This study aimed to compare the effectiveness of outcome-oriented visual assessment and process-oriented visual assessment using ATP bioluminescence test as a comparator in order to find out which method can be used to assess hospital cleanliness.

This study was conducted in a 17-bed adult medical intensive care unit at a medical center during December 2019 to December 2020. First of all, high-touch room surfaces were selected in patient rooms, including bed rails / controls, light switch, IV pump control, feeding pump control, monitor control, bedside table handle, call button, IV pole (grab area) and suction machine control. Then, Areas to be sampled on those high-touch room surfaces were identified. Whenever the housekeepers started to do terminal cleaning after patients were transferred or discharged, the researcher also started to observe directly the practices of cleaning at the same time and recorded "cleaned" if surfaces were cleaned and disinfected properly. Then, the researcher inspected surfaces and recorded "clean" if surfaces were free of dust, debris, and stains immediately after terminal cleaning.Ten minutes after terminal cleaning, Hygiena Ultrasnap Surface ATP test was performed to swab a standard area of 10 square centimeters on specific surfaces. After completing sampling, swabs were replace back in swab tube and all liquid in bulbs was expelled to activate the reaction. Once activated, samples were read right after shaking swab tube for 5-10 seconds.

Inclusion Criteria:

• the environmental surfaces immediately after patients are discharged

Exclusion Criteria:

• no

We compare the degrees of agreement between the ATP data, process-oriented visual assessment scores and outcome-oriented visual assessment scores after environmental cleaning.