Studies compare hospital cleaning methods

Health care-associated infections are down, according to a national report from the Centers for Disease Control and Prevention (CDC). In its latest National and State Healthcare-Associated Infections Progress Report, the CDC reports that in 2014, five out of six common HAIs have seen slight to dramatic reductions. Central line-associated blood stream infection, for instance, saw a 50 percent reduction while hospital-onset Clostridium difficile infections decreased 8 percent. Only one, catheter-associated urinary track infections, has remained relatively the same.

In its report, the CDC states that “health care-associated infections are a major, yet often preventable, threat to patient safety.” Those in the field know there is no shortage of studies looking into how to reduce HAIs, but as researchers working with the Agency for Healthcare Research and Quality noted last year, there is a dearth of comparative studies that examine the effectiveness of one method over another.

Duke University and the University of North Carolina, which together make one of the CDC’s Prevention Epicenters, have released two studies that address this specific concern.

The partnership created a program called BETR (Benefits of Enhanced Terminal Room) Disinfection. In one of its studies, researchers examined four different cleaning strategies used across nine hospitals over 28 months. The four strategies were employed in seed rooms, which were rooms containing a patient infected by one of four target multidrug-resistant organisms. The next patient in the room was considered an “exposed” patient, and the team examined HAI rates among this set of patients.

The four cleaning strategies employed included a standard cleaning process using quaternary ammonium and three enhanced strategies: quaternary ammonium plus a UV-C emitting device, bleach and bleach plus UV-C.

During the two-year-plus study, the researches examined 24,589 “exposed” patients and found that UV-C made a significant contribution in HAI reduction. Clinical evidence of all target multidrug resistant infections was 37 percent lower for those who stayed in rooms cleaned with quaternary ammonium and UV-C and 32 percent lower in those cleaned with bleach and UV-C. Patients who stayed in rooms cleaned with only bleach had slightly higher infection rates compared with the standard cleaning approach.

In another BETR study, researchers evaluated two different monitoring strategies commonly used by hospitals to determine hospital room cleanliness.

Environmental services (ES) supervisors placed fluorescent dots on five to seven high-touch surfaces in study rooms prior to terminal cleaning and examined the dots with a black light after cleaning. Validators, noted as non-ES personnel, performed the same task on the same rooms. Of the 56 rooms examined by both groups, the researchers found large discrepancies between the two groups’ results.

Overall, ES supervisors determined that 82.5 percent of tested surfaces were clean, whereas the validation team found only 52.4 percent of surfaces to be clean. Greater discrepancies were found between certain surfaces. For instance, ES supervisors identified 90.5 percent of doorknobs and 95.2 percent of light switches as clean. The validation group, however, found 23. 1 percent and 23.8 percent, respectively, to be clean. The same pattern held for other surfaces, but were not as significant.

The researchers concluded that “ES self-monitoring of hospital room cleanliness may not accurately measure how well high-touch room surfaces are cleaned. Similar to hand hygiene, validation of room cleaning may be a useful tool to improve terminal cleaning and decrease the risk of bacterial transmission between patients.”

These types of studies that look at the effectiveness of one cleaning method over the other could prove much more useful in the national fight against HAIs.