Nursing & Health

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    A Randomised Controlled Trial Investigating the Effect of Improving the Cleaning and Disinfection of Shared Medical Equipment on Healthcare-associated Infections: The CLEaning and Enhanced disiNfection (CLEEN) Study
    (2023-02-22) Mitchell, Brett; Brain, David; Kiernan, Martin; King, Jennie; O'Kane, Gabrielle; Graham, Kirsty; Cheng, Allen; Stewardson, Andrew; Amin, Maham; Russo, Philip; Tehan, Peta; White, Nicole; Browne, Katrina

    Background

    Healthcare-associated infections (HAIs) are a common, costly, yet largely preventable complication impacting patients in healthcare settings globally. Improving routine cleaning and disinfection of the hospital environment has been shown to reduce the risk of HAI. Contaminated shared medical equipment presents a primary transmission route for infectious pathogens, yet is rarely studied. The CLEEN study will assess how enhanced cleaning and disinfection of shared medical equipment affects the rate of HAIs in a tertiary hospital setting. The initiative is an evidence-based approach combining staff training, auditing and feedback to environmental services staff to enhance cleaning and disinfection practices.

    Methods

    The CLEEN study will use a stepped wedge randomised controlled design in 10 wards of one large Australian hospital over 36 weeks. The intervention will consist of 3 additional hours per weekday for the dedicated cleaning and disinfection of shared medical equipment on each ward. The primary outcome is to demonstrate the effectiveness of improving the quality and frequency of cleaning shared medical equipment in reducing HAIs, as measured by a HAI point prevalence study (PPS). The secondary outcomes include the thoroughness of equipment cleaning assessed using fluorescent marker technology and the cost-effectiveness of the intervention.

    Discussion

    Evidence from the CLEEN study will contribute to future policy and practice guidelines about the cleaning and disinfection of shared medical equipment. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in healthcare facilities.

    Trial registration

    Australia New Zealand Clinical Trial Registry ACTRN12622001143718.

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    Investigating the Effect of Enhanced Cleaning and Disinfection of Shared Medical Equipment on Health-Care-Associated Infections in Australia (CLEEN): A Stepped-Wedge, Cluster Randomised, Controlled Trial
    (Elsevier, 2024) Browne, Katrina; White, Nicole M; Russo, Philip L; Cheng, Allen C; Stewardson, Andrew J; Matterson, Georgia; Tehan, Peta E; Graham, Kirsty; Amin, Maham; Northcote, Maria; Kiernan, Martin; King, Jennie; Brain, David; Mitchell, Brett G
    Summary Background There is a paucity of high-quality evidence based on clinical endpoints for routine cleaning of shared medical equipment. We assessed the effect of enhanced cleaning and disinfection of shared medical equipment on health-care-associated infections (HAIs) in hospitalised patients. Methods We conducted a stepped-wedge, cluster randomised, controlled trial in ten wards of a single hospital located on the central coast of New South Wales, Australia. Hospitals were eligible for inclusion if they were classified as public acute group A according to the Australian Institute of Health and Welfare, were located in New South Wales, had an intensive care unit, had a minimum of ten wards, and provided care for patients aged 18 years or older. Each cluster consisted of two randomly allocated wards (by use of simple randomisation), with a new cluster beginning the intervention every 6 weeks. Wards were informed of their allocation 2 weeks before commencement of intervention exposure, and the researcher collecting primary outcome data and audit data was masked to treatment sequence allocation. In the control phase, there was no change to environmental cleaning practices. In the intervention phase, a multimodal cleaning bundle included an additional 3 h per weekday for the dedicated cleaning and disinfection of shared medical equipment by 21 dedicated cleaning staff, with ongoing education, audit, and feedback. The primary outcome was the number of confirmed cases of HAI, as assessed by a fortnightly point prevalence survey and measured in all patients admitted to the wards during the study period. The completed trial is registered with Australia New Zealand Clinical Trials Registry (ACTRN12622001143718). Findings The hospital was recruited on July 31, 2022, and the study was conducted between March 20 and Nov 24, 2023. We assessed 220 hospitals for eligibility, of which five were invited to participate, and the first hospital to formally respond was enrolled. 5002 patients were included in the study (2524 [50·5%] women and 2478 [49·5%] men). In unadjusted results, 433 confirmed HAI cases occurred in 2497 patients (17·3%, 95% CI 15·9 to 18·8) in the control phase and 301 confirmed HAI cases occurred in 2508 patients (12·0%, 10·7 to 13·3) in the intervention phase. In adjusted results, there was a relative reduction of –34·5% (–50·3 to –17·5) in HAIs following the intervention (odds ratio 0·62, 95% CI 0·45 to 0·80; p=0·0006), corresponding to an absolute reduction equal to –5·2% (–8·2 to –2·3). No adverse effects were reported. Interpretation Improving the cleaning and disinfection of shared medical equipment significantly reduced HAIs, underscoring the crucial role of cleaning in improving patient outcomes. Findings emphasise the need for dedicated approaches for cleaning shared equipment. Funding National Health and Medical Research Council.
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    Patient Perspectives of Healthcare Associated Infection
    (Australasian College for Infection Prevention and Control, 2022) Mitchell, Brett G.; Northcote, Maria; Rickett, Carolyn; Russo, Phil; Amin, Maham; De Souza, Fiona; Pearce, Kirsty; Sim, Jenny; Curryer, Cassie
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    Patient Perspectives of Healthcare associated Infection: "You don't know what impacts it will have on your life"
    (2022-08-01) Curryer, Cassie; Sim, Jenny; Pearce, Kirsty; De Sousa, Fiona; Amin, Maham; Russo, Philip; Rickett, Carolyn; Northcote, Maria T.; Mitchell, Brett G.

    Background: Healthcare associated infections (HAIs) are not present on admission but contracted while a patient is undergoing hospital treatment. While the prevalence of HAIs, their causes and treatments have been researched in varied contexts to date, the patients’ perspectives of contracting and living with the consequences of HAI remains under-researched.

    Objective: To explore the patients’ experience of having an HAI.

    Methods: We conducted a qualitative phenomenological study which drew on data from semi-structured interviews to explore the lived experiences of patients who had recently contracted an HAI while in hospital. Participants were recruited from two Australian hospitals during 2019 and 2021. Telephone interviews were conducted with ten participants by two research team members and transcripts from these interviews were qualitatively analysed using a thematic coding process to identify the patients’ perspectives of contracting an HAI.

    Results: The participants had a range of different HAIs. The participants described how the experience of having an HAI can be very isolating and distressing from the patient perspective, with life-long implications. This contributes to our understanding of the way in which patients are impacted emotionally and mentally as a result of contracting an HAI.

    Conclusion: There is a need for improved, person-centred communication about the source, treatment, and prognosis of HAIs. The findings from our study indicate the importance of considering patients’ voices in their own health care