title: Implementation of hospital-wide enhanced terminal cleaning of targeted patient rooms and its impact on endemic Clostridium difficile infection rates.
abstract: BACKGROUND
  Implementation of a hospital-wide program of terminal cleaning of patient rooms revolving around hydrogen peroxide vapor (HPV) technology and evaluation of its impact on endemic nosocomial Clostridium difficile-associated diarrhea (CDAD) have not been previously reported.
  
  
  METHODS
  This was a retrospective quasiexperimental study involving a 900-bed community hospital. During the preintervention period (January 2007-November 2008), rooms vacated by patients with CDAD or on contact precautions for other targeted pathogens underwent 1 or more rounds of cleaning with bleach. During the intervention period (January-December 2009), targeted newly evacuated rooms underwent "enhanced cleaning" consisting of use of bleach followed by HPV decontamination utilizing a priority scale based on the pathogen and room location. Rooms vacated by patients with CDAD but for which HPV decontamination was not possible the same day underwent 4 rounds of cleaning with bleach instead.
  
  
  RESULTS
  During the intervention period, 1,123 HPV decontamination rounds were performed involving 96.7% of hospital rooms. Of 334 rooms vacated by patients with CDAD (May-December 2009), 180 (54%) underwent HPV decontamination. The rate of nosocomial CDAD rate dropped significantly from 0.88 cases/1,000 patient-days to 0.55 cases/1,000 patient-days (rate ratio, 0.63; 95% confidence interval: 0.50-0.79, P < .0001).
  
  
  CONCLUSIONS
  A hospital-wide program of enhanced terminal cleaning of targeted patient rooms revolving around HPV technology was practical and was associated with a significant reduction in CDAD rates.
authors.affiliation: Department of Infection Control, Mercy Hospital, St Louis, MO 603141, USA. farrinman@gmail.com
authors.forename: Farrin A
authors.initials: FA
authors.lastname: Manian
authors.forename: Sandra
authors.initials: S
authors.lastname: Griesnauer
authors.forename: Alex
authors.initials: A
authors.lastname: Bryant
mesh_terms: D000328:Adult; D003015:Clostridium Infections / Q000453:epidemiology* / Q000517:prevention & control; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D003967:Diarrhea / Q000453:epidemiology / Q000517:prevention & control; D004202:Disinfectants / Q000145:classification; D004203:Disinfection / Q000379:methods*; D019353:Endemic Diseases / Q000517:prevention & control*; D006764:Hospitals, Community; D006797:Housekeeping, Hospital / Q000379:methods*; D006801:Humans; D006861:Hydrogen Peroxide; D017053:Infection Control / Q000379:methods*; D010362:Patients' Rooms; D012189:Retrospective Studies; D012973:Sodium Hypochlorite; D014835:Volatilization
chemical_list: D004202:Disinfectants; D006861:Hydrogen Peroxide; D012973:Sodium Hypochlorite