A quasi-experimental study investigating the effect of improving the cleaning of shared medical equipment on multi-resistant organisms in an intensive care unit: protocol for the ICU-CLEaning and Enhanced disiNfection (I-CLEEN) study

A quasi-experimental study investigating the effect of improving the cleaning of shared medical equipment on multi-resistant organisms in an intensive care unit: protocol for the ICU-CLEaning and Enhanced disiNfection (I-CLEEN) study

Georgia Matterson^1,2, Kate Browne^1,2, Philip Russo^3,4, Nicole White⁵, Andrew Stewardson^3,6, Allen Cheng^3,6, Maria Northcote¹, Patrick Harris⁷, Brian Forde⁷, Maham Amin², Kirsty Graham², Gabrielle O’Kane², Jennie King², Martin Kiernan⁸, Peta Tehan³, Nola Hitchick⁹, Brett, Mitchell, 1,2

¹Avondale University, Cooranbong, NSW, Australia
²Central Coast Local Health District, Gosford, NSW, Australia
³Monash University, Monash, VIC, Australia
⁴Cabrini Health, Melbourne, VIC, Australia
⁵Queensland University of Technology, Brisbane, QLD, Australia
⁶Alfred Health, Melbourne, VIC, Australia
⁷University of Queensland, Brisbane, QLD, Australia
⁸University of West London, London United Kingdom
⁹NSW Pathology NSW, Australia








Background
Healthcare-associated infections (HAIs) pose a significant burden on healthcare facilities, especially in the intensive care unit (ICU). With the emergence of multi-resistant organisms (MROs), these infections are becoming increasingly difficult to treat. Enhancing environmental cleaning and disinfection practices offers an evidence-based strategy for preventing the transmission of infectious pathogens. Shared medical equipment poses an additional HAI risk as contaminated equipment may facilitate the spread of pathogens between patients.

Methods
The I-CLEEN study builds upon the CLEEN study protocol and incorporates environmental sampling, patient screening, and whole genome sequencing (WGS) analysis of MROs. A prospective, quasi-experimental before/after study will be conducted over six months in a New South Wales hospital’s 22-bed adult ICU. This study aims to demonstrate the effectiveness of improving the quality and frequency of cleaning shared medical equipment in reducing HAI and MRO transmission. Secondary objectives include determining whether the transmission dynamics of MROs, are influenced by additional cleaning in an ICU using WGS analysis of environmental and patient isolates. Furthermore, the study will investigate the perceptions of patient services assistants and determine their preferences on receiving feedback on cleaning adherence.

Results
The I-CLEEN study is currently in progress, and results are expected to be available in 2024. Here, we present the methodology for this trial.

Conclusion
This study will implement strategies to enhance the cleaning of shared medical equipment and offer new insights into the epidemiological links among related bacterial lineages, providing definitive evidence on the transmission pathways of MROs in the healthcare environment.

Biography

Georgia Matterson is a Research Assistant at Avondale University. She has a Bachelor of Biotechnology (Hons I) from the University of Newcastle. Her research focuses on clinical trials to prevent healthcare-associated infections.