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A Multicenter Randomized Trial to Determine the Effect of an Environmental Disinfection Intervention on the Incidence of Healthcare-Associated Clostridium difficile Infection

Part of: BARRY FARR AWARD RECIPIENTS

Published online by Cambridge University Press:  02 May 2017

Amy J. Ray ,
Abhishek Deshpande ,
Dennis Fertelli ,
Brett M. Sitzlar ,
Priyaleela Thota ,
Thriveen Sankar C ,
Annette L. Jencson ,
Jennifer L. Cadnum ,
Robert A. Salata  and
Richard R. Watkins
...Show all authors
Amy J. Ray
Affiliation:
Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio Case Western Reserve University School of Medicine, Cleveland, Ohio
Abhishek Deshpande
Affiliation:
Cleveland Clinic Foundation, Cleveland, Ohio
Dennis Fertelli
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Brett M. Sitzlar
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Priyaleela Thota
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Thriveen Sankar C
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Annette L. Jencson
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Jennifer L. Cadnum
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Robert A. Salata
Affiliation:
Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio Case Western Reserve University School of Medicine, Cleveland, Ohio
Richard R. Watkins
Affiliation:
Department of Medicine, Akron General Medical Center, Akron, Ohio
Ajay K. Sethi
Affiliation:
Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin
Philip C. Carling
Affiliation:
Carney Hospital and Boston University School of Medicine, Boston, Massachusetts
Brigid M. Wilson
Affiliation:
Geriatric Research, Education and Clinical Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Curtis J. Donskey*
Affiliation:
Case Western Reserve University School of Medicine, Cleveland, Ohio Geriatric Research, Education and Clinical Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
*
Address correspondence to Curtis J. Donskey, MD, Geriatric Research, Education, and Clinical Center 1110W, Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, Ohio 44106 ([email protected]).
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Abstract

OBJECTIVE

To determine the impact of an environmental disinfection intervention on the incidence of healthcare-associated Clostridium difficile infection (CDI).

DESIGN

A multicenter randomized trial.

SETTING

In total,16 acute-care hospitals in northeastern Ohio participated in the study.

INTERVENTION

We conducted a 12-month randomized trial to compare standard cleaning to enhanced cleaning that included monitoring of environmental services (EVS) personnel performance with feedback to EVS and infection control staff. We assessed the thoroughness of cleaning based on fluorescent marker removal from high-touch surfaces and the effectiveness of disinfection based on environmental cultures for C. difficile. A linear mixed model was used to compare CDI rates in the intervention and postintervention periods for control and intervention hospitals. The primary outcome was the incidence of healthcare-associated CDI.

RESULTS

Overall, 7 intervention hospitals and 8 control hospitals completed the study. The intervention resulted in significantly increased fluorescent marker removal in CDI and non-CDI rooms and decreased recovery of C. difficile from high-touch surfaces in CDI rooms. However, no reduction was observed in the incidence of healthcare-associated CDI in the intervention hospitals during the intervention and postintervention periods. Moreover, there was no correlation between the percentage of positive cultures after cleaning of CDI or non-CDI rooms and the incidence of healthcare-associated CDI.

CONCLUSIONS

An environmental disinfection intervention improved the thoroughness and effectiveness of cleaning but did not reduce the incidence of healthcare-associated CDI. Thus, interventions that focus only on improving cleaning may not be sufficient to control healthcare-associated CDI.

Infect Control Hosp Epidemiol 2017;38:777–783

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 7 , July 2017 , pp. 777 - 783
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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