrent Cleaning in an Intensive Care Unit Using Fluorescence: A Descriptive Study in a Tertiary Hospital

Healthcare-associated infections represent a persistent challenge in hospital settings, especially in intensive care units (ICUs), where patients are more susceptible to pathogens. Concurrent cleaning — performed with the patient present — is an essential infection control measure, but its effectiveness can be compromised by technical failures and low adherence to protocols. To evaluate, using a fluorescent marker, the effectiveness of concurrent cleaning performed in ICU beds. This is an observational, cross-sectional, descriptive, and semiquantitative study, developed in the ICUs of a tertiary hospital. Sixty occupied beds were evaluated (43 standard, 11 isolation, and 6 under contact precautions). Specific surfaces were marked with a 20% fluorescein-based suspension and inspected with ultraviolet light after cleaning. Points were classified according to the responsibility of the nursing staff or the cleaning team. High-touch points and areas difficult to clean were selected. “Not removed” was considered both visibly present marker and partially removed marker. Cleaning effectiveness rates between different bed types and responsible teams were analyzed statistically using the Clopper-Pearson method, followed by mixed-effects binomial regression. In standard beds, nursing showed 50.0% effectiveness in removing marked points (100/200; 95% CI: 42.9–57.1) and the cleaning team, 41.1% (97/236; 95% CI: 34.8–47.7), p = 0.067. In isolation beds, nursing had 46.2% (30/65; 95% CI: 33.7–59.0) and cleaning 40.5% (32/79; 95% CI: 29.6–52.1), with no significant difference (p = 0.505). In beds under contact precautions, lower overall effectiveness in marker removal was observed: 21.0% for nursing (8/38; 95% CI: 9.6–37.3) and 39.3% for cleaning (11/28; 95% CI: 21.5–59.4), p = 0.168. Concurrent cleaning showed unsatisfactory effectiveness, especially in beds under contact precautions. Although statistical significance was not reached, a trend toward better nursing performance in standard beds was observed. The data reinforce the need for continuous training of teams, strengthening oversight, and adopting objective methods, such as fluorescence and statistical analysis with exact intervals, to qualify surveillance of hospital cleaning.