title: Researching effective approaches to cleaning in hospitals: protocol of the REACH study, a multi-site stepped-wedge randomised trial.
abstract: BACKGROUND
  The Researching Effective Approaches to Cleaning in Hospitals (REACH) study will generate evidence about the effectiveness and cost-effectiveness of a novel cleaning initiative that aims to improve the environmental cleanliness of hospitals. The initiative is an environmental cleaning bundle, with five interdependent, evidence-based components (training, technique, product, audit and communication) implemented with environmental services staff to enhance hospital cleaning practices.
  
  
  METHODS
  The REACH study will use a stepped-wedge randomised controlled design to test the study intervention, an environmental cleaning bundle, in 11 Australian hospitals. All trial hospitals will receive the intervention and act as their own control, with analysis undertaken of the change within each hospital based on data collected in the control and intervention periods. Each site will be randomised to one of the 11 intervention timings with staggered commencement dates in 2016 and an intervention period between 20 and 50 weeks. All sites complete the trial at the same time in 2017. The inclusion criteria allow for a purposive sample of both public and private hospitals that have higher-risk patient populations for healthcare-associated infections (HAIs). The primary outcome (objective one) is the monthly number of Staphylococcus aureus bacteraemias (SABs), Clostridium difficile infections (CDIs) and vancomycin resistant enterococci (VRE) infections, per 10,000 bed days. Secondary outcomes for objective one include the thoroughness of hospital cleaning assessed using fluorescent marker technology, the bio-burden of frequent touch surfaces post cleaning and changes in staff knowledge and attitudes about environmental cleaning. A cost-effectiveness analysis will determine the second key outcome (objective two): the incremental cost-effectiveness ratio from implementation of the cleaning bundle. The study uses the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework to support the tailored implementation of the environmental cleaning bundle in each hospital.
  
  
  CONCLUSIONS
  Evidence from the REACH trial will contribute to future policy and practice guidelines about hospital environmental cleaning. 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 hospitals.
  
  
  BACKGROUND
  Australia New Zealand Clinical Trial Registry ACTRN12615000325505.
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Hall
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia. alison.farrington@qut.edu.au.
authors.forename: Alison
authors.identifier: http://orcid.org/0000-0003-0586-3916
authors.initials: A
authors.lastname: Farrington
authors.affiliation: Faculty of Nursing and Health, Avondale College, 185 Fox Valley Road, Wahroonga, NSW, 2076, Australia.
authors.forename: Brett G
authors.initials: BG
authors.lastname: Mitchell
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia.
authors.forename: Adrian G
authors.initials: AG
authors.lastname: Barnett
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Halton
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Allen
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia.
authors.forename: Katie
authors.initials: K
authors.lastname: Page
authors.affiliation: School of Nursing, Midwifery and Paramedicine, Australian Catholic University, PO Box 256, Dickson, ACT, 2062, Australia.
authors.forename: Anne
authors.initials: A
authors.lastname: Gardner
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia.
authors.forename: Sally
authors.initials: S
authors.lastname: Havers
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Bailey
authors.affiliation: Department of Microbiology, Hairmyres Hospital, Eaglesham Rd, East Kilbride, G75 8RG, UK.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Dancer
authors.affiliation: School of Pathology and Laboratory Medicine, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Riley
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia.|School of Public Health, University of Queensland, Herston, QLD, 4006, Australia.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Gericke
authors.affiliation: Wesley Medical Research, Wesley Hospital, PO Box 499, Toowong, QLD, 4066, Australia.|University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.
authors.forename: David L
authors.initials: DL
authors.lastname: Paterson
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Graves
mesh_terms: D001315:Australia / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D055317:Evidence-Based Practice; D007722:Health Knowledge, Attitudes, Practice; D006797:Housekeeping, Hospital / Q000191:economics / Q000592:standards*; D006801:Humans; D017060:Patient Satisfaction; D015397:Program Evaluation
keywords: Cleaning bundle; Cost-effectiveness; Healthcare-associated infection; Hospital cleaning; iPARIHS