In the Journals

Hospital cleaning bundle reduces VRE infections by 37%

A novel cleaning bundle improved cleaning thoroughness and reduced vancomycin-resistant enterococci, or VRE, infections by 37% in almost a dozen hospitals in Australia, according to results from the REACH study.

“The hospital environment is a reservoir for the transmission of microorganisms that can lead to infection. Some microorganisms can survive in-hospital for several months, posing an ongoing transmission risk unless removed by cleaning,” Brett G. Mitchell, PhD, professor of nursing at Avondale College in Wahroonga, Australia, and colleagues wrote in The Lancet Infectious Diseases.

Mitchell and colleagues noted that frequently touched hospital surfaces are important reservoirs of nosocomial infections, and that prior studies have focused on the cleaning of common “touch points.”

“Evidence also suggests that patients admitted to a room that was previously occupied by another patient with a multidrug-resistant organism are at increased risk of subsequent colonization and infection with that organism,” they wrote. “This finding suggests that current cleaning practices fail to reduce the risk of acquisition and highlights the critical role of hospital cleaning, also known as environmental hygiene, in infection prevention and control.”

The multicenter, randomized trial was conducted in 11 acute-care hospitals in Australia. From May 9, 2016, through July 30, 2017, Mitchell and colleagues implemented an evidence-based cleaning bundle — explained in detail in an appendix — with five components. The bundle “makes recommendations on optimal types of cleaning agents, frequency of cleaning, cleaning techniques, auditing strategies, environmental cleaning staff training, and creating a hospital-wide commitment to improved cleaning,” the authors wrote.

According to the study, during the preintervention phase, there were 230 cases of VRE infection, 362 cases of Staphyloccous aureus bacteremia and 968 cases of Clostridioides difficile infection, for 3,534,439 occupied bed-days. During the intervention, infections dropped to 50 cases of VRE infection, 109 of S. aureus bacteremia and 278 C. difficile infections over 1,267,134 occupied bed-days, they reported.

Following the intervention, VRE infections fell from 0.35 to 0.22 per 10,000 occupied bed-days (RR = 0.63; 95% CI, 0.41-0.97). However, the researchers noted that the incidences of S. aureus bacteremia and C. difficile did not change significantly. Additionally, according to the study, the intervention increased the proportion of frequent “touch points” that were cleaned from 55% to 76% in bathrooms and 64% to 86% in bedrooms, as determined by fluorescent markers.

“The intervention is broadly applicable to cleaning in any hospital, throughout the continuum of care, because it does not solely focus on discharge cleaning,” Mitchell and colleagues concluded.

“We have shown the benefits using a bundle that accommodates the complexity of hospital environments and allows for better consideration of culture and context, and hopefully greater ownership by hospitals. As a result, the findings of this study are relevant to hospitals internationally. We recommend that health services and policymakers that are interested in reducing vancomycin-resistant enterococci infections by improving hospital cleaning should consider both this bundle and our implementation approach.” – by Caitlyn Stulpin

Disclosures: All authors report receiving grants from the Australian National Health and Medical Research Council, and nonfinancial support from Kimberly-Clark Professional, Ecolab and Whiteley Corporation, during the conduct of the study. Please see the study for all other relevant financial disclosures.

A novel cleaning bundle improved cleaning thoroughness and reduced vancomycin-resistant enterococci, or VRE, infections by 37% in almost a dozen hospitals in Australia, according to results from the REACH study.

“The hospital environment is a reservoir for the transmission of microorganisms that can lead to infection. Some microorganisms can survive in-hospital for several months, posing an ongoing transmission risk unless removed by cleaning,” Brett G. Mitchell, PhD, professor of nursing at Avondale College in Wahroonga, Australia, and colleagues wrote in The Lancet Infectious Diseases.

Mitchell and colleagues noted that frequently touched hospital surfaces are important reservoirs of nosocomial infections, and that prior studies have focused on the cleaning of common “touch points.”

“Evidence also suggests that patients admitted to a room that was previously occupied by another patient with a multidrug-resistant organism are at increased risk of subsequent colonization and infection with that organism,” they wrote. “This finding suggests that current cleaning practices fail to reduce the risk of acquisition and highlights the critical role of hospital cleaning, also known as environmental hygiene, in infection prevention and control.”

The multicenter, randomized trial was conducted in 11 acute-care hospitals in Australia. From May 9, 2016, through July 30, 2017, Mitchell and colleagues implemented an evidence-based cleaning bundle — explained in detail in an appendix — with five components. The bundle “makes recommendations on optimal types of cleaning agents, frequency of cleaning, cleaning techniques, auditing strategies, environmental cleaning staff training, and creating a hospital-wide commitment to improved cleaning,” the authors wrote.

According to the study, during the preintervention phase, there were 230 cases of VRE infection, 362 cases of Staphyloccous aureus bacteremia and 968 cases of Clostridioides difficile infection, for 3,534,439 occupied bed-days. During the intervention, infections dropped to 50 cases of VRE infection, 109 of S. aureus bacteremia and 278 C. difficile infections over 1,267,134 occupied bed-days, they reported.

Following the intervention, VRE infections fell from 0.35 to 0.22 per 10,000 occupied bed-days (RR = 0.63; 95% CI, 0.41-0.97). However, the researchers noted that the incidences of S. aureus bacteremia and C. difficile did not change significantly. Additionally, according to the study, the intervention increased the proportion of frequent “touch points” that were cleaned from 55% to 76% in bathrooms and 64% to 86% in bedrooms, as determined by fluorescent markers.

“The intervention is broadly applicable to cleaning in any hospital, throughout the continuum of care, because it does not solely focus on discharge cleaning,” Mitchell and colleagues concluded.

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“We have shown the benefits using a bundle that accommodates the complexity of hospital environments and allows for better consideration of culture and context, and hopefully greater ownership by hospitals. As a result, the findings of this study are relevant to hospitals internationally. We recommend that health services and policymakers that are interested in reducing vancomycin-resistant enterococci infections by improving hospital cleaning should consider both this bundle and our implementation approach.” – by Caitlyn Stulpin

Disclosures: All authors report receiving grants from the Australian National Health and Medical Research Council, and nonfinancial support from Kimberly-Clark Professional, Ecolab and Whiteley Corporation, during the conduct of the study. Please see the study for all other relevant financial disclosures.