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

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dc.contributor.authorMitchell, B.G.
dc.contributor.authorHall, L.
dc.contributor.authorWhite, N.
dc.contributor.authorBarnett, A.G.
dc.contributor.authorHalton, K.
dc.contributor.authorPaterson, D.L.
dc.contributor.authorRiley, T.V.
dc.contributor.authorGardner, A.
dc.contributor.authorPage, K.
dc.contributor.authorFarrington, A.
dc.contributor.authorGericke, C.A.
dc.contributor.authorGraves, N.
dc.date.issued2019
dc.description.abstractBACKGROUND: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).
dc.description.statementofresponsibilityBrett G. Mitchell, Lisa Hall, Nicole White, Adrian G. Barnett, Kate Halton ... Christian AGericke ... et al.
dc.identifier.citationThe Lancet Infectious Diseases, 2019; 19(4):410-418
dc.identifier.doi10.1016/S1473-3099(18)30714-X
dc.identifier.issn1473-3099
dc.identifier.issn1474-4457
dc.identifier.orcidGericke, C.A. [0000-0002-7834-0406]
dc.identifier.urihttp://hdl.handle.net/2440/120850
dc.language.isoen
dc.publisherElsevier
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1076006
dc.rights© 2019 Elsevier Ltd. All rights reserved.
dc.source.urihttps://doi.org/10.1016/s1473-3099(18)30714-x
dc.subjectHumans
dc.subjectStaphylococcus aureus
dc.subjectBacteremia
dc.subjectClostridium Infections
dc.subjectStaphylococcal Infections
dc.subjectCross Infection
dc.subjectHygiene
dc.subjectIncidence
dc.subjectPrevalence
dc.subjectUltraviolet Rays
dc.subjectDisinfection
dc.subjectIntensive Care Units
dc.subjectHospitals
dc.subjectAustralia
dc.subjectVancomycin-Resistant Enterococci
dc.subjectClostridioides difficile
dc.titleAn environmental cleaning bundle and health-care-associated infections in hospitals (REACH): a multicentre, randomised trial
dc.typeJournal article
pubs.publication-statusPublished

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