{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T02:46:24Z","timestamp":1792205184473,"version":"4.4.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,4,18]],"date-time":"2025-04-18T00:00:00Z","timestamp":1744934400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,4,18]],"date-time":"2025-04-18T00:00:00Z","timestamp":1744934400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["GH000044"],"award-info":[{"award-number":["GH000044"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Antimicrob Resist Infect Control"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Environmental cleaning is a key infection prevention and control (IPC) intervention in healthcare settings. The U.S. Centers for Disease Control and Prevention (CDC), with Infection Control Africa Network (ICAN), developed best practices for global healthcare environmental cleaning in resource-limited settings to help fill gaps in guidance in low- and middle-income countries (LMICs). We aimed to evaluate the feasibility, appropriateness, and acceptability of a quality improvement toolkit developed to assist with implementing the CDC\/ICAN best practices at Lagos University Teaching Hospital in Nigeria.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A mixed-methods approach was used to evaluate the implementation of the toolkit from March through September of 2021. A monitoring checklist assessed feasibility after three defined steps within the toolkit. Key informant interviews and electronic surveys were conducted with toolkit team members at three time points during implementation to assess appropriateness and acceptability. A deductive analytic process was used to code and analyze interview data based on constructs of appropriateness and acceptability. Additional codes and sub-themes that emerged during analysis followed an inductive process.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Within the interviews and surveys, themes identified for the appropriateness included concern related to (1) time commitment for the toolkit activities and (2) resources required to sustain improvements. Themes identified for acceptability included (1) perceived challenges with time commitment and resource requirements, (2) perceived effectiveness of toolkit structure and usability, (3) perceived benefits and success associated with knowledge gained about environmental cleaning and environmental cleaning staff, (4) perceived benefits and success associated with the training for cleaning staff undertaken during toolkit implementation, and (5) perceived benefits and success associated with the multidisciplinary team approach with the inclusion of facility leadership and a project coordinator.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>The results showed that the toolkit materials were feasible within the local context and highlighted perceived effectiveness, benefits, and success of the toolkit process and experience contributing to a high level of acceptability. Challenges relating to time commitment and concern for sustainability have implications for the appropriateness of this toolkit, similar approaches to quality improvement, and the need for strengthening support for IPC improvements at the facility and national levels in resource-limited healthcare settings in LMICs.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s13756-025-01550-5","type":"journal-article","created":{"date-parts":[[2025,4,18]],"date-time":"2025-04-18T14:12:09Z","timestamp":1744985529000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Evaluation of the feasibility, appropriateness, and acceptability of an environmental cleaning program improvement toolkit at a tertiary care hospital in Nigeria"],"prefix":"10.1186","volume":"14","author":[{"given":"Cori","family":"Dennison","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Hudson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damilola","family":"Adeniyi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Folasade","family":"Ogunsola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanako","family":"Osuka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"P. Oakley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Malpiedi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber","family":"Vasquez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly","family":"Patrick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,18]]},"reference":[{"key":"1550_CR1","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1016\/S0140-6736(10)61458-4","volume":"377","author":"B Allegranzi","year":"2011","unstructured":"Allegranzi B, Nejad SB, Combescure C, Graafmans W, Attar H, Donaldson L, Pittet D. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377:228\u201341.","journal-title":"Lancet"},{"key":"1550_CR2","unstructured":"World Health Organization. Guidelines on core components of infection prevention and control programmes at the national and acute health care level. 2016. https:\/\/www.who.int\/publications\/i\/item\/9789241549929. Accessed 4 Oct 2023."},{"key":"1550_CR3","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1016\/S1473-3099(21)00809-4","volume":"22","author":"S Tomczyk","year":"2022","unstructured":"Tomczyk S, Twyman A, de Kraker ME, Coutinho Rehse AP, Tartari E, Toledo JP, Cassini A, Pittet D, Allegranzi B. The first WHO global survey on infection prevention and control in health-care facilities. Lancet Infect Dis. 2022;22:845\u201356.","journal-title":"Lancet Infect Dis"},{"issue":"4","key":"1550_CR4","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1097\/QCO.0b013e3283630f04","volume":"26","author":"DJ Weber","year":"2013","unstructured":"Weber DJ, Anderson D, Rutala WA. The role of the surface environment in healthcare-associated infections. Curr Opin Infect Dis. 2013;26(4):338\u201344.","journal-title":"Curr Opin Infect Dis"},{"issue":"6","key":"1550_CR5","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1001\/archinternmed.2011.64","volume":"171","author":"R Datta","year":"2011","unstructured":"Datta R, Platt R, Yokoe DS, Huang SS. Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants. Arch Intern Med. 2011;171(6):491\u201394.","journal-title":"Arch Intern Med"},{"key":"1550_CR6","doi-asserted-by":"publisher","first-page":"S6","DOI":"10.1016\/j.ajic.2012.12.004","volume":"41","author":"JA Otter","year":"2013","unstructured":"Otter JA, Yezli S, Salkeld JA, French GL. Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings. Am J Infect Control. 2013;41:S6\u201311.","journal-title":"Am J Infect Control"},{"key":"1550_CR7","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1016\/j.ijid.2017.10.014","volume":"67","author":"M Doll","year":"2018","unstructured":"Doll M, Stevens M, Bearman G. Environmental cleaning and disinfection of patient areas. Int J Infect Dis. 2018;67:52\u20137.","journal-title":"Int J Infect Dis"},{"issue":"8","key":"1550_CR8","doi-asserted-by":"publisher","first-page":"598","DOI":"10.7326\/M15-1192","volume":"163","author":"JH Han","year":"2015","unstructured":"Han JH, Sullivan N, Leas BF, Pegues DA, Kaczmarek JL, Umscheild CA. Cleaning hospital room surfaces to prevent health care-associated infections. Ann Intern Med. 2015;163(8):598\u2013607.","journal-title":"Ann Intern Med"},{"key":"1550_CR9","doi-asserted-by":"publisher","first-page":"S12","DOI":"10.1016\/j.ajic.2012.12.010","volume":"41","author":"CJ Donskey","year":"2013","unstructured":"Donskey CJ. Does improving surface cleaning and disinfection reduce health care-associated infections? Am J Infect Control. 2013;41:S12\u201319.","journal-title":"Am J Infect Control"},{"key":"1550_CR10","unstructured":"Centers for Disease Control and Prevention, ICAN. Best practices for environmental cleaning in healthcare facilities in resource limited settings. 2019. https:\/\/www.cdc.gov\/hai\/pdfs\/resource-limited\/environmental-cleaning-RLS-H.pdf. Accessed 28 Aug 2023."},{"key":"1550_CR11","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1016\/S1473-3099(18)30714-X","volume":"19","author":"BG Mitchell","year":"2019","unstructured":"Mitchell BG, Hall L, White N, Barnett AG, Halton K, Paterson DL, Riley TV, Gardner A, Page K, Farrington A, Gericke CA, Graves N. An environmental cleaning bundle and health-care-associated infections in hospitals (REACH): a multicentre, randomized trial. Lancet Infect Dis. 2019;19:410\u201318.","journal-title":"Lancet Infect Dis"},{"key":"1550_CR12","unstructured":"World Health Organization. Water and sanitation for health facility improvement tool (WASH FIT). 2017. https:\/\/www.who.int\/publications\/i\/item\/9789241511698. Accessed 28 Aug 2023."},{"key":"1550_CR13","unstructured":"World Health Organization. Infection prevention and control assessment framework at the facility level. 2018. https:\/\/www.who.int\/publications\/i\/item\/WHO-HIS-SDS-2018.9. Accessed 28 Aug 2023."},{"key":"1550_CR14","unstructured":"Centers for Disease Control and Prevention. Environmental cleaning program improvement toolkit: a practical guide for implementing the best practices for environmental cleaning in healthcare facilities in resource-limited settings. 2022. https:\/\/www.cdc.gov\/hai\/pdfs\/resource-limited\/environmental-cleaning-toolkit-guide-508.pdf. Accessed 28 Aug 2023."},{"key":"1550_CR15","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1186\/s12913-017-2031-8","volume":"17","author":"M Sekhon","year":"2017","unstructured":"Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017;17:88.","journal-title":"BMC Health Serv Res"},{"key":"1550_CR16","doi-asserted-by":"crossref","unstructured":"Hill Z, Keraga D, Alemayehu AK, Schellenberg J, Magge H, Estifanos A. \u2018The objective was about not blaming one another\u2019: a qualitative study to explore how collaboration is experienced within quality improvement collaboratives in Ethiopia. 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The evaluation protocol was reviewed and approved by the LUTH Health Research Ethics Committee. This activity was reviewed by CDC and was consistent with applicable federal law and CDC policy (See e.g., 45\u00a0C.F.R. part 46, 21\u00a0C.F.R. part 56; 42 U.S.C. \u00a7\u00a0241(d); 5 U.S.C. \u00a7\u00a0552a; 44 U.S.C. \u00a7\u00a03501 et seq.). Participation in all interviews was voluntary and informed and verbal consent was obtained from participating staff prior to the recording of interviews via teleconference using Zoom. Electronic surveys did not collect any personally identifiable information, and transcripts and key informant interviews were de-identified prior to analysis.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The conclusions and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention or the institutions with which the authors are affiliated.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclaimer"}}],"article-number":"33"}}