An environmental cleaning bundle and health-care-associated infections in hospitals (REACH): a multicentre, randomised trial

Mitchell, BG; Hall, L; White, N; Barnett, AG; Halton, K; Paterson, DL; Riley, TV; Gardner, A; Page, K; Farrington, A; Gericke, CA; Graves, N

An environmental cleaning bundle and health-care-associated infections in hospitals (REACH): a multicentre, randomised trial

Mitchell, BG Hall, L White, N Barnett, AG Halton, K Paterson, DL Riley, TV Gardner, A Page, K

Farrington, A Gericke, CA Graves, N

Permalink

Publication Type:: Journal Article
Citation:: The Lancet Infectious Diseases, 2019, 19 (4), pp. 410 - 418
Issue Date:: 2019-04-01

Closed Access

	Filename	Description	Size
	An environmental cleaning bundle and health-care-associated infections in hospitals (REACH) a multicentre, randomised trial.pdf	Published Version	1.04 MB	Adobe PDF	View/Open

Copyright Clearance Process

Recently Added
In Progress
Closed Access

This item is closed access and not available.

Full metadata record

Field	Value	Language
dc.contributor.author	Mitchell, BG	en_US
dc.contributor.author	Hall, L	en_US
dc.contributor.author	White, N	en_US
dc.contributor.author	Barnett, AG	en_US
dc.contributor.author	Halton, K	en_US
dc.contributor.author	Paterson, DL	en_US
dc.contributor.author	Riley, TV	en_US
dc.contributor.author	Gardner, A	en_US
dc.contributor.author	Page, K https://orcid.org/0000-0001-9183-9175	en_US
dc.contributor.author	Farrington, A	en_US
dc.contributor.author	Gericke, CA	en_US
dc.contributor.author	Graves, N	en_US
dc.date.available	2018-11-13	en_US
dc.date.issued	2019-04-01	en_US
dc.identifier.citation	The Lancet Infectious Diseases, 2019, 19 (4), pp. 410 - 418	en_US
dc.identifier.issn	1473-3099	en_US
dc.identifier.uri	http://hdl.handle.net/10453/134864
dc.description.abstract	© 2019 Elsevier Ltd 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).	en_US
dc.relation	http://purl.org/au-research/grants/nhmrc/GNT1076006
dc.relation.ispartof	The Lancet Infectious Diseases	en_US
dc.relation.isbasedon	10.1016/S1473-3099(18)30714-X	en_US
dc.subject.classification	Microbiology	en_US
dc.title	An environmental cleaning bundle and health-care-associated infections in hospitals (REACH): a multicentre, randomised trial	en_US
dc.type	Journal Article
utslib.citation.volume	4	en_US
utslib.citation.volume	19	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1108 Medical Microbiology	en_US
utslib.for	1117 Public Health and Health Services	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Business
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
utslib.copyright.status	closed_access
pubs.issue	4	en_US
pubs.publication-status	Published	en_US
pubs.volume	19	en_US

Abstract:

© 2019 Elsevier Ltd 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).

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/134864