The impact of enhanced cleaning within the intensive care unit on contamination of the near-patient environment with hospital pathogens: a randomized crossover study in critical care units in two hospitals.
OBJECTIVE
To determine the effect of enhanced cleaning of the near-patient environment on the isolation of hospital pathogens from the bed area and staff hands.


METHODS
Prospective randomized crossover study over the course of 1 yr.


METHODS
Intensive care units at two teaching hospitals.


METHODS
There were 1252 patients staying during enhanced cleaning and 1331 staying during standard cleaning.


METHODS
In each of six 2-month periods, one unit was randomly selected for additional twice-daily enhanced cleaning of hand contact surfaces.


RESULTS
Agar contact samples were taken at five sites around randomly selected bed areas, from staff hands, and from communal sites three times daily for 12 bed days per week. Patients admitted in the year commencing April 2007 were analyzed for hospital-acquired colonization and infection. Over the course of 1152 bed days, 20,736 samples were collected. Detection of environmental methicillin-resistant Staphylococcus aureus per bed-area day was reduced during enhanced cleaning phases from 82 of 561 (14.6%) to 51 of 559 (9.1%) (adjusted odds ratio, 0.59; 95% confidence interval, 0.40-0.86; p = .006). Other targeted pathogens (Acinetobacter baumannii, extended-spectrum β-lactamase-producing Gram-negative bacteria, vancomycin-resistant enterococci, and Clostridium difficile) were rarely detected. Subgroup analyses showed reduced methicillin-resistant Staphylococcus aureus contamination on doctors' hands during enhanced cleaning (3 of 425; 0.7% vs. 11 of 423; 2.6%; adjusted odds ratio, 0.26; 95% confidence interval, 0.07-0.95; p = .025) and a trend to reduction on nurses' hands (16 of 1647; 1.0% vs. 28 of 1694; 1.7%; adjusted odds ratio 0.56; 95% confidence interval, 0.29-1.08; p = .077). All 1252 critical care patients staying during enhanced and 1,331 during standard cleaning were included, but no significant effect on patient methicillin-resistant Staphylococcus aureus acquisition was observed (adjusted odds ratio, 0.98; 95% confidence interval, 0.58-1.65; p = .93).


CONCLUSIONS
Enhanced cleaning reduced environmental contamination and hand carriage, but no significant effect was observed on patient acquisition of methicillin-resistant Staphylococcus aureus.


BACKGROUND
ISRCTN. Identifier: 06298448. http://www.controlled-trials.com/isrctn/.
Departments of Microbiology and Infection Control, University College London Hospitals, London, United Kingdom. peter.wilson@uclh.nhs.uk
A Peter R
AP
Wilson
Deborah
D
Smyth
Ginny
G
Moore
Julie
J
Singleton
Richard
R
Jackson
Vanya
V
Gant
Annette
A
Jeanes
Steven
S
Shaw
Edward
E
James
Ben
B
Cooper
George
G
Kafatos
Barry
B
Cookson
Mervyn
M
Singer
Geoffrey
G
Bellingan
D040981:Acinetobacter baumannii; D000328:Adult; D000368:Aged; D016360:Clostridioides difficile; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D018592:Cross-Over Studies; D003666:Decontamination / Q000379:methods*; D005260:Female; D006235:Hand Disinfection / Q000592:standards; D006784:Hospitals, Teaching / Q000592:standards; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged