# Clean to Prevent, Monitor to Protect: A Scoping Review on Strategies for Monitoring Cleaning in Hospitals to Prevent HAIs

## TL;DR

This review examines different methods used to monitor hospital cleaning to prevent infections, highlighting the need for standardized approaches and better integration of new technologies.

## Contribution

The study provides a comprehensive overview of current monitoring strategies and identifies key gaps in standardization and pathogen coverage.

## Key findings

- Fluorescent markers, ATP assays, microbiological methods, and direct observation are commonly used for monitoring.
- MRSA is the most targeted pathogen, with limited focus on other resistant organisms.
- Recent studies show increased use of molecular and digital technologies, but implementation is resource-heavy.

## Abstract

Background/Objectives: Hospital environmental contamination represents a significant source of healthcare-associated infections, yet standardized monitoring approaches are still inconsistent globally. This scoping review aimed to find and assess various tools and strategies used to monitor hospital environmental cleaning and disinfection practices, mapping current evidence and finding research gaps to inform evidence-based recommendations for healthcare facilities. Methods: Following PRISMA Scoping Review guidelines, we conducted comprehensive searches on PubMed and Scopus databases from 2010–2025 using terms related to environmental monitoring, surface sampling, air sampling, and infection control in hospital settings. Eighteen studies met inclusion criteria; data were extracted using standardized forms and synthesized narratively, organizing findings by monitoring approach categories. Results: These studies revealed diverse monitoring approaches including fluorescent markers (22.2%), ATP bioluminescence assays (33.3%), microbiological methods (44.4%), and direct observation techniques (27.8%). MRSA was the most frequently targeted pathogen (55.6%), with limited attention to Gram-negative multidrug-resistant organisms and fungi. Studies showed significant variability in pass/fail thresholds (ATP: 50–500 RLU) and lack of standardized benchmarks. Recent research (50% post-2021) increasingly incorporates molecular techniques and digital technologies, though implementation remains resource intensive. Conclusions: A multimodal approach combining visual inspection, ATP assays, and microbiological methods appears most effective for comprehensive environmental monitoring. Critical gaps include lack of standardized thresholds, limited pathogen diversity focus, and insufficient integration of emerging digital technologies. Future research should focus on setting universal standards, expanding pathogen coverage, and assessing cost-effective monitoring strategies, all while ensuring legal compliance with hygiene regulations to enhance patient safety.