A major trial of a bundle of hospital cleaning practices in 11 Australian hospitals has made significant reductions in healthcare-associated infections and demonstrated cost-benefits.
The NHMRC-funded study, “An environmental cleaning bundle and health care-associated infection in hospitals (REACH): a multi-centre randomised trial”, was led by Queensland University of Technology (QUT) health economist Professor Nick Graves from the Australian Centre for Health Services Innovation (AusHSI) at the Institute of Health and Biomedical Innovation (IHBI) and is published in The Lancet Infectious Diseases.
The research project is believed to be the largest prospective, multi-site and multi-factorial trial of hospital cleaning in the world. Its aim was to investigate whether a change in cleaning practices was effective in reducing the 165,000 healthcare-associated infections in Australia each year.
Professor Graves said the REACH (Researching Effective Approaches to Cleaning Hospitals) project introduced a bundle of cleaning initiatives, tailored to each hospital in the study, to improve both routine and discharge hospital room cleaning.
Hospital-wide promotion of the importance of cleaning in reducing infections was undertaken to support a culture shift in the profile of environmental services staff, Professor Graves said.
“Cleaning was audited using fluorescent marker technology. This system used gel dots, invisible to the naked eye, applied to surfaces. The dots resist dry abrasion and are removed only by a thorough cleaning technique,” he said.
Hospitals in the study improved their cleaning practices from 55 to 76 per cent in bathroom areas and from 64 to 86 per cent in bedroom areas.
This resulted in a 37 per cent reduction in the major healthcare-associated infection, vancomycin-resistance enterococci (VRE), and a 5.8 per cent decrease overall in three types of infections.
“In contrast to previous research, the cleaning bundle development prioritised evidence-based strategies that were easy to implement and lower cost, over newer expensive technologies.”
Overall, the cleaning bundle cost approximately $2,500 per 10,000 bed days to implement in participating hospitals.
The REACH cleaning bundle was successful at improving cleaning thoroughness and showed great promise in reducing vancomycin-resistant enterococci infections. It also demonstrated cost-savings and increased health benefits from infections prevented.
Dr Greg Whiteley, chairman of Whiteley Corporation and Adjunct Fellow at the School of Medicine at Western Sydney University, said the study is a very relevant piece of research as healthcare facilities face the challenge of increasing antimicrobial resistance, pressure to reduce costs and an often-revolving door of cleaning staff.
“One of the key learnings from this research is the importance of surface cleaning as part of the overall infection prevention toolkit” said Dr. Whiteley.
“There has been a justified focus on hand hygiene as means to reduce HAIs and this is very important, however focusing on cleaning efficacy will assist in reducing HAIs further, as has been proven by the REACH study.”
The REACH study was funded by an NHMRC grant, led by QUT, in partnership with Wesley Medical Research. Industry partners included Kimberly-Clark Professional, Ecolab Pty Ltd, Whiteley Corporation, the Deeble Institute for Health Policy Research, Australasian College for Infection Prevention and Control and the Australasian Society for Infectious Diseases.
Study investigators were Prof Nick Graves, Prof Adrian Barnett, A/Prof Lisa Hall, Dr Kate Balcon, Dr Katie Page, Prof Anne Gardner (QUT), Prof Brett Mitchell (Avondale College), Prof David Paterson, Prof Christian Gericke (University of Queensland) and Prof Tom Riley (University of Western Australia).
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