on high-touch surfaces have relied on micro- biological techniques such as aerobic plate counts (APCs) and coliform counts to assess the cleanliness of surfaces in various environ- ments. For example, APCs are used to assess levels of generic bacteria in a given sample (Maturin & Peeler, 2021), which is why this technique is commonly used as an indicator of environmental cleanliness. Additionally, E. coli and coliforms are commonly used as indicators of fecal contamination in the en- vironment (Feng et al., 2020). Although not all strains of E. coli are inherently pathogenic, they can act as opportunistic pathogens that present potential risks for immunocompro- mised hotel guests who come in contact with contaminated surfaces (Feng et al., 2020). Another environmental microorganism of note is Staphylococcus aureus , which is a potential concern in the hotel room setting because the pathogen is naturally produced by the human body, has a high transmission rate, can survive on a variety of surfaces for months at a time, and is highly resistant to desiccation (Lutz et al., 2013). Further, S. au- reus is an opportunistic pathogen and a major cause of nosocomial infections (Otto, 2009), meaning that if the skin or mucous mem- branes (which serve as barriers against infec- tion) are breached, S. aureus might gain ac- cess to underlying tissues or the bloodstream and cause infection (Minnesota Department of Health, 2010). Due to the nature of this pathogen and its ability to persist on surfaces, a major risk for travelers could be present if they have open wounds or if they belong to an immunosuppressed population. To date, we know of no research that has evaluated the microbiological efficacy of the enhanced cleaning procedures implemented in response to the COVID-19 pandemic since 2020. General cleaning practices in hotel rooms follow common cleaning practices such as removing linens, making the bed with fresh linens, clearing the trash, and cleaning the bathroom (Kline et al., 2014). In response to the COVID-19 pandemic, lodging operators have placed a much greater emphasis on wiping and disinfecting surfaces to enhance consumer perceptions of hotel and lodging safety. A common method used in lodging and food service establishments to assess surface cleanliness is using an adenos- ine triphosphate (ATP) meter. ATP meters provide a practical means of assessing surface
cleanliness for hospitality professionals; the devices are user-friendly, require minimal training, and offer immediate results in rela- tive light units (RLUs). These meters, how- ever, measure ATP that is present in all types of organic material—including food, soil, and bacteria—and thus are unable to distinguish the difference between microbial and nonmi- crobial contamination (Bellamy, 2012). Moreover, studies have shown mixed results as to the true reliability of ATP meters as indicators of surface cleanliness, particu- larly in correlation with traditional microbial plate count methods (Deshpande et al., 2020; Omidbakhsh et al., 2014; Snyder et al., 2013). This gap in knowledge presents a health and safety risk for consumers and lodging opera- tors, as travelers have been found to spread diseases caused by bacterial and viral micro- organisms such as E. coli O157:H7 (King et al., 2020), Staphylococcus spp. (Xu, Mkrt- chyan, et al., 2015), Streptococcus (Weiser et al., 2018), hepatitis (Centers for Disease Control and Prevention [CDC], 2019), rhi- novirus (Winther et al., 2011), rotavirus (Kribs-Zaleta et al., 2011), and influenza (CDC, 2024a) through indirect contact via high-touch fomites, which are objects capa- ble of transmitting infection. A key output of these studies showed the importance of creating and maintaining effective cleaning programs designed to enhance not only guest perceptions of the lodging property but also guest safety by reducing potentially patho- genic microorganisms to safe levels. To address this gap, microbiological sam- pling of high-touch surfaces in addition to the use of an ATP meter can offer a more robust assessment of enhanced cleaning practices (ECPs) by identifying microorganisms com- monly used as indicators of environmental cleanliness in addition to the organic residue detected by the ATP meter. According to the Centers for Disease Control and Prevention (CDC, 2024b), microbiological sampling of the environment is an effective approach for quality assurance purposes to evaluate the ef- fects of a change in infection control practic- es or to ensure that systems perform accord- ing to specifications and expected outcomes. Although routine microbiological sampling of hotel rooms might not be practical for lodging operations due to costs and the time required for laboratory testing (Park et al., 2019), having a microbiologic comparator is
appropriate when assessing changes in infec- tion control practices (Snyder et al., 2013), especially considering that the goal of ECPs implemented during a pandemic is to ensure guest safety by enhancing hygiene and infec- tion prevention practices. Therefore, the objectives of our study were 2-fold: 1. To assess current ECPs specific to 37 high- touch surfaces found in hotel rooms by collecting 740 environmental samples and 740 ATP meter readings in 10 hotel rooms to quantify the number of microorganisms and organic matter, respectively, present on high-touch surfaces in hotel rooms. 2. To analyze the data collected to determine if there were statistically significant differ- ences in the number of logs for the micro- organisms detected during microbiological sampling and organic matter detected with the ATP meter before and after the rooms were cleaned.
Methods
Study Setting and Surfaces A microbial sampling of high-touch surfaces was conducted in 10 hotel guest rooms. These rooms are representative of standard guest rooms in midscale hotel properties in the U.S. A total of 37 surfaces were sampled in our study and divided into 3 areas of use: 1. Guest traffic area, which included the doorknobs inside of the bedroom, closet door handles, drapery pull handles, table- top, table handles, dresser handles, cli- mate control panels, iron handles, coffee makers, safety latches, peepholes, trash cans, entry carpet, and the light switch for the bedroom. 2. Bed area, which included the lamp switches, telephone handset, telephone keypad, remote control keypad, clock (which doubled as a phone dock), pil- lowcases, top of the nightstand, and night- stand handles. 3. Bathroom area, which included the toi- let handles, toilet seats, amenity trays, bathroom sink, bathroom faucet handles, bathroom floor, shower floor, toilet paper holder, bathroom light switch, doorknob on the inside of the bathroom, doorknob on the outside of the bathroom, toilet bowl, hair dryer, vanity surface, and the shower handle.
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March 2025 • Journal of Environmental Health
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