- Title
- An environmental cleaning bundle and health-care-associated infections in hospitals (REACH): a multicentre, randomised trial
- Creator
- Mitchell, Brett G.; Hall, Lisa; Gericke, Christina A.; Graves, Nicholas; White, Niole; Barnett, Adrian G.; Halton, Kate; Paterson, David L.; Riley, Thomas V.; Gardner, Anne; Page, Katie; Farrington, Alison
- Relation
- NHMRC.GNT1076006 http://purl.org/au-research/grants/nhmrc/1076006
- Relation
- The Lancet Infectious Diseases Vol. 19, Issue 4, p. 410-418
- Publisher Link
- http://dx.doi.org/10.1016/S1473-3099(18)30714-X
- Publisher
- The Lancet Publishing Group
- Resource Type
- journal article
- Date
- 2019
- Description
- Background: The hospital environment is a reservoir for the transmission of microorganisms. The effect of improved cleaning on patient-centred outcomes remains unclear. We aimed to evaluate the effectiveness of an environmental cleaning bundle to reduce health care-associated infections in hospitals. Methods: The REACH study was a pragmatic, multicentre, randomised trial done in 11 acute care hospitals in Australia. Eligible hospitals had an intensive care unit, were classified by the National Health Performance Authority as a major hospital (public hospitals) or having more than 200 inpatient beds (private hospitals), and had a health-care-associated infection surveillance programme. The stepped-wedge design meant intervention periods varied from 20 weeks to 50 weeks. We introduced the REACH cleaning bundle, a multimodal intervention, focusing on optimising product use, technique, staff training, auditing with feedback, and communication, for routine cleaning. The primary outcomes were incidences of health-care-associated Staphylococcus aureus bacteraemia, Clostridium difficile infection, and vancomycin-resistant enterococci infection. The secondary outcome was the thoroughness of cleaning of frequent touch points, assessed by a fluorescent marking gel. This study is registered with the Australian and New Zealand Clinical Trial Registry, number ACTRN12615000325505. Findings: Between May 9, 2016, and July 30, 2017, we implemented the cleaning bundle in 11 hospitals. In the pre-intervention phase, there were 230 cases of vancomycin-resistant enterococci infection, 362 of S aureus bacteraemia, and 968 C difficile infections, for 3 534 439 occupied bed-days. During intervention, there were 50 cases of vancomycin-resistant enterococci infection, 109 of S aureus bacteraemia, and 278 C difficile infections, for 1 267 134 occupied bed-days. After the intervention, vancomycin-resistant enterococci infections reduced from 0.35 to 0.22 per 10 000 occupied bed-days (relative risk 0.63, 95% CI 0.41-0.97, p=0.0340). The incidences of S aureus bacteraemia (0.97 to 0.80 per 10 000 occupied bed-days; 0.82, 0.60-1.12, p=0.2180) and C difficile infections (2.34 to 2.52 per 10 000 occupied bed-days; 1.07, 0.88-1.30, p=0.4655) did not change significantly. The intervention increased the percentage of frequent touch points cleaned in bathrooms from 55% to 76% (odds ratio 2.07, 1.83-2.34, p<0.0001) and bedrooms from 64% to 86% (1.87, 1.68-2.09, p<0.0001). Interpretation: The REACH cleaning bundle was successful at improving cleaning thoroughness and showed great promise in reducing vancomycin-resistant enterococci infections. Our work will inform hospital cleaning policy and practice, highlighting the value of investment in both routine and discharge cleaning practice. Funding: National Health and Medical Research Council (Australia).
- Subject
- infections; hospitals; transmission; REACH
- Identifier
- http://hdl.handle.net/1959.13/1416414
- Identifier
- uon:37048
- Identifier
- ISSN:1473-3099
- Language
- eng
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