Brett G Mitchell 1-4, Katrina Browne1,2, Nicole White5, Philip L Russo1,3,6, Allen C Cheng3,7, Andrew J Stewardson3,8, Georgia Matterson1,2, Peta E Tehan1,3, Kirsty Graham2, Maham Amin2, Maria Northcote1, Martin Kiernan1,9, Jennie King2, David Brain5.
1 Avondale University, NSW, Australia, 2 Central Coast Local Health District, NSW, Australia, 3 Monash University, VIC, Australia, 4 Hunter Medical Research Institute, NSW, Australia, 5 Queensland University of Technology, QLD, Australia, 6 Cabrini Health, VIC, NSW, Australia, 7 Monash Health, VIC, Australia, 8 Alfred Health, VIC Australia, 9 University of West London, England, United Kingdom
Abstract:
Background
There is a paucity of high-quality evidence for routine cleaning of shared medical equipment based on clinical endpoints. We assessed the impact of enhanced cleaning and disinfection of shared medical equipment on healthcare-associated infections (HAI) in hospitalised patients (CLEEN study).
Methods
We conducted a stepped-wedge, cluster randomised trial. Fortnightly point prevalence surveys were used to assess all adult inpatients’ for any HAI. During the control, there was no change to environmental cleaning practices. The intervention was a multimodal cleaning bundle: three additional hours per weekday for the dedicated cleaning and disinfection of shared medical equipment, ongoing education, audit and feedback. The primary outcome was the prevalence of patients with any HAI. Data collectors were blinded.
Results
In unadjusted results, 433 of 2,497 (17·3%) patients in the control and 301 of 2,508 in the intervention phase (12·0%) acquired a HAI. There was a reduction of -34·5% (95%CI -50·3 to -17·5) in HAIs following the intervention (OR 0·62, 95%CI 0·45 to 0·80, p<0·001), corresponding to an absolute reduction of -5·2% (95%CI -8·2 to 2·3).
Interpretation
Improving the cleaning and disinfection of shared medical equipment led to a large reduction in HAIs, underscoring the critical role of cleaning in improving patient outcomes.