Comparison of fluorescent marker systems with 2 quantitative methods of assessing terminal cleaning practices

Infect Control Hosp Epidemiol. 2011 Dec;32(12):1187-93. doi: 10.1086/662626. Epub 2011 Oct 20.


Objective: To compare fluorescent markers with aerobic colony counts (ACCs) and an adenosine triphosphate (ATP) bioluminescence assay system for assessing terminal cleaning practices.

Design: A prospective observational survey.

Setting: A 500-bed university-affiliated community teaching hospital.

Methods: In a convenience sample of 100 hospital rooms, 5 high-touch surfaces were marked with fluorescent markers before terminal cleaning and checked after cleaning to see whether the marker had been entirely or partially removed. ACC and ATP readings were performed on the same surfaces before and after terminal cleaning.

Results: Overall, 378 (76%) of 500 surfaces were classified as having been cleaned according to fluorescent markers, compared with 384 (77%) according to ACC criteria and 225 (45%) according to ATP criteria. Of 382 surfaces classified as not clean according to ATP criteria before terminal cleaning, those with the marker removed were significantly more likely than those with the marker partially removed to be classified as clean according to ATP criteria (P = .003).

Conclusions: Fluorescent markers are useful in determining how frequently high-touch surfaces are wiped during terminal cleaning. However, contaminated surfaces classified as clean according to fluorescent marker criteria after terminal cleaning were significantly less likely to be classified as clean according to ACC and ATP assays.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Academic Medical Centers
  • Adenosine Triphosphate / analysis
  • Colony Count, Microbial
  • Cross Infection / prevention & control
  • Fluorescent Dyes
  • Hospitals
  • Housekeeping, Hospital / methods
  • Housekeeping, Hospital / standards*
  • Humans
  • Infection Control / methods
  • Infection Control / standards*
  • Logistic Models
  • Luminescent Measurements
  • Patients' Rooms / standards
  • Prospective Studies
  • Sanitation / methods
  • Sanitation / standards*


  • Fluorescent Dyes
  • Adenosine Triphosphate