Monitoring data feedback to cleaning staff through periodic audits can be a valid aid for improving cleaning and disinfection procedures and adherence to protocols. This strategy was adopted in our study and, thanks to the collaboration between the infection control team and the outsourced cleaning company, it was possible to identify the critical issues and take corrective actions. To this end, environmental monitoring is essential for process verification.

Our study has some limitations. Firstly, the non-homogeneous sampling for all of the settings, where a greater number of analyses were dedicated to the OTs rather than the ICUs or patient rooms: it was not always possible to proceed with the UV-C treatment at the patient discharge because trained personnel were limited and not always available. This problem underlines the importance of having dedicated personnel identifiable as that of the outsourced cleaning company. The use of new technologies could in fact be included in outsourcing contracts as an improvement action in the event of non-compliance in the cleaning service. These personnel could be adequately trained not only on the cleaning protocols to be adopted but also on infection control issues.

Each hospital should have an infection control team aiming to evaluate the risk factors involved in healthcare infection occurrences with a multidisciplinary and dynamic approach. Epidemiological infection control in hospital may detect all of the critical points of the healthcare procedures performed by nurses, healthcare workers, physicians, students, and external staff. This evaluation may also include the sanitization process and its management. An appropriate evaluation of the whole sanitization process, including the reprocessing of cleaning materials, would be the best practice.

In the OT and ICU, where the limit for hygiene quality is defined by national guidelines, respectively, % (/) and % (/) of the surface samples resulted in being non-compliant after SOP. In the ward rooms, according to the standard reported in the literature, % (/) of the sampled sites resulted in being non-compliant. All of the samples were compliant after UV-C disinfection. In all of the settings, % (/) of the sampled points received a medium UV-C dose of mJ/cm

The UV-C disinfection robot (Mediland Enterprise Corporation, Taoyuan City, Taiwan) uses amalgam lamps (UV lamp NNI / XL Niederdruck VUV Strahler) and protective reflector technology to generate high-energy, broad-spectrum ultraviolet light (UV-C &#x; nm). The manufacturer of the lamps declares in the technical data sheet that the lamps have a filter that blocks radiation between &#x; nm, eliminating the possibility of producing ozone as a by-product of UV-C radiation. The UV-C device uses min disinfection cycles and multiple positions with minimal distances from high-touch surfaces. Due to the use of high-intensity UV-C radiation, the device must operate in unoccupied rooms. There are multi-motion sensors that shut off the device if any movement is detected inside the room being disinfected or if the door is accidentally opened. When the robot operates in accordance with these procedures, the manufacturer declares that the amalgam lamps produce no ozone gas and leave no toxic residues.