Carling Philip, Herwaldt Loreen A
1Infectious Diseases Section,Caritas Carney Hospital,Dorchester,Massachusetts.
3Department of Internal Medicine,Carver College of Medicine,The University of Iowa,Iowa City,Iowa.
Infect Control Hosp Epidemiol. 2017 Aug;38(8):960-965. doi: 10.1017/ice.2017.109.
OBJECTIVE A diverse group of hospitals in Iowa implemented a program to objectively evaluate and improve the thoroughness of disinfection cleaning of near-patient surfaces. Administrative benefits of, challenges of, and impediments to the program were also evaluated. METHODS We conducted a prospective, quasi-experimental pre-/postintervention trial to improve the thoroughness of terminal room disinfection cleaning. Infection preventionists utilized an objective cleaning performance monitoring system (DAZO) to evaluate the thoroughness of disinfection cleaning (TDC) expressed as a proportion of objects confirmed to have been cleaned (numerator) to objects to be cleaned per hospital policy (denominator)×100. Data analysis, educational interventions, and objective performance feedback were modeled on previously published studies using the same monitoring tool. Programmatic analysis utilized unstructured and structured information from participants irrespective of whether they participated in the process improvement aspects to the program. RESULTS Initially, the overall TDC was 61% in 56 hospitals. Hospitals completing 1 or 2 feedback cycles improved their TDC percentages significantly (P90% for at least 38 months. A survey of infection preventionists found that lack of time and staff turnover were the most common reasons for terminating the study early. CONCLUSION The study confirmed that hospitals using this program can improve their TDC percentages significantly. Hospitals must invest resources to improve cleaning and to sustain their gains. Infect Control Hosp Epidemiol 2017;38:960-965.
目的 爱荷华州的一组不同医院实施了一项计划，以客观评估并改善患者附近表面消毒清洁的彻底性。还评估了该计划的管理效益、挑战和障碍。方法 我们进行了一项前瞻性、准实验性干预前/后试验，以提高终末病房消毒清洁的彻底性。感染预防人员使用客观清洁性能监测系统（DAZO）来评估消毒清洁的彻底性（TDC），其计算方式为确认已清洁的物品数量（分子）占医院政策规定的应清洁物品数量（分母）的比例×100。数据分析、教育干预和客观性能反馈以先前发表的使用相同监测工具的研究为模型。方案分析利用了来自参与者的非结构化和结构化信息，无论他们是否参与了该计划的流程改进方面。结果 最初，56家医院的总体TDC为61%。完成1或2个反馈周期的医院其TDC百分比显著提高（P<0.001）。到第3个反馈周期结束时，所有医院的TDC百分比均达到90%或更高，并在至少38个月内保持这一水平。对感染预防人员的一项调查发现，时间不足和人员流动是提前终止研究的最常见原因。结论 该研究证实，使用该计划的医院可显著提高其TDC百分比。医院必须投入资源来改善清洁工作并维持所取得的成果。《感染控制与医院流行病学》2017年；38：960 - 965。
