Healthier Hotel Rooms: Training Procedures for Hotel Guestroom Sanitation
A Master’s Thesis Presented to the
Faculty of the
Conrad N. Hilton College of Hotel and Restaurant Management
University of Houston
In Partial Fulfillment
Of the Requirements for the Degree
Master of Science
Kristen Leigh Kirkwood
May 2015
Healthier Hotel Rooms: Training Procedures for Hotel Guestroom Sanitation
A Master’s Thesis Presented to the
Faculty of the
Conrad N. Hilton College of Hotel and Restaurant Management
University of Houston
Approved by:
John T. Bowen, PhD CHE
Dean, Conrad N. Hilton College
Mary Dawson, EdD CHE
Interim Associate Dean for Academic Programs
Jack A. Neal, PhD CHE
Thesis Chair
Sujata Sirsat, PhD
Thesis Committee Member
Mary Dawson, EdD CHE
Thesis Committee Member
Kristen Leigh Kirkwood
May 2015
i
Dedication
To my mother, father, brother, and loving family. Thank you for your continuing support
and motivational words of encouragement.
“Is féidir leat aon ní a dhéanamh a chuir tú d'intinn freisin”
(You can do anything you put your mind to)
~ Gail Kirkwood
ii
Acknowledgements
To those who have helped me continue to climb, even when all I wanted to do was fall.
Dr. Jay Neal, thank you for always pushing me to cromulent new levels and supporting
me. You never gave up on me and I promise to do the same.
Dr. Sujata Sirsat, thank you for all that you have taught me and introducing me to the
subject of microbiology. My nerd status is embiggened thanks to microbiology.
Dr. Mary Dawson, thank you for continuing support and teaching my favorite class at
Hilton College.
Dean John T. Bowen, Ph.D., thank you for your guidance and support over the last two
years. It was a privilege to assist you in your class.
iii
Table of Contents
Healthier Hotel Rooms: Training Procedures for Hotel Guestroom Sanitation .................. i
Healthier Hotel Rooms: Training Procedures for Hotel Guestroom Sanitation .................. i
Dedication ........................................................................................................................... ii
Acknowledgements ............................................................................................................ iii
Table of Contents ............................................................................................................... iv
List of Tables ..................................................................................................................... vi
List of Figures ................................................................................................................... vii
Abstract ............................................................................................................................ viii
Introduction ......................................................................................................................... 1
Statement of the Problem ................................................................................................ 4
Research Question .......................................................................................................... 4
Literature Review ............................................................................................................... 6
Effective Cleaning Procedures........................................................................................ 7
Previous Research ........................................................................................................... 8
ATP and APC ........................................................................................................................................8
Hospitals .............................................................................................................................................. 10
Educational and Child Care Facilities. ................................................................................................. 11
Hospitality Industry. ............................................................................................................................ 12
Methodology ..................................................................................................................... 13
Research Design ........................................................................................................... 13
Hotel Sampling ............................................................................................................. 14
Sampling Protocol......................................................................................................... 15
Data Analysis ................................................................................................................ 17
APC and ATP-B Quantification .......................................................................................................... 17
Corrective Action and Factsheet .......................................................................................................... 18
Post-Factsheet Environmental Sampling ............................................................................................. 20
Chapter IV......................................................................................................................... 21
Results ............................................................................................................................... 21
iv
Pre-Intervention ............................................................................................................ 21
CHAPTER V .................................................................................................................... 36
Discussion ......................................................................................................................... 36
Modified Cleaning Recommendations ......................................................................... 36
Thresholds and Benchmarks ......................................................................................... 38
Conclusion .................................................................................................................... 44
References ......................................................................................................................... 46
Appendix A ....................................................................................................................... 55
Appendix B ....................................................................................................................... 56
Appendix C ....................................................................................................................... 57
v
List of Tables
Table 1 Bedroom Environmental Sampling Locations ..................................................... 15
Table 2 Bathroom Environmental Sampling Locations.................................................... 15
Table 3 Cleaning Essentials Sampled ............................................................................... 15
Table 4 Labeling Format ................................................................................................... 16
Table 5 Sample Set 1 average Log CFU/cm2 and Log RLU/cm2 results per location ...... 22
Table 6 Five Pre-Cleaning Locations with the Highest Log CFU/cm2 Results ................ 23
Table 7 Five Pre-Cleaning Locations with the Highest Log RLU/cm2 Results ................ 24
Table 8 Post- Cleaning Locations with the Highest Log CFU/cm2 Results...................... 24
Table 9 Post-Cleaning Locations with the Highest Log RLU/cm2 Results ...................... 25
Table 10 Sample Set 1 Average Difference between Pre-Guestroom Cleaning and PostGuestroom Cleaning - Log CFU/cm2 and Log RLU/cm2 ................................................. 26
Table 11 Sample Set 1 Critical Areas and Average Differences ...................................... 27
Table 12 Averaged Log CFU/cm2 per guestroom location for Sample Set 2 .................. 32
Table 13 Log CFU/cm2 Average Differences Between Sample Sets .............................. 33
Table 14 Log RLU/cm2 Average Differences Between Sample Sets .............................. 34
Appendix A Swabbing Areas for APC and ATP-B .......................................................... 55
Appendix B Environmental Sampling Flow Chart ........................................................... 56
Appendix C Per Hotel Guestroom Sampling Flow Chart ................................................. 57
vi
List of Figures
Figure 1. Corrective Action Procedures and Distributed Factsheet – English Edition ..... 29
Figure 2. Corrective Action Procedures and Distributed Factsheet - Spanish Edition ..... 30
vii
Abstract
The focus of this project was to close the existing gap between current hotel
cleaning standards and sanitization levels. In conjunction with a thorough content
analysis of industry cleaning procedures, this study aimed to determine effective and
efficient cleaning procedures currently used in the lodging industry by sampling 23
locations within hotel rooms using aerobic plate counts (APC) and adenosine
triphosphate bioluminescence (ATP-B). Implementing correction action procedures and
factsheet information into the housekeeping cleanliness routine effectively altered the
level of cleanliness present in hotel guestrooms. The results demonstrated that focusing
on specific areas during cleaning effectively reduced the presence of contamination in
guestrooms. When ATP-B and APC measurements reduced, the possibility of guests and
employees contacting an illness reduced as well.
viii
CHAPTER I
Introduction
Multiple instances of hotel stays have resulted in illness and, in some severe cases,
death (CNN, 2012; Dell’Amore, 2014; HC Information Resources Inc, 2015; Hunter,
2011; Kinney, 2014; Jones, 2006; Mason, 2015; Prisco, 2014; Southall, 2014; Smith,
2012). There is an increasing need to standardize cleaning protocols in the hospitality
industry (Acampora et al., 2005; Albrecht & Leon, 2007; Boyce, et al., 2009; Infections,
such as Norovirus, Legionnaires disease, and gastroenteritis, are some of the leading
contributing factors associated to these illnesses and deaths. These infections spread to
hotel guests and employees, through forms of cross-contamination, as a result of
insufficient guestroom cleaning procedures in hotels. Inadequate cleaning methods can
consist of employees neglecting to properly sanitize items featured in hotel rooms (i.e.
T.V. remote, phone keypad, etc.), failing to replace the provided mug from prior guest,
the improper use of cleaning materials, and more.
Several hotel guests and employees have contracted a wide range of illnesses, from
Norovirus to Legionnaires’ disease after staying and/or working in hotels. Specifically,
the Chicago JW Marriott, the Flamingo and Monte Carlo hotels in Las Vegas, Nevada,
and the Monhonk Mountain House in New York all were afflicted with hazardous
environmental outbreaks (CNN, 2012; Jones, 2006; Kinney, 2014; Southall, 2014). More
recently, in November of 2014, Hotel Sofitel in Redwood City California was to blame
for 60 hotel guests and employees contracting Norovirus (Kinney, 2014). Additionally, in
February of 2015, health officials in Nashville, Tennessee confirmed Norovirus was
discovered at the Gaylord Opryland Resort and Convention Center for the second time
1
since January of 2015 (Mason, 2015). The rise of disease outbreaks, such as Norovirus
and Legionnaires’ Disease, occurring in hotels may be due primarily in part of ineffective
guestroom cleaning procedures derived from the absence of consistent cleaning standards
among and within industry brands. Therefore, an increasing need exists to standardize
cleaning protocols in the hospitality industry as well as additional industry sectors
(Acampora et al., 2005; Leon and Albretch, 2007; Boyce, et al., 2009; Carling et al.,
2005; Cates et al., 2014; Chen & Godwin, 2006; Cooper, et al., 2007; Cosby et al., 2008;
Cunningham et al., 2006; Dancer, 2004; Jones, 2006; Lewis et al., 2008; Mulvey et al.
2011; Sherlock et al., 2009; Larson et al., 2003).
Moreover, the hotel industry is not alone in this matter. According to the Center for
Disease Control (CDC) (2012) outbreaks of Norovirus, a very contagious acute
gastroenteritis, which is easily transferable from person to person through bodily contact,
contaminated food and/or water, or contaminated contact surfaces commonly occur in
healthcare facilities, restaurants, educational institutes, and cruise ships. Legionnaires’
disease is caused by Legionella a type of bacteria that commonly grows in warm water
environments (i.e. hot tubs, water fountains, shower heads, HVAC systems) and can be
transmitted by inhalation of water vapor or mist droplets (CDC, 2012). Legionella
outbreaks usually occur in facilities that have complex water systems, (i.e. hospitals and
hotels) or surrounded by mist environments, such as cruise ships (CDC, 2010).
Previous research analyzed cleanliness levels in childcare and educational facilities
(Li et al., 2014; Cosby et al., 2008) as well as food preparation facilities (Cunningham et
al., 2010; Leon and Albrecht, 2007) and hospitals (Mulvey et al., 2011; Sherlock et al.,
2009; Lewis et al., 2008; Cooper et al., 2007; Acampora et al., 2005; Boyce et al., 2009;
2
Dancer, 2004; Carling et al., 2005). Each of these industries, at one point, have been
financially impacted as a result of bacterial or viral outbreaks derived from ineffective
cleaning procedures..
According to Zingg, (2005), the estimated financial impact that a disease outbreak has
on a public facility, in this case a 500-bed hospital, can reach upwards of $40,000. At
least three of the previously mentioned hotel outbreak contracted out environmental
specialists to sanitize and disinfect the hotels (CNN, 2012; Dell’Amore, 2014; Prisco,
2014; Southall, 2014; Smith, 2012). This additional expenditure could result in major
financial impacts on the facilities yearly budget (Dell’Amore, 2014; Prisco, 2014;
Southall, 2014 Smith, 2012).
The specific cleaning procedures determined for this study were of two common
environmental sampling techniques: Adenosine triphosphate bioluminescence (ATP-B)
and aerobic plate counts (APC). These techniques have been utilized in varies studies to
identify cleanliness standards for the facilities of the healthcare industry, educational
industry, and in food processing facilities. These techniques were utilized in this study to
generate the most effective and efficient guestroom cleaning procedures through
analytical and quantitative methods. The determined procedures were formatted into a
factsheet to analyze the validity of the generated procedures and a proposed universal for
the hotel industry was created.
ATP-B and APC environmental sampling procedures are used to indicate the level of
contamination in or around a food sampling surfaces and/ or contact surface. ATP is a
cellular transport that supplies energy enzymes for metabolism (Hattori and Gouaux,
2012; Held, 2006; Sherlock, 2009). “ATP is the most widely distributed high-energy
3
compound within the human body” (as cited in Bergman, 1999; Ritter, 1996, p.301).
Additionally, ATP cells are present in all living things and are detected through an ATPB meter. This meter is “a rapid sanitation test using light signals to measure the level of
microbial through relative light units (RLU)” (Easter, 2008; Leon and Albrecht, 2007).
APC sampling method is a widely used as “ microbiology test for measuring sanitation
levels” (Leon and Albrecht, 2007). ATP-B is used to measure the level of proteins on a
contact surface within 60 seconds of extracting the surface sample. APC is the traditional
laboratory method used when measuring sanitation levels of contact surfaces by
quantifying aerobic bacteria. For the purpose of this study, uniformed cleaning
material/factsheet were developed from an analysis of environmental sampling results
generated from APC and ATP-B sampling procedures.
Statement of the Problem
In an attempt to eliminate this presently existing gap, specific guestroom cleaning
training procedures were created for the purpose of decreasing the risk of crosscontamination and the spread of illness among the hotel community.
Research Question
The focus of this project was to close the existing gap between current hotel cleaning
standards and sanitization levels. This study aimed to 1) determine effectiveness of
current hotel guestroom cleaning protocols through environmental sampling of
guestrooms using ATP-B and APC methods, 2) conduct a comparative analysis across
hotel guestroom cleaning focus utilizing ATP-B and APC quantification results generated
from Objective 1, 3) generate hotel guestroom sanitation training material (training
information sheets and upper limit ATP-B thresholds) derived from Objectives 1 and 2 in
4
multiple languages (specifically English and Spanish), and 4) verify and validate
effectiveness of area training sheets through the replication of Objective 1 by quantifying
ATP-B and APC results.
With the completion of the objectives, the following research questions will be
answered:
1.) What are the current levels of cleanliness in hotel guestrooms?
2.) What surface locations in hotel guestrooms need more attention when cleaning?
3.) Is the designed factsheet an effective intervention to improve cleaning methods
that reduce the level of microorganisms present on various hotel guestrooms
surfaces?
4.) Does a correlation exist between the environmental sampling methods
implemented in this study (ATP-B and APC)?
5
CHAPTER II
Literature Review
There is a lack of guestroom cleaning standardization in the hotel industry, within
and across all brands. Hence, the hotel industry is in need of science based cleaning and
sanitizing standards as well as training materials based on these standards. Many
guestroom-cleaning evaluations are based upon visual observations and are absent of
empirical data validation, such as environmental sampling (Almanza et al., 2015 in
press). Even though hotel rooms may appear clean, a lack of sanitizing and proper
disinfecting could lead to the spread of disease in hotel rooms.
In 2004, in Las Vegas, Nevada, over 1,200 guests and hotel employees of the
Flamingo and Monte Carlo hotels were affected by a norovirus outbreak (Jones, 2006).
Forward to 2012, the JW Marriott Chicago was tied to a Legionnaires’ outbreak, resulting
in ten ill and three dead (CNN, 2012). In 2013, a Turkish hotel faced a lawsuit stemming
from a bacterial infection, which sickened over 100 guests (Myers, 2013). February of
2014, Monhonk Mountain House “was shut down for a week after a virus outbreak
sickened hundreds of people during the span of a month” (Southall, 2014). The New
York State Department of Health confirmed an outbreak of norovirus (Southall, 2014). In
November of 2014, Hotel Sofitel in Redwood City, California was to blame for 60 hotel
guests and employees contracting norovirus (Kinney, 2014). Additionally, in February of
2015, health officials in Nashville, Tennessee confirmed the discovery of norovirus at the
Gaylord Opryland Resort and Convention Center (Mason, 2015). Ironically, this was
neither Hotel Sofitel’s nor Gaylord Opryland’s first hotel outbreak. In 2008, a county
health investigation found Hotel Sofitel responsible for exposing 62 hotel guests to
6
norovirus (Kinney, 2014) and in January, 2015 the Gaylord Opryland property was
disinfected for norovirus after several guests complained of gastrointestinal illness
(Mason, 2015). With at least two hotels experiencing additional outbreaks in the past ten
years, the need to implement standardized guestroom cleaning protocol across the hotel
industry has significantly increased.
Effective Cleaning Procedures
Several industries require effective cleaning methods to complete daily objectives and
responsibilities. For instances, educational and childcare facilities, hospitals, and food
preparation facilities are sanitized on a routine basis to eliminate the possible threat of
spreading infectious bacteria and viruses to others (Cooper et al, 2007; Li, et al., 2014;
Cosby et al. 2008).
Previous studies have shown that effective cleaning procedures are evaluated
according to cleaning validation programs created by the equipment manufacturer
(Lombardo et al., 1995; Walsh, 2011). The FDA’s Guide to Inspections Validation of
Cleaning Processes, derived from the Pharmaceutical Process Validation, second edition,
(McCormick and Cullen, 1993) created general recommendations for “validation of
cleaning processes” geared towards industry equipment. These requirements include 1)
company generated written procedures, including sampling and evaluation methods, for
the cleaning validation processes, 2) the trained industry employees are responsible for
performing and approving the validation study, 3) detailed findings of the validation,
which depicts a reduction of present contamination (McCormick and Cullen, 1993).
7
Previous Research
Several service focused industries have analyzed the effectiveness of surface
cleanliness and measurement evaluation in respects to the utilized industry facilities
(Boyce, et al., 2009; Albrecht & Leon, 2007; Cooper, et al., 2007; Chen & Godwin,
2006; Cunningham et al., 2006; Larson et al., 2003; Cates et al., 2014; Mulvey et al.
2011; Lewis et al., 2008; Cosby et al., 2008). Specifically, previous environmental
cleanliness research has been conducted in the educational and child care industry (Li et
al., 2014; Cosby et al., 2008) the U.S., U.K., and Italian healthcare industries (Mulvey et
al., 2011; Sherlock et al., 2009; Lewis et al., 2008; Cooper et al., 2007; Acampora et al.,
2005; Boyce et al., 2009; Dancer, 2004; Carling et al., 2005) and food preparation
facilities and/or equipment in the U.S. (Cunningham et al. 2010; Leon and Albrecht,
2007) Additionally, previous research also analyzed the validity and feasibility of ATP-B
sampling in the average U.S. household (Chen and Godwin, 2006; Larson et al., 2003).
ATP and APC
A significant portion of previous research focused on assessing the accuracy of
cleanliness levels by conducting a comparative analysis between the quantitative and
subjective, microbial sampling and the objective, visual observation (Cunningham et al.,
2010; Mulvey et al., 2011; Sherlock et al., 2009; Cooper et al., 2007). Specifically,
Cunningham et al. (2010) assessed the hygienic quality of retail food service
establishments by environmentally sampling eight surface locations at three university
dining centers. A comparative analysis revealed a disconnect between ATP-B, total
aerobic plate counts (TAPC), and visual observations, where visual observations of clean
8
surfaces failed to pass ATP-B upper limit levels 70.3% of the time (Cunningham et al.,
2010).
Comparatively, past research also evaluated the level of comparison between
ATP-B results and standard microbiological sampling (Niksic et al., 2012; Leon and
Albrecht, 2008) as well as the robustness of the ATP-B method (Trudil et al., 2000;
Larson et al, 2003; Yue and Bai, 2012). Leon and Albrecht (2007) concluded that “APC
and ATP –B were closely related, and did follow a linear relationship.” With Leon and
Albrecht (2007) finding APC and ATP –B to have a linear relationship, the possibility for
ATP –B meter reading becoming a proper guestroom sanitation measuring instrument is
high.
Adversely, Boyce et al. (2009) conducted a two-phase microbiological study,
consisting of environmental sampling procedures and newly developed training material,
focusing on the effectiveness of cleaning procedures at a teaching hospital (Boyce et al.,
2009). ATP and APC were utilized in the sampling procedures to quantify the level of
cleanliness on 5 high-touch surfaces in 20 patient rooms (Boyce et al., 2009). Results
showed a reduction in ATP readings following the distribution of the corrective action
material (Boyce et al, 2009). Certain surface areas, however, did increase in APC and
ATP readings after cleaning (Boyce et al., 2009). Results were stated as incomparable to
previous studies due to inconsistencies in sampling dimensions (Boyce et al., 2009). This
study will attempt to overcome this limitation by utilizing the sampling procedures
created by the manufacturer.
9
Hospitals
Hotel guestrooms and hospital rooms are similar in the matter that they both
continuously serve new clientele, for lack of a better term, on a daily basis. Both are
required to uphold high standards of room cleanliness with brief turnaround time. As
previously mentioned, healthcare facilities host the ideal environmental settings for
outbreaks, such as norovirus and Legionnaires’ disease, to take shape (CDC, 2010). The
revolving door of patients and the close proximity of healthcare workers creates the ideal
breeding ground for a vast amount of pathogen outbreaks in healthcare facilities. Hotel
guests and staff are subjected to similar environmental hazards as they serve worldwide
travelers. In November 2014, at a Rhode Island hospital, two patients fell ill with
Legionnaires’ disease from an unreported source within the hospital (HC Information
Resources, Inc., 2015). Prior to this outbreak, a VA hospital in Pittsburg was found to
have Legionella bacteria present in the hospital (CBS, 2014). According to a CBS report
(2014), one patient died and two others were infected with Legionnaires’ disease as a
result of Legionella bacteria found in the hospitals ice machines. Furthermore, in the past
year, two additional hospitals were contaminated with Legionnaires’ disease, resulting in
10 patients testing positive and one hospital shutting off patients access to clean water
and proper hygiene regimen (HC Information Resources, Inc., 2014).
In the healthcare industry, patient room cleanliness and environmental
contamination can be a source of cross-contamination between the healthcare employee
and constituents (Boyce et al., 2009). According to Boyce et al. (2009), few hospitals
evaluate the level of environmental cleanliness through an visual inspection process. This
inspection process is similar to current guestroom cleaning inspections, with the majority
10
of hotels evaluating cleanliness through a visual inspection. Moreover, Boyce et al.
(2009), explained that through the use of a visual inspection process, the possibility of
missing microorganisms, which may remain on the surface area after cleaning, could be
highly significant. To elaborate, a study published in Open Medicine in 2014 found that
elevator buttons in hospitals had a larger percentage of bacterial colonies present on the
contact surface than that of a public toilet seat (Kandel et al., 2014). If this study were to
be replicated in a hotel setting, the bacterial colony percentage on hotel elevator buttons
could be just as high, if not higher due in part to sanitation differences.
Educational and Child Care Facilities.
Infants, toddlers, and school-aged children interact with a vast number of individuals
while attending childcare or education facilities. The potential for contracting harmful
bacterial from environmental contamination are much higher in the younger population
due in part to lower functioning immune system. For instance, in 2014, Food Safety
News (Norovirus was…, 2014) reported over 130 elementary school students had
contracted what was most likely norovirus. Health officials were not able to confirm that
source of the outbreak; however, they were able to determine the threat originated from a
teacher or student present at the school (Norovirus suspected…, 2014). Similarly, in
March of 2015, two elementary school males were confirmed to be infected with
Escherichia coli (E. coli) – a common bacteria located in the intestines, but certain strains
can cause serious illness (CDC, 2015, E.coli, 2015). The source of contamination was
unable to be located; however, the health department tested the school’s cafeteria and
found no trace of the pathogen (E. coli, 2015).
11
Harmful pathogens can infect a range of individuals, regardless of age. In November
of 2014, Emory University, and the University of Virginia confirmed to having norovirus
within the school systems (Food Safety News, 2014). Over 100 students from Emory
University (Vashi and Slade, 2014) and 18 from the University of Virginia were treated
by healthcare centers and/ or the University Hospital (The Daily Progress, 2014).
Hospitality Industry
A study conducted by Auburn University found that even on airplanes, the threat
of coming in contract with harmful pathogens could be significant. Methicillin-resistant
Staphylococcus aureus (MRSA) – a bacterial infection, resistant to many antibiotics
(CDC, 2015) – was found to survive for seven full days on a passenger seat cloth pocket
(State News Wire, 2014). Moreover, the study found that E. coli. has the ability to
survive up to four day on a plane armrest (State News Wire, 2014).
Concluding a U.S. Food and Drug Administration (FDA) inspection in July of
2014, nSpired Natural Foods Inc. manufactory plant in Ashland, Oklahoma, tested
positive for Salmonella. The facility was cited for several violations, including
“inadequate cleaning and sanitizing of the facility, procedure utensils, and processing
equipment (FDA, 2014).”
12
CHAPTER III.
Methodology
Research Design
ATP-B and APC environmental sampling procedures were conducted for this
study for quantifying effective and efficient standardized guestroom cleaning procedures.
As previously stated, ATP-B is defined as “a rapid sanitation test using light signals to
measure the level of microbial through Relative Light Units (RLU)” (Easter, 2008; Leon
and Albrecht, 2007). APC sampling method is a widely used as “ microbiology test for
measuring sanitation levels” (Leon and Albrecht, 2007). ATP-B results can be received
within 60 seconds or less, indicating the level of proteins on a contact surface. Adversely,
APC is a prolonged, traditional laboratory method measuring sanitation levels of contact
surfaces by quantifying aerobic bacteria. APC results are given with 24 to 48 hours after
the incubation period.
An experimental research design was implemented for this study. This design
encompassed ATP-B and APC microbial sampling methods to assess the level of
cleanliness on hotel guestroom contact surfaces. The environmental sampling procedures
consisted of steps derived from hotel room Hazard Analysis Critical Control Point
(HACCP). Each step encompasses several procedures. This protocol was provided to
three universities prior to the start of environmental sampling. This was completed to
ensure the validity and reliability of the data collected. ATP-B and APC measurements
were observed after the sampling procedures were completed and a factsheet (containing
specific sanitation guidelines for housekeeping staff) was designed.
13
Hotel Sampling
To determine the effectiveness of current hotel guestroom cleaning procedures, 23
high touch contact areas were sampled at two separate intervals using the environmental
sampling techniques of ATP-B and the traditional microbial method (APCs). The 23
guestroom locations were determined from a pilot study completed in 2011 identifying
high touch areas within the guestroom (Almanza et al., 2015 in press; Shoemaker, 2007;
Winther et al., 2007, 2011). These locations were divided between the bedroom area,
bathroom area, and current housekeeping cleaning essentials. Tables 1, 2, and 3
demonstrate the selected locations chosen for environmental sampling in relation to the
guestroom and labeling format. In total, nine different guestroom, from three upscale,
full-service, hotels, were sampled before the cleaning process occurred and after.
14
Table 1 Bedroom Environmental Sampling Locations
Bedroom Area
L1 - Internal Door Handle of Room
L8 - TV Remote Keypad
L2 - Light Switch at Entryway
L19 - Pen
L3 - Carpet at Entryway
L20 - Couch: Right Armrest
L4 - Surface of Provided Mug
L21 - Mirror: Right lower side
L5 - Headboard (Right side sampled
L22 - Back Inside of Chest Drawer
L6 - Bedside Lamp Switch
L23 - Inside Door Above Peephole
L7 - Telephone Keypad
Table 2 Bathroom Environmental Sampling Locations
Bathroom Area
L9 - Internal Bathroom Door Handle
L13 - Bathtub/Shower Floor
L10 - Bathroom Floor
L14 - Toilet Paper Holder
L11 - Bathroom Faucet (Right)
L15 - Toilet Basin
L12 - Bathroom Sink Basin
Table 3 Cleaning Essentials Sampled
Housekeeping Essentials/Cleaning Material
L16 - Gloves from Maid Cart
L17 - Mop from Maid Cart
L18 - Towel from Maid Cart
Sampling Protocol
ATP-B and microbial samples occurred on two intervals from three separate hotels.
When conducting environmental experiments, samples should be extracted over a period
15
of time instead of all at once (Collins, et al., 1995, p. 215). This is to ensure validity and
reliability of the determined total microbial counts.
Each hotel sampled nine guestrooms before the housekeeping staff cleaned the
guestrooms (Dirty) and after (Clean). There was no single, dedicated housekeeper for all
nine rooms sampled. The objective was to determine which areas currently need more
attention when cleaning. Prior to sampling guestrooms, 150 hygiena UltraSnap ATP-B
swabs (Camarillo, CA) and 150 centrifuge tubes (15 mL) were labeled according to the
sampling order of the rooms (e.g. first room sampled – A, second room sampled – B,
third room sampled – C, etc.), housekeeping status of the room (e.g. Dirty – D, Clean –
C), and the location sampled (e.g. Internal Door Handle of Room – 1, etc. ). Table 4
depicts the labeling format.
Table 4 Labeling Format
Room Order
Room Status
Sample Location
Label
First Room Sampled,
First room sampled - A
Dirty - D
Internal door handle of
Dirty, Interior Door
Clean - C
the room – 1, etc.
Handle of Room – AD1
Second room sampled,
Second room sampled -
Dirty - D
Internal door handle of
Dirty, Interior door handle
B
Clean - C
the room – 1, etc.
of room – BD1
Third room sampled, Dirty,
Third room sampled - C
Dirty - D
Internal door handle of
Interior door handle of
Clean - C
the room – 1, etc.
room – CD1
Refer to Appendix A for a depiction of the swabbing area for each location. These
sampling procedures were identical for each room.
16
Prior to entering guestrooms, researchers washed their hands using aseptic techniques
and then put on sterile latex gloves. To collect each ATP-B sample, a 10 X 10 cm (4 X 4
in) area was swabbed according to the manufacturer’s guidelines (hygiene, SystemSure
Plus, UltraSnap) using a sterilized plastic template. The plastic template was made using
transparency film, measured and cut to the dimensions needed, and sterilized with a 70%
ethanol and water solution. For microbial samples, a 5 X 5 cm was swabbed using a
similar sterilized plastic template. Each sample was extracted using a diagonal and back
and forth motion for 10 seconds, in accordance with the manufacturer’s instructions (3M
Microbiology, Forest City, IA and hygiene, Camarillo, CA).
To determine the level of cleanliness at each location, ATP-B readings were collected
on the day APC samples were collected from the surfaces. These readings were recorded
as RLU/cm2. In contrast, APC were quantified by plating the samples on 3M
Microbiology APC and Escherichia coli (E. coli) Petrifilm™. For each measurement, 1
mL of the sample was pipetted on to an APC petrifilm. An additional 1 mL was extracted
and pipetted on to E. coli Petrifilm. All APC and E. coli Petrifilm were incubated for 24
to 48 hours at 37°C and the Colony Forming Units (CFUs) were quantified.
Data Analysis
APC and ATP-B Quantification
ATP-B and APC microbial samples measured the level of protein present on each of
the 23 high touch surface areas and determined if Escherichia coli (E. coli) and coliform
were present on these surfaces. Total RLU averages per location (RLU/cm2) and total
CFU averages per location (CFU/cm2) were calculated for all samples. These averages
were used to determine areas needing more attention when cleaning and the design of the
17
factsheet. The purpose of the factsheet was to inform room attendants of possible
cleaning improvements as well as evaluate the effectiveness of the recommendations.
Replicating the ATP-B sampling procedures fulfilled validation of the factsheet.
Results for CFUs were averaged per 25cm2 surface area and converted to
logarithmic scale (log). ATP-B results (RLUs) were averaged per 100cm2 surface area
and converted to logarithmic scale (log). Conversions were then processed using IBM®
SPSS® Statistics (Version 22.0, Ireland). The Mean, Range, and Standard Deviation
were calculated according to the average differences between Sample Set 1 and 2 Log
CFU/cm2 and Log RLU/cm2. were determined Two-Paired Test, Correlation,
Prior to the training intervention and distribution of the factsheet, ATP-B and
APC data were collected (Sample Set 1). Data was collected post-training intervention
and distribution of the factsheet (Sample Set 2). A comparison was made by calculating
the differences between the Dirty and Clean results. A negative outcome indicated an
increase in RLUs and CFUs after cleaning (e.g. the surface location increased in bacteria
counts) and positive indicated a reduction in RLUs and CFUs (e.g. the surface location
decreased in bacteria counts).
Corrective Action and Factsheet
In conjunction with prior training research, an additional microbial experiment,
and the results determined from Sample Set 1, recommendations were developed for
improving the current guestroom cleaning procedures. Pluta and Hall’s (2009) Effective
Manual Cleaning Procedures – Development, Documentation, Performance, and
Maintenance included key considerations when developing and implementing effective
18
physical cleaning procedures. Specifically, the key considerations utilized in the creation
of the factsheets were:
“Procedures must be carefully developed using scientific and technical
principles, yet practical for daily utilization by all employees. A hands-on
approach should be executed when training necessary personnel of these
procedures. Lastly, procedures should be monitored and evaluated on a regular
basis (Pluta and Hall, 2009)”
Chapman et al. (2011) and Leventhal et al. (1965) determined that instilling a
fearful image, that the observer can personally connect with, will and influence the
observers behavior. This idea was utilized in the creation of the factsheet. To help create
visual images to train housekeepers, Glo-Germ Gel, a liquid based fluorescent lotion was
used to simulate the spread of pathogens (bacteria and viruses). In the presence of UV
light, this lotion is visible and cross-contamination is easily mimicked. Glo-Germ Gel is a
primary training and inspecting tool for major fast food chains, hotels, and hospitals
(www.glogerm.com). Four separate hotel cleaning cloths (e.g. Microfiber clothes, Magic
Eraser sponge, a cloth towel, and disinfectant wipes) were obtained and used to replicate
the cleaning process for the bathroom sink areas. Glo-Germ Gel was place in a bathroom
sink basin and each cleaning cloth was utilized to enact the cleaning process. Pictures
were taken to illustrate what remains on the four cleaning cloths once the cleaning
process was completed.
This exercise looked at the possibility of cross-contaminating the guestroom
bathroom countertop after cleaning the sink basin. Hotel cleaning cloths were utilized to
examine which transferred the greatest potential for cross-contamination when cleaning
19
from the bathroom sink basin to the bathroom countertop. Results revealed a clean
Microfiber cloth and a clean cloth towel had the lowest cross-contamination between the
bathroom countertop and the bathroom sink basin. In conjunction, this result gave way to
the possibility of the room attendants cleaning material being contaminated with large
amounts of bacteria/germs.
The featured recommendations were formulated in to an informative training
factsheet consisting of detailed images regarding the recommended cleaning process.
Previous research has shown an increase in performance outcomes when training
procedures are depicted as image base content in lux of text-based content (Madera et al.,
2012). The training factsheet was then translated into Spanish for non-English-speaking
employees. The purpose of the factsheet was to inform room attendants of possible
cleaning improvements as well as evaluate the effectiveness of the suggested
recommendations.
Post-Factsheet Environmental Sampling
To validate and verify the effectiveness of the suggested best practices and
factsheet material, the original study was replicated using the identical protocol and
preparation steps. The difference between data collected in Sample Set 1 and data
collected in Sample Set 2 was the addition of the factsheet. Appendix B and C depict the
flow chart of environmental sampling process used in this study.
20
Chapter IV
Results
Pre-Intervention
A total of 329 usable microbial samples and 360 usable ATP-B samples were
collected for Sample Set 1 from nine guestrooms at three different hotels from 23 high
contact surface locations. APC and coliform samples were quantified for ColonyForming Units (CFU), while ATP-B samples were quantified for Relative Light Units
(RLU). All CFUs and RLUs were averaged across each surface location according to
room status (e.g. pre-guestroom cleaning and post-guestroom cleaning) for the purpose of
comparing CFU/cm2 and RLU/cm2 results. Furthermore, to mathematically compare
CFUs and RLUs, results must be converted into logarithms (log) format.
Pre-guestroom cleaning and post-guestroom cleaning log averages from Sample
Set 1 revealed the current level of guestroom cleanliness among the sampled locations
APC results for Sample Set 1, pre-guestroom cleaning, ranged from a minimum 0.03 Log
CFU/cm2 (0.17 average CFU) at L4 (Mug Surface) to a maximum of 2.32 Log CFU/cm2
(354.33 average CFU) at L12 (Bathroom Sink Basin). ATP-B readings ranged from a
minimum 0.00 Log RLU/cm2 (0.00 average RLU) at the L17 (Towel from Housekeeper’s
Cart) to a maximum of 1.18 Log RLU/cm2 (422.20 average RLU) at the L8 (TV Remote
Keypad) (Table 5).
21
Table 5 Sample Set 1 average Log CFU/cm2 and Log RLU/cm2 results per location
Location
Log CFU/cm2
Average Log RLU/cm2
D. APC
D. E.coli.
C. APC
C. E.coli.
Dirty
Clean
L1 - Internal Door Handle of the Room
0.66
0.00
0.16
0.00
1.09
1.02
L2 - Light Switch Closest to the Entrance
0.52
0.00
0.33
0.33
0.72
0.78
1.39
0.29
1.72
0.03
0.49
0.45
L4 - Surface of the Provided Mug
0.03
0.00
0.03
0.00
0.21
0.18
L5 - Headboard (Right Side of the Bed)
0.25
0.00
0.48
0.00
0.42
0.56
L6 - Bedside Lamp Switch
0.45
0.00
0.25
0.00
0.68
0.68
L7 - Phone Keypad
0.70
0.00
0.59
0.00
0.60
0.46
L8 - TV Remote Keypad
1.20
0.00
0.41
0.00
1.18
1.15
L9 - Internal Bathroom Door Handle
0.63
0.00
0.19
0.00
0.82
0.81
L10 - Bathroom Floor
1.78
0.44
0.36
0.00
0.68
0.59
L11 - Bathroom Faucet (Right)
0.97
0.04
0.57
0.00
0.93
0.59
L12 - Bathroom Sink Basin
2.32
0.05
0.33
0.00
0.85
0.68
L13 - Bathtub or Shower Floor
1.17
0.18
0.61
0.00
0.54
0.14
L14 - Toilet Paper Holder
0.94
0.00
0.33
0.00
0.28
0.32
L15 - Toilet Basin
0.51
0.05
0.20
0.00
0.41
0.07
L16 - Gloves from Housekeeping Cart
0.56
0.00
0.91
0.71
0.26
0.65
L17 - Towel from Housekeeping Cart
0.09
0.00
1.18
0.07
0.00
0.26
L18 - Mop from Housekeeping Cart
1.22
0.00
0.82
1.04
0.53
0.15
L19 - Pen
0.71
0.00
0.15
0.00
0.52
0.56
L20 - Couch: Right Armrest
1.38
0.00
1.18
0.00
0.92
0.91
L21 - Mirror: Bottom Right Hand Corner
0.07
0.00
0.17
0.04
0.22
0.05
L3 - Carpet at the entryway of the hotel
room
L22 - Back of Inside of Chest Drawers
0.12
0.00
0.26
0.00
0.36
0.15
L23 - Inside Door Above Peephole
0.29
0.00
0.10
0.00
0.26
0.58
22
Post-guestroom cleaning APC results ranged from 0.03 Log CFU/cm2 (0.17
average CFU) at the L4 (Mug Surface) to 1.72 Log CFU/cm2 (100.44 average CFU) at
the L3 (Carpet Entryway Guestroom). ATP-B readings ranged from 0.05 Log RLU/cm2
(21.20 averaged RLU) at the L21 (Mirror: Bottom Right Hand Corner) location to a
maximum of 1.15 Log RLU/cm2 (325.10 averaged RLU) at the L8 (TV Remote Keypad).
The five highest levels of CFUs pre-guestroom cleaning were present at the L12
(Bathroom Sink Basin; 2.32 Log CFU/cm2), L10 (Bathroom Floor; 1.78 Log CFU/cm2),
L3 (Carpet at the Entryway of Guestroom; 1.39 Log CFU/cm2), L20 (Couch: Right
Armrest) (1.38 Log CFU/cm2), and L18 (Mop from Housekeeping Cart) (1.22 Log
CFU/cm2). Table 6 depicts these results.
Table 6 Five Pre-Cleaning Locations with the Highest Log CFU/cm2 Results
Log CFU/cm2
Locations
L12 - Bathroom Sink Basin
2.32 Log CFU/cm2
L10 - Bathroom Floor
1.78 Log CFU/cm2
L3 - Carpet at the Entryway of Guestroom
1.39 Log CFU/cm2
L20 - Couch: Right Armrest
1.38 Log CFU/cm2
L18 - Mop from Housekeeping Cart
1.22 Log CFU/cm2
The five highest RLUs were present at L8 (TV Remote Keypad) (1.18 Log
RLU/cm2), L1 (Internal Door Handle of Room) (1.09 Log RLU/cm2), L11 (Bathroom
Faucet: Right) (0.93 Log RLU/cm2), L20 (Couch: Right Armrest) (0.92 Log RLU/cm2),
and the L12 (Bathroom Sink Basin) Log RLU/cm2). Table 7 contains the highest RLU
levels per location.
23
Table 7 Five Pre-Cleaning Locations with the Highest Log RLU/cm2 Results
Log RLU/cm2
Locations
L8 - TV Remote Keypad
1.18 Log RLU/cm2
L1 - Internal Door Handle of Room
1.09 Log RLU/cm2
L11 - Bathroom Faucet: Right
0.93 Log RLU/cm2
L20 - Couch: Right Armrest
0.92 Log RLU/cm2
L12 - Bathroom Sink Basin
Log RLU/cm2
Post-cleaning, the areas containing the highest CFUs were at L3 (Carpet at the
Entryway of Guestroom) (1.72 Log CFU/cm2), L17 (Towel from Housekeeping Cart)
(1.18 Log CFU/cm2), and L20 (Couch: Right Armrest) (1.18 Log CFU/cm2). Results are
depicted in Table 8.
Table 8 Post- Cleaning Locations with the Highest Log CFU/cm2 Results
Log CFU/cm2
Locations
L3 - Carpet at the Entryway of Guestroom
1.72 Log CFU/cm2
L17 – Towel from Housekeeping Cart
1.18 Log CFU/cm2
L20 - Couch: Right Armrest
1.18 Log CFU/cm2
L8 (TV Remote Keypad) (1.15 Log RLU/cm2), L1 (Internal Door Handle of
Room) (1.02 Log RLU/cm2), L20 (Couch: Right Armrest) (0.91 Log RLU/cm2), L9
(Internal Bathroom Door Log RLU/cm2), and L2 (Light Switch Closest to the Entrance)
(0.78 Log RLU/cm2) revealed the highest RLUs in Sample Set 1 post-cleaning. Table 9
shows these results.
24
Table 9 Post-Cleaning Locations with the Highest Log RLU/cm2 Results
Log RLU/cm2
Locations
1.15 Log RLUU/cm2
L8 - TV Remote Keypad
L1 - Internal Door Handle of Room
1.02 Log RLU/cm2
L20 - Couch: Right Armrest
0.91 Log RLU/cm2
L9 – Internal Bathroom Door Handle
0.81 Log RLU/cm2
L2 – Light Switch Closest to the Entrance
0.78 Log RLU/cm2
It is important to note that the highest area of E. coli/Coliform contamination was
present on the housekeepers mop/sponge used to clean a majority of locations in the
bathroom.
Corrective Action and Factsheet
The factsheet was designed according to the average pre-cleaning results
subtracted from the averaged post-cleaning results from Sample Set 1 ATP-B and APC
results . Table 10 depicts the average difference between pre-cleaning and post-cleaning
Log CFU/cm2 and Log RLU/cm2 per location for Sample Set 1.
25
Table 10 Sample Set 1 Average Difference between Pre-Guestroom Cleaning and Post-Guestroom Cleaning Log CFU/cm2 and Log RLU/cm2
Location
Log CFU/cm2
Log RLU/cm2
L1 - Internal Door Handle of the Room
0.50
0.00
L2 - Light Switch Closest to the Entrance
0.19
-0.33
L3 - Carpet at the entryway of the hotel room
-0.33
0.26
L4 - Surface of the Provided Mug
0.00
0.00
L5 - Headboard (Right Side of the Bed)
-0.22
0.00
L6 - Bedside Lamp Switch
0.20
0.00
L7 - Phone Keypad
0.11
0.00
L8 - TV Remote Keypad
0.79
0.00
L9 - Internal Bathroom Door Handle
0.44
0.00
L10 - Bathroom Floor
1.42
0.44
L11 - Bathroom Faucet (Right)
0.40
0.04
L12 - Bathroom Sink Basin
1.99
0.05
L13 - Bathtub or Shower Floor
0.56
0.18
L14 - Toilet Paper Holder
0.61
0.00
L15 - Toilet Basin
0.31
0.05
L16 - Gloves from Housekeeping Cart
-0.36
-0.71
L17 - Towel from Housekeeping Cart
-1.09
-0.07
L18 - Mop from Housekeeping Cart
0.40
-1.04
L19 - Pen
0.55
0.00
L20 - Couch: Right Armrest
0.21
0.00
L21 - Mirror: Bottom Right Hand Corner
-0.10
-0.04
L22 - Back of Inside of Chest Drawers
-0.14
0.00
L23 - Inside Door Above Peephole
0.19
0.00
Four guestroom locations either increased in log averages, or produced the
smallest reductions, after cleaning. L2 (Light Switch Closest to the Entrance), L9
(Internal Bathroom Door Handle), L10 (Bathroom Floor), and L16 (Gloves from
26
Housekeeping Cart) were determined to be the critical areas requiring a larger amount of
attention during the cleaning process. In addition to the four critical areas previously
identified, seven additional locations were added to the corrective action procedures and
were included in the factsheet for the purpose of increasing awareness regarding the
possibility of cross-contamination and methods to reduce this potential. These locations
included: L6 (Bedside Lamp Switch), L11 (Bathroom Faucet {Right}), L12 (Bathroom
Sink Basin), L13 (Bathtub/Shower Floor), L14 (Toilet Paper Holder), L15 (Toilet Basin),
and L18 (Mop from Housekeeping Cart). These locations were labeled as the critical
areas in hotel guestrooms and were the focal points of the factsheet information. Table 11
depicts the Log CFU/cm2 and Log RLU/cm2 results for the locations featured in the
corrective action process and factsheet.
Table 11 Sample Set 1 Critical Areas and Average Differences
Location
Log CFU/cm2
Log RLU/cm2
L2 -Light Switch Closest to Entryway
Reduction of 0.19 Log CFU/cm2
Increase of 0.05 Log RLU/cm2
L9 - Internal Bathroom Door Handle
Reduction of 0.44 Log CFU/cm2
Reduction of 0.01 Log RLU/cm2
L10 - Bathroom Floor
Increase of 1.42 Log CFU/cm2
Reduction of 0.09 Log RLU/cm2
L16 - Gloves from Housekeeping Cart
Increase of 0.36 Log CFU/cm2
Increase of 0.39 Log RLU/cm2
L6 - Bedside Lamp Switch
Reduction of 0.20 Log CFU/cm2
No Change in Log RLU/cm2
L11 - Bathroom Faucet (Right)
Reduction of 0.40 Log CFU/cm2
Reduction of 0.34 Log RLU/cm2
L12 - Bathroom Sink Basin
Reduction of 1.99 Log CFU/cm2
Reduction of 0.18 Log RLU/cm2
L13 - Bathtub/Shower Floor
Reduction of 0.56 Log CFU/cm2
Reduction of 0.40 Log RLU/cm2
L14 - Toilet Paper Holder
Reduction 0.61 Log CFU/cm2
Increase of 0.03 Log RLU/cm2
L15 - Toilet Basin
Reduction of 0.31 Log CFU/cm2
Reduction of 0.34 Log RLU/cm2
L18 - Mop/Sponge from Housekeeping Cart
Reduction of 0.40 Log CFU/cm2
Increase of 0.37 Log RLU/cm2
Figures 4 and 5 depict the designed corrective action procedures and factsheet
information given to the housekeepers in English and Spanish. Results from Table 7 were
27
compared and contrasted against Sample Set 2 results, explained in the following section,
generated for each critical location.
28
Figure 1. Corrective Action Procedures and Distributed Factsheet – English Edition
29
Figure 2. Corrective Action Procedures and Distributed Factsheet - Spanish Edition
30
Post Intervention
The microbial procedures for the pre intervention were replicated in for the post
intervention following the introduction of the corrective action procedures and
distribution of the factsheet (the intervention). A total of 588 usable APC and coliform
samples and 412 ATP-B readings were quantified, averaged, and log transformed for
Sample Set 2. Following the pre-intervention sampling, it was decided that the E. coli and
coliform samples would only be collected for areas resulting in the highest counts; L16
(Gloves from Housekeepers Cart), L17 (Towel from Housekeepers Cart), and L18
(Mop/Sponge from Housekeepers Cart). Sample Set 2 averaged Log CFU/cm2 and Log
RLU/cm2 results are depicted in Table 12.
The averaged Log CFU/cm2 results for post-intervention, pre-cleaning, ranged
from a minimum of 0.33 Log CFU/cm2 (12,14 average CFU) at the L11 (Bathroom
Faucet: {Right}) to a maximum of 2.90 Log CFU/cm2 (536.25 average CFU) at the L18
(Mop/Sponge from Housekeeping Cart). Averaged pre-cleaning Log RLU/cm2 ranged
from a minimum of 0.00 Log RLU/cm2 (>1 averaged RLU) at the L22 (Back Inside of
Chest Drawer Side), L14 (Toilet Paper Holder), L16 (Gloves from Housekeeping Cart),
and L18 (Mop/Sponge from Housekeeping Cart) to a maximum of 0.39 Log RLU/cm2
(3.67 averaged RLU) at the L10 (Bathroom Floor).
Critical areas featured in the corrective action procedures and factsheet were
evaluated based upon the average differences between sample sets. This was to establish
validity and reliability of the recommended procedures and factsheet. Following the
introduction of these recommendations, average Log CFU/cm2 and average Log
31
RLU/cm2 per location were reduced. Tables 13 and 14 depict the average Log CFU/cm2
and Log RLU/cm2 differences between sample sets.
Table 12 Averaged Log CFU/cm2 per guestroom location for Sample Set 2
Log CFU/cm2
Locations
Log RLU/cm2
D. APC
D. E. coli.
C. APC
C. E. coli.
Dirty
Clean
L1 - Internal Door Handle of the Room
0.90
-
0.58
-
0.19
0.33
L2 - Light Switch Closest to the Entrance
1.11
-
0.60
-
0.32
0.18
L3 - Carpet at the entryway of the hotel room
1.95
-
1.99
-
0.09
0.06
L4 - Surface of the Provided Mug
0.61
-
0.17
-
0.20
0.00
L5 - Headboard (Right Side of the Bed)
0.61
-
0.95
-
0.03
0.05
L6 - Bedside Lamp Switch
0.50
-
0.46
-
0.19
0.10
L7 - Phone Keypad
1.03
-
0.91
-
0.02
0.11
L8 - TV Remote Keypad
1.93
-
0.97
-
0.27
0.11
L9 - Internal Bathroom Door Handle
1.13
-
0.77
-
0.32
0.15
L10 - Bathroom Floor
2.03
-
0.66
-
0.39
0.12
L11 - Bathroom Faucet (Right)
0.33
-
0.67
-
0.15
0.08
L12 - Bathroom Sink Basin
2.28
-
0.69
-
0.11
0.05
L13 - Bathtub or Shower Floor
2.30
-
1.49
-
0.06
0.00
L14 - Toilet Paper Holder
0.86
-
0.61
-
0.00
0.02
L15 - Toilet Basin
0.45
-
0.84
-
0.16
0.04
L16 - Gloves from Housekeeping Cart
1.05
0.00
1.70
0.61
0.00
0.27
L17 - Towel from Housekeeping Cart
1.37
0.00
1.73
0.31
0.00
0.06
L18 - Mop from Housekeeping Cart
2.90
1.10
2.07
0.84
0.13
0.00
L19 - Pen
0.67
-
0.53
-
0.05
0.02
L20 - Couch: Right Armrest
1.89
-
1.74
-
0.14
0.21
L21 - Mirror: Bottom Right Hand Corner
0.57
-
0.10
-
0.00
0.00
L22 - Back of Inside of Chest Drawers
0.73
-
0.31
-
0.00
0.03
L23 - Inside Door Above Peephole
1.05
-
0.65
-
0.01
0.10
32
Table 13 Log CFU/cm2 Average Differences Between Sample Sets
Location
Sample Set
1
APC
0.50
Sample Set
1 E. coli.
0.00
Sample Set
2
APC
0.32
Sample
Set 2 E.
coli
-
Log
CFU/cm2
0.19
Log E.
coli.
0.00
0.19
-0.33
0.51
-
-0.32
-0.33
-0.33
0.26
-0.03
-
-0.30
0.26
L4 - Surface of the Provided Mug
0.00
0.00
0.44
-
-0.44
0.00
L5 - Headboard (Right Side of the Bed)
-0.22
0.00
-0.35
-
0.12
0.00
L6 - Bedside Lamp Switch
0.20
0.00
0.04
-
0.16
0.00
L7 - Phone Keypad
0.11
0.00
0.12
-
-0.01
0.00
L8 - TV Remote Keypad
0.79
0.00
0.96
-
-0.17
0.00
L9 - Internal Bathroom Door Handle
0.44
0.00
0.36
-
0.08
0.00
L10 - Bathroom Floor
1.42
0.44
1.37
-
0.06
0.44
L11 - Bathroom Faucet (Right)
0.40
0.04
-0.35
-
0.75
0.04
L12 - Bathroom Sink Basin
1.99
0.05
1.59
-
0.40
0.05
L13 - Bathtub or Shower Floor
0.56
0.18
0.81
-
-0.25
0.18
L14 - Toilet Paper Holder
0.61
0.00
0.24
-
0.37
0.00
L15 - Toilet Basin
0.31
0.05
-0.39
-
0.70
0.05
L16 - Gloves from Housekeeping Cart
-0.36
-0.71
-0.64
-0.61
0.29
-0.10
L17 - Towel from Housekeeping Cart
-1.09
-0.07
-0.36
-0.31
-0.73
0.25
L18 - Mop from Housekeeping Cart
0.40
-1.04
0.83
0.27
-0.42
-1.31
L19 - Pen
0.55
0.00
0.14
-
0.41
0.00
L20 - Couch: Right Armrest
0.21
0.00
0.15
-
0.05
0.00
L21 - Mirror: Bottom Right Hand Corner
-0.10
-0.04
0.47
-
-0.57
-0.04
L22 - Back of Inside of Chest Drawers
-0.14
0.00
0.42
-
-0.56
0.00
L23 - Inside door above peephole
0.19
0.00
0.40
-
-0.21
0.00
L1 - Internal Door Handle of the Room
L2 - Light Switch Closest to the Entrance
L3 - Carpet at the Entryway of the Hotel
Room
33
Table 14 Log RLU/cm2 Average Differences Between Sample Sets
Location
Sample Set 1 ATP
Sample Set 2 ATP
Sample Set Differences
L1 - Internal Door Handle of the Room
0.06
-0.14
0.20
L2 - Light Switch Closest to the Entrance
-0.05
0.14
-0.20
L3 - Carpet at the Entryway of the Hotel Room
0.04
0.04
0.00
L4 - Surface of the Provided Mug
0.04
0.20
-0.16
L5 - Headboard (Right Side of the Bed)
-0.14
-0.03
-0.11
L6 - Bedside Lamp Switch
0.00
0.09
-0.09
L7 - Phone Keypad
0.14
-0.09
0.22
L8 - TV Remote Keypad
0.03
0.15
-0.12
L9 - Internal Bathroom Door Handle
0.01
0.17
-0.16
L10 - Bathroom Floor
0.09
0.27
-0.18
L11 - Bathroom Faucet (Right)
0.34
0.07
0.27
L12 - Bathroom Sink Basin
0.18
0.07
0.11
L13 - Bathtub or Shower Floor
0.40
0.06
0.34
L14 - Toilet Paper Holder
-0.03
-0.02
-0.01
L15 - Toilet Basin
0.34
0.12
0.21
L16 - Gloves from Housekeeping Cart
-0.39
-0.27
-0.13
L17 - Towel from Housekeeping Cart
-0.26
-0.06
-0.20
L18 - Mop from Housekeeping Cart
0.37
0.12
0.25
L19 - Pen
-0.03
0.03
-0.06
L20 - Couch: Right Armrest
0.01
-0.07
0.08
L21 - Mirror: Bottom Right Hand Corner
0.17
0.00
0.17
L22 - Back of Inside of Chest Drawers
0.21
-0.03
0.24
L23 - Inside Door Above Peephole
-0.32
-0.09
-0.23
Nine of the eleven critical locations had significant microbial reductions after
cleaning post-intervention. For example, L2 (Light Switch Closet to the Entryway) had
count reduced in CFUs by 0.51 Log CFU/cm2 and in RLUs by 0.14 Log RLU/cm2. Also,
L6 (Bedside Lamp Switch) reduced in CFUs by 0.04 Log CFU/cm2 and in RLUs by 0.14
Log RLU/cm2 after cleaning. All bathroom locations reduced in CFUs and RLUs after
cleaning, with the exception of L11 (Bathroom Faucet: Right) and L15 (Toilet Basin.)
The largest reduction in CFUs was located at the L12 (Bathroom Sink Basin), reducing
34
by 1.59 Log CFU/cm2. RLUs appeared to have the greatest reduction in Sample Set 2 at
the L10 (Bathroom Floor), with a reduction of 0.27 Log RLU/cm2. L16 (Gloves from the
Housekeeping Cart) did increase in both CFUs and RLUs after cleaning, but this is to be
expected due to the cleaning process.
To determine if a significant relationship exists between ATP-B and APC, a
Pearson Correlation equation was performed pre and post intervention, pre-guestroom
cleaning and post-guestroom cleaning averages, using SPSS (Version, 22). Results
suggested that a statistically significant correlation existed between the averages of preintervention, pre-guestroom cleaning, ATP-B and APC, (R = 0.554, P = 0.006).
35
CHAPTER V
Discussion
Previous sections have discussed the analytical results of environmental sampling
in hotel guestrooms to determine effective universal sanitation procedures. This section
will theorize these results in relation to hygiene research conducted in the healthcare,
education, and food processing industries.
Modified Cleaning Recommendations
This study’s results suggest that achieving 100% guestroom cleanliness on all
contact surfaces is improbable. Therefore, hotels should adopt similar corrective action
procedures for determining effective cleanliness levels in hotel rooms. Benchmarks and
thresholds can provide adequate numbers for determining proper cleanliness levels of
certain locations within a guestroom. Housekeeping staff will be able to effectively
evaluate the cleanliness level accordingly across all hotel guestrooms.
Findings of this study suggest that the pre-intervention focusing on specific areas
during cleaning can effectively reduce the presence of contamination in guestrooms.
More so, a factsheet created for the purpose of this study, illustrates that effective
cleaning procedures can be achieved through the introduction of proper training
materials. By proactively implementing standardized cleaning procedures in all hotels in
sanitation and cleaning procedures ahead of time, the hotel industry might save millions
of dollars in the future. Adjusting and modifying current cleaning procedures can reduce
the level of bacteria present among the locations described above.
The reduction in both CFUs and RLUs at the L1 (Light Switch Closest to
Entrance) may stem from the proper cleaning techniques featured on the factsheet. When
36
cleaning guestroom light switches, housekeepers should only touch the switches with the
designated cleaning cloth and proper cleaning solutions. This could reduce the risk of
exposing hotel guests to harmful pathogens through the light switches.
It appears that the gloves and housekeeping cart actually increased in microbial
counts and RFUs suggesting a reduction in cleanliness. However, this was expected due,
in part, to the cleaning materials collecting bacteria after usage. The count reductions in
the bathroom and bedroom locations may be due to the cleaning method featured on the
factsheet. For example, the bathroom the cleaning process should begin at the top of the
bathroom counter, moving in a diagonal motion, and ending in the sink basin.
Additionally, implementing the exchange of cleaning material between locations. . It
may be suggested that the cleaning material utilized by housekeepers be swabbed and
tested prior to cleaning a guestroom to ensure the reduction of cross-contamination.
Another alternative for reducing the levels on the carpet and couch armrest would
be to vacuum and/or clean the carpet during the inspection process. This would ensure
the guest would be the first person to touch the area after it was cleaned. Furthermore,
this method should be implemented if it is found to be effective in cost and time
management.
Adversely, the reduction Mop from Housekeeping Cart after cleaning were
opposite of the projected goal. When using a mop, the level of bacteria on the mop after
cleaning a location can be high. This is caused by the collection of bacteria onto the
mop/sponge. It is recommended, from this outcome, to exchange the mop heads and/or
the sponges after cleaning critical locations to reduce the risk of possible crosscontamination.
37
Thresholds and Benchmarks
Thresholds and benchmarks, previously, have been utilized to evaluate the level
of cleanliness in different industries. Critical limits for hospital surfaces have been
suggested at 2 CFU/cm2 (0.30 Log CFU) (Dancer, 2004, Almanza et al., 2015 in press).
Ogden (1993) suggested <10 CFU/ plate (1.00 Log RLU) would be the sufficient hygiene
level of a brewery plant. Cunningham et al. (2010) benchmarked locations in retail food
service establishments as passing if < 200 RLUs were found.. Almanza et al. (2015, in
press) analyzed levels according to several different CFU/cm2 thresholds, beginning with
hospital standards of 2 CFU/cm2 and continuing on with 5 CFU/cm2, 10 CFU/cm2, and
50 CFU/cm2. To expand upon this research, CFU benchmarks were analyzed at 2
CFU/cm2, 2.5 CFU/cm2, 5 Log CFU/cm2, 10 CFU/cm2, 15 CFU/cm2, 20 CFU/cm2, 25
CFU/cm2, 30 CFU/cm2, and 50 CFU/cm2. Tables 11 and 12 depict the relationship
between the averaged sample set results and industry benchmark results, where industry
benchmarks are featured as the lead comparison. These thresholds can be utilized in the
future to determine specific critical limits for additional hotel locations and if critical
limits are being met.
The carpet at entryway (L3) ,Bathroom Sink Basin (L12), Bathtub and Shower
Floor (L13), Mop/Sponge from Housekeeping Cart (L18), and Couch: Right Armrest
(L20) had at least three rooms or more fail to pass the 50 CFU/cm2 threshold preguestroom cleaning. These areas can be looked at as requiring the most amount of
cleaning relevant to location type. Additionally, the towel from housekeeping cart (L17)
and the inside door above the peephole (L23) resulted in at least two out of six rooms
failing to pass the 50 CFU/cm2 threshold.
38
Results from this study, as compared to hospital and food processing facilities,
suggested that a majority of CFU results fell at or between 10 CFU/cm2 and 20 CFU/cm2.
Therefore, an effective APC threshold for the hotel industry could be possible between or
within this range of CFU/cm2. Thresholds can be utilized to determine specific levels
according to different locations within hotels. Additionally, these thresholds can be
utilized for future research to determine if the level of cleanliness changes over a certain
period of time or is effected by outside elements.
39
Table 11
Sample Set 1 Benchmark Comparisons
Thresholds – Sample Set 1a
<2 CFU/cm2
<2.5 CFU/cm2
<5 CFU/cm2
<10 CFU/cm2
<15 CFU/cm2
<20 CFU/cm2
<25 CFU/cm2
<30 CFU/cm2
<50 CFU/cm2
>50 CFU/cm2b
Dirty
Clean
Dirty
Clean
Dirty
Clean
Dirty
Clean
Dirty
Clean
Dirty
Clean
Dirty
Clean
Dirty
Clean
Dirty
Clean
Dirty
Clean
3/9
6/9
3/9
6/9
5/9
8/9
7/9
0/9
8/9
9/9
8/9
9/9
8/9
9/9
8/9
9/9
8/9
9/9
1/9
0/9
5/9
2/9
5/9
2/9
7/9
8/9
7/9
8/9
7/9
8/9
7/9
8/9
8/9
8/9
8/9
8/9
8/9
8/9
0/9
1/9
1/9
1/9
1/9
1/9
1/9
1/9
3/9
2/9
5/9
2/9
5/9
2/9
5/9
2/9
6/9
2/9
7/9
4/9
3/9
5/9
6/6
6/6
6/6
6/6
6/6
6/6
6/6
6/6
6/6
6/6
6/6
6/6
6/6
6/6
6/6
6/6
6/6
6/6
0/6
0/6
1/9
4/9
1/9
4/9
8/9
6/9
8/9
7/9
9/9
7/9
9/9
7/9
9/9
7/9
9/9
7/9
9/9
8/9
0/9
0/9
5/9
7/9
5/9
7/9
7/9
7/9
7/9
8/9
8/9
8/9
8/9
9/9
8/9
9/9
8/9
9/9
8/9
9/9
1/9
0/9
4/9
5/9
4/9
5/9
4/9
5/9
5/9
6/9
7/9
8/9
8/9
8/9
8/9
8/9
8/9
8/9
9/9
9/9
0/9
0/9
1/9
6/9
1/9
6/9
6/9
3/9
4/9
7/9
6/9
8/9
6/9
8/9
7/9
8/9
8/9
9/9
8/9
9/9
1/9
0/9
3/9
7/9
3/9
7/9
4/9
8/9
8/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
0/9
0/9
1/9
6/9
1/9
6/9
2/9
8/9
2/9
8/9
3/9
8/9
4/9
8/9
4/9
8/9
4/9
8/9
5/9
9/9
2/9
0/9
3/9
5/9
3/9
5/9
3/9
6/9
4/9
7/9
5/9
7/9
6/9
7/9
6/9
8/9
6/9
8/9
8/9
8/9
1/9
1/9
0/9
7/9
0/9
7/9
0/9
7/9
0/9
7/9
1/9
8/9
1/9
7/9
1/9
7/9
2/9
7/9
2/9
9/9
7/9
0/9
4/9
5/9
4/9
5/9
4/9
5/9
5/9
7/9
5/9
7/9
5/9
8/9
5/9
8/9
5/9
8/9
5/9
8/9
3/9
1/9
0/9
5/9
0/9
5/9
4/9
7/9
4/9
9/9
6/9
9/9
7/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
0/9
0/9
5/9
7/9
5/9
7/9
7/9
7/9
7/9
9/9
8/9
9/9
8/9
9/9
8/9
9/9
8/9
9/9
8/9
9/9
1/9
0/9
6/6
2/9
6/6
2/6
6/6
3/6
6/6
4/6
6/6
5/6
5/6
5/6
6/6
5/6
6/6
5/6
6/6
5/6
2/6
1/6
7/8
1/6
7/8
1/6
8/8
1/6
8/8
1/6
8/8
3/6
8/8
3/6
8/8
4/6
5/6
4/6
8/8
4/6
0/6
2/6
3/6
3/6
3/6
3/6
4/6
4/6
4/6
5/6
4/6
5/6
4/6
5/6
4/6
5/6
5/6
5/6
5/6
5/6
3/6
1/6
3/9
8/9
3/9
8/9
4/9
8/9
4/9
9/9
6/9
9/9
6/9
9/9
6/9
9/9
6/9
9/9
6/9
9/9
1/9
0/9
2/9
1/9
2/9
1/9
2/9
3/9
3/9
4/9
3/9
5/9
4/9
5/9
4/9
5/9
6/9
5/9
7/9
6/9
2/9
3/9
9/9
6/9
9/9
6/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
0/9
0/9
8/9
7/9
8/9
7/9
9/9
8/9
9/9
8/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
0/9
0/9
5/9
8/9
5/9
8/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
9/9
0/9
0/9
a
Above data depicts the number of rooms that passed the specific CFU threshold per the the number of rooms sampled according to each location (e.g. 3/9 – three out of nine L1 samples
were lower than 2 CFU/cm2).
b
Data is according to number of samples per location which contained more than 50 CFU/cm 2 (e.g. 1/9 – one out of nine rooms resulted in larger than 50 CFU/cm2 pre-guestroom cleaning at
L1).
40
Table 12.
Sample Set 2 Benchmark Comparison
Thresholds Sample Set 2
<2 CFU/cm2
<2.5 CFU/cm2
<5 CFU/cm2
< 10
CFU/cm2
<15 CFU/cm2
<20 CFU/cm2
<25 CFU/cm2
<30 CFU/cm2
<50 CFU/cm2
>50 CFU/cm2
Dirty
Clean
Dirty
Clean
Dirty
Clean
Dirty
Clean
Dirty
Clean
Dirty
Clean
Dirty
Clean
Dirty
Clean
Dirty
Clean
Dirty
Clean
1/6
3/6
1/6
3/6
2/6
3/6
4/6
4/6
5/6
5/6
5/6
5/6
5/6
6/6
5/6
6/6
5/6
6/6
1/6
0/6
2/6
4/6
2/6
4/6
2/6
4/6
4/6
4/6
4/6
4/6
4/6
4/6
4/6
4/6
4/6
4/6
4/6
5/6
2/6
1/6
0/6
0/6
0/6
0/6
0/6
0/6
0/6
0/6
1/6
0/6
1/6
1/6
1/6
2/6
1/6
2/6
2/6
3/6
4/6
3/6
2/4
3/4
2/4
4/4
3/4
4/4
3/4
4/4
3/4
4/4
3/4
4/4
3/4
4/4
3/4
3/4
1/4
0/4
3/5
1/6
3/5
1/6
3/5
3/6
3/5
3/6
3/5
3/6
3/5
3/6
4/5
4/6
4/5
5/6
5/5
5/6
0/5
1/6
3/6
4/6
3/6
4/6
5/6
5/6
5/6
5/6
5/6
5/6
5/6
5/6
5/6
5/6
5/6
5/6
5/6
5/6
1/6
1/6
3/6
3/6
3/6
3/6
3/6
3/6
4/6
3/6
4/6
3/6
4/6
3/6
4/6
4/6
4/6
4/6
5/6
5/6
1/6
1/6
0/6
2/6
0/6
2/6
0/6
3/6
1/6
3/6
1/6
3/6
2/6
4/6
3/6
4/6
3/6
5/6
3/6
5/6
3/6
1/6
2/6
3/6
2/6
3/6
3/6
3/6
3/6
3/6
3/6
3/6
3/6
5/6
3/6
5/6
3/6
5/6
4/6
5/6
2/6
1/6
1/6
4/6
1/6
4/6
1/6
5/6
1/6
5/6
1/6
5/6
1/6
3/6
1/6
5/6
1/6
5/6
2/6
5/6
4/6
1/6
2/4
3/6
2/4
3/6
3/4
4/6
4/4
4/6
¾
4/6
4/4
5/6
4/4
5/6
4/4
5/6
4/4
5/6
0/4
1/6
0/6
4/6
0/6
4/6
0/6
4/6
0/6
4/6
1/6
4/6
1/6
4/6
1/6
4/6
1/6
4/6
1/6
4/6
5/6
2/6
0/5
1/5
0/5
1/5
0/5
1/5
0/5
1/5
0/5
2/5
0/5
2/5
0/5
2/5
0/5
2/5
0/5
2/5
3/5
2/5
3/6
3/6
3/6
3/6
3/6
4/6
3/6
3/6
4/6
4/6
5/6
4/6
5/6
4/6
5/6
4/6
5/6
4/6
1/6
1/6
2/5
¾
2/5
¾
4/5
¾
5/5
4/4
4/5
4/4
5/5
4/4
5/5
4/4
5/5
4/4
5/5
4/4
0/5
2/4
1/6
0/5
1/6
0/5
3/6
0/5
3/6
2/5
4/6
2/5
4/6
2/5
4/6
2/5
5/6
2/5
5/6
2/5
1/6
2/5
2/5
2/6
2/5
2/6
2/5
2/6
2/5
2/6
2/5
2/6
2/5
2/6
2/5
2/6
2/5
2/6
3/5
2/6
3/5
3/6
0/3
0/3
0/3
0/3
0/3
0/3
0/3
0/3
0/3
0/3
0/3
0/3
0/3
0/3
0/3
1/3
0/3
2/3
3/3
1/3
3/6
4/6
3/6
4/6
4/6
4/6
5/6
5/6
5/6
5/6
5/6
5/6
5/6
5/6
5/6
5/6
5/6
5/6
1/6
1/6
1/6
1/6
1/6
1/6
1/6
1/6
1/6
1/6
1/6
1/6
1/6
1/6
1/6
1/6
1/6
1/6
1/6
1/6
5/6
5/6
3/6
6/6
3/6
6/6
4/6
6/6
4/6
6/6
5/6
6/6
5/6
6/6
5/6
6/6
5/6
6/6
6/6
6/6
0/6
0/6
2/6
3/6
2/6
3/6
4/6
4/6
4/6
4/6
4/6
5/6
4/6
5/6
4/6
5/6
4/6
5/6
6/6
5/6
0/6
0/6
3/6
4/6
3/6
4/6
4/6
5/6
4/6
5/6
4/6
5/6
4/6
5/6
4/6
5/6
4/6
5/6
4/6
5/6
2/6
1/6
3/4
3/4
41
To elaborate, pre-intervention RLU results depict the current industry cleaning
levels for guestroom cleanliness. Critical fail limits could be identified using preintervention data, post-guestroom cleaning, RLU/cm2 averages due in part to the
implementation of the corrective action procedures following this set. If limits are
reached or surpassed, the cleaning procedures should be replicated or extended due to
exceeding pre-intervention thresholds.
Post intervention results depicted the adjusted level of cleanliness following the
corrective action procedures. The averages collected from post-intervention data, postguestroom cleaning, could be utilized, as the critical good limits for each location due in
part to these results resembling the ideal level of cleanliness for each location.
The averages between pre and post-intervention data could be identified as the
critical pass limits due to these results resembling an even medium between the critical
good limits and the critical fail limits. Table 13 depicts the theorized ATP-B thresholds
per guestroom location.
42
Table 13 ATP-B Threshold Readings per Guestroom Locationsc
Location
Goodd
Passe
Failf
L1 - Internal door handle of the room
39.89
119.14
198.40
L2 - Light switch closest to the entrance
15.56
62.98
110.40
L3 - Carpet at the entryway of the hotel room
8.22
20.91
33.60
L4 - Surface of the provided mug
1.11
8.34
15.57
L5 - Headboard (right side of the bed)
7.33
58.38
109.43
L6 - Bedside lamp switch
11.78
45.19
78.60
L7 - Phone keypad
9.11
24.36
39.60
L8 - TV remote keypad
10.00
167.55
325.10
L9 - Internal bathroom door handle
23.67
56.83
90.00
L10 - Bathroom floor
12.89
40.80
68.71
L11 - Bathroom faucet (right)
10.67
30.38
50.10
L12 - Bathroom sink basin
7.00
119.70
232.40
L13 - Bathtub or shower floor
2.67
7.98
13.29
L14 - Toilet paper holder
3.78
14.17
24.57
L15 - Toilet basin
4.33
4.95
5.57
L16 - Gloves from maid cart
22.63
78.31
134.00
L17 - Towel from maid cart
6.44
49.87
93.29
L18 - Mop from maid cart
4.22
11.33
18.43
L19 - Pen
5.11
36.76
68.40
L20 - Couch: Right armrest
18.56
73.83
129.10
L21 - Mirror: Bottom right hand corner
1.78
2.96
4.14
L22 - Back of inside of chest drawers
3.22
8.33
13.43
L23 – Inside Door Above Peephole
3.89
72.80
141.71
Uncontrollable limitations were present during certain aspects of this experiment
as with any other study. Such limitations, for future research, existed in verifying and
c
Based upon the average ATP-B readings collected from sample sets post-guestroom cleaning. Thresholds
are presented as starting points for ATP-B cleanliness thresholds.
d
Averages collected post-corrective action and factsheet implementation.
e
Average of Sample Set 1 and Sample Set 2 results.
e
Averages collected from Sample Set 1.
43
insuring housekeeping staff was following the corrective action procedures and the
factsheet directions. Furthermore, verifying the housekeeping staff would continue to
utilize the corrective action procedures once the responsibility was handed over. Future
research should focus on controlling these limitations within the training portion of this
study. Additional limitations were found when conducting the microbial sampling
portion.
In Sample Set 1, 26 APC samples and 70 coliform samples were unusable due to
uncontrollable evaporation of the peptone solution. One university, after sampling all
three hotel guestrooms and shipping the centrifuge tubes back to University of Houston
for plating and microbial analysis, a certain amount of the peptone solution had
evaporated. As a result, those samples were eliminated from the dataset because it was
not possible to extract and plate 1 mL of the solution onto the Petrifilm. This could be the
cause of the absence of a correlational relationship between ATP-B and APC results.
Due to the lack of prior industry research regarding critical levels of cleanliness,
replication of this study, for future research, should focus on verifying the strength of the
relationship between APC and ATP-B. In doing so, additional ATP-B benchmarks can be
determined for the hotel industry.
Conclusion
Hotel properties, brands, and textbooks vary significantly in cleaning standards
due to the absence of standardized guestroom cleaning procedures. This study’s results of
the environmental sampling procedures suggest that specific locations in the guestroom
need more attention when cleaning. Furthermore, introduction of a factsheet with
enhanced cleaning suggestions, illustrates that average log CFUs and log RLUs per
44
location can decrease with sufficient training materials. Thus, enhanced cleaning may be
achievable with greater attention to target areas.
The incorporation of these practices to the determined target areas into these steps
and procedures may increase guestroom cleaning efficiencies and decrease the risk of
illness. Uniformed sanitization procedures for guestroom cleaning should be incorporated
for the safety and well-being of hotel guests and room attendants. In doing so, the risk of
cross-contamination and the spread of disease may significantly decrease, generating
possible increase in brand image as well as a decrease in brand dilution.
45
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54
Appendix A
APC
Dirty
ATP-B
Dirty
APC
Clean
ATP-B
Clean
Appendix A Swabbing Areas for APC and ATP-B
55
Appendix B
9 Hotel Guest Rooms
APC and ATP-B Environmental
Sampling Set 1
23 Guest Room Locations
Pre-Cleaning Sampling
Room Cleaned
Post-Cleaning Sampling
CFU and RLUs
Averages
Calculated
CFU and RLUs
Averages
Calculated
Control Points Identified
Fact sheet Created/Corrective Action
APC and ATP Environmental
Sampling Set 2
23 Guest Room Locations
Pre-Cleaning Sampling
Fact Sheet Created
Fact sheet Discussed with
Room Attendants
9 Hotel Guest Rooms
Room Cleaned
Post-Cleaning Sampling
Total CFU and RLU Averages from
Set 1 & 2/ Verification of Procedures
Appendix B Environmental Sampling Flow Chart
56
CFU and RLUs
Averages
Calculated
CFU and RLUs
Averages
Calculated
Appendix C
Appendix C Per Hotel Guestroom Sampling Flow Chart
57