Cleaning and disinfection in neonatal intensive care units: correlation of evaluation methods.

The study measured surface test results, not newborn infection outcomes. Only two units were studied, one private and one public, with surfaces chosen intentionally rather than randomly, so results may not apply to other NICUs. ATP measures organic matter, not only microorganisms, so ATP readings alone can misclassify a surface as clean or dirty. Visual inspection cannot detect microorganisms and is subjective, so it cannot by itself confirm effective disinfection. Before the educational intervention, staff used different products and materials and had no specific cleaning training, which may have contributed to variability. The Staphylococcus aureus ROC analysis could not be done because of insufficient sample representativeness and many null values. The authors note that ATP values can persist after microorganisms are killed and can vary by device, sampling area and surface material. The study did not randomise units or cleaning methods, so it cannot prove that standardisation caused the observed changes.

Funded by CAPES, UFMS/MEC, and the Foundation for the Support of the Development of Education, Science and Technology of Mato Grosso do Sul. No separate conflict-of-interest declaration is provided.

Do not treat the 28 URL or 38 URL ATP cut-off as a universal neonatal unit standard. These thresholds came from two Brazilian NICUs and were judged against surface microbial counts, not against infections in newborns.