ADVANCEMENT OF THE SCIENCE
the patient room were the tray table, bed sur- faces, and medical equipment located near the patient bed area. The authors suggested that because these surfaces have been impli- cated in viral and bacterial contamination, transmission of microorganisms via contact with these fomites is likely to occur. Bathroom Area It is not surprising that the bathroom area had the most significant decreases in microbial counts and RLU readings, considering that bathrooms are among the key areas in guest sat- isfaction ratings for lodging properties (Prasad et al., 2014). Furthermore, bathroom cleaning is an inherent part of standard operating proce- dures in the lodging industry (Casado, 2012). A survey to determine consumer perceptions of hotel room cleanliness by Zemke et al. (2015) supports the idea that lodging properties focus more on cleaning the bathroom area in guest rooms because consumers generally think that bathroom surfaces are the cleanest; these find- ings suggest that bathroom surfaces are gener- ally easier for guests to observe as a marker of overall room cleanliness. Further, many of the high-touch sur- faces—as identified by leading hotel brands (Hilton, 2021; IHG, 2021; Marriott, 2021; Wyndham Hotels, 2021), sanitation compa- nies (Ecolab, 2021; Reckitt, 2021), and health organizations (CDC, 2024a; WHO, 2021)— were located in the bathroom area. Although many of the surfaces in the bath- room area after cleaning showed a decrease in RLU readings and log CFU/cm 2 , it is impor- tant to note that research looking at collected environmental samples in hotel guest rooms has identified the highest level of surface contamination to be found in the bathroom. Consistent with our findings, Almanza et al. (2015) found that the surfaces with the highest levels of APCs included samples col- lected from the toilet bowl, bathroom floor, and bathroom sink—and that the bathroom sink was among the surfaces with the high- est coliform counts. Additionally, the shower floor maintained a relatively high log CFU/ cm 2 throughout the duration of their study.
studies, however, have focused on assess- ing microbial counts of high-touch surfaces found in hotel guest rooms. Park et al. (2019) propose that 1) the concept of high- and low-touch surfaces originates from research done in the hospital and healthcare industry and 2) there is limited information regarding contamination of high-touch areas for the lodging industry. Thus, studies conducted in clinical settings that focus on high-touch fomites found in patient rooms can pro- vide hospitality-focused research with new insights regarding the presence, persistence, and transfer of microorganisms from surface- to-surface and surface-to-guest via high- touch fomites found in hotel rooms. For example, the methods in our study were adopted from the CDC (2019) Guide- lines for Environmental Infection Control in Health-Care Facilities and tailored for the environment of a standard hotel guest room. The principles highlighted in these guide- lines serve as a framework to conduct similar research by identifying suitable sampling sur- faces, assay techniques, and procedures. Fur- ther, these guidelines provide a justification for our study by determining when such a study is appropriate (i.e., changes in infection control practices), including the enhance- ment of cleaning procedures in response to a pandemic. Although it might not be practical to use microbiologic techniques in day-to-day oper- ations, research using environmental sam- pling techniques has addressed the impor- tance of having a microbiologic comparator when assessing changes in infection control practices (Snyder et al., 2013). This concept is not foreign in the hospitality context: envi- ronmental public health professionals already use data from research on microbial contami- nation and microbial prevention methods to implement strategies targeted at reducing risks to public health. Examples include food safety management systems in food service operations (Food and Drug Administration [FDA], 2023), conducting hazard analyses and identifying critical control points for various contaminants that enter hospitality operations (Altemimi et al., 2022; Soriano et al., 2002), and creating guidelines to mini- mize microbial safety hazards for fresh fruits and vegetables (FDA, 2018). As such, our study provides a more robust list of high-touch surfaces that can be adopted
by the lodging industry to enhance preexist- ing cleaning procedures. Although properties might not all have the same high-touch sur- faces, our list (Tables 1, 2, 3) can be tailored easily to address property-specific needs. In terms of high-touch surfaces, our study incorporated elements of triangulation (a method commonly used in qualitative studies) to identify high-touch surfaces across lead- ing brands, sanitation companies, and public health agencies to create a list of high-touch surfaces identified across these agencies. Addi- tionally, combining publicly available infor- mation from leading hotel brands allowed us to account for variation in cleaning products, which in turn informed our methods by allow- ing us to identify the active ingredient in each cleaner to determine the appropriate times between sampling events and the incorpora- tion of a neutralizing agent in the sample col- lection tubes used after cleaning. The interdisciplinary nature of our study methods offers meaningful contributions to scientific literature and industry practice by integrating hard science and social science to address an understudied research area and respond to calls to examine the evolving rela- tionship between hospitality and healthcare sectors (Jiang & Wen, 2020). Additionally, our analysis identified high-touch surfaces that could benefit from greater attention from housekeeping staff to reduce the microbial contamination and organic matter present on these surfaces. This study finding is meaningful for hotel and lodging operators in terms of inspec- tions conducted through the Diamond Inspection Program from AAA. For more than 80 years, AAA (2021) has awarded lodging properties various Diamond Rat- ings based on inspections that evaluate the quality of employee satisfaction and safety, guest experience, amenities, and service delivery. In response to the COVID-19 pandemic, AAA incorporated an Inspected Clean Program in July 2021 into their Dia- mond Rating criteria that incorporates the use of an ATP meter to evaluate the cleanli- ness of eight randomly selected high-touch surfaces found in hotel room guest traffic areas and bathrooms. These surfaces are the ones that we sampled in our study. Interestingly, a study conducted by Xu, Mkrtchyan, et al. (2015) to establish a base- line assessment of sanitary status in hotel
Practical Implications for Practitioners
Most research conducted in the hospitality setting has focused on evaluating visible sur- face cleanliness by using an ATP meter. Few
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Volume 87 • Number 7
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