Thomas R E, Thomas B C, Conly J, Lorenzetti D
Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Independent Researcher, Calgary, Alberta, Canada.
J Hosp Infect. 2022 Apr;122:9-26. doi: 10.1016/j.jhin.2021.12.017. Epub 2022 Jan 6.
Multiply drug-resistant organisms (MDROs) in hospitals and long-term care facilities (LTCFs) of particular concern include meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus, multidrug-resistant Acinetobacter species, and extended-spectrum β-lactamase-producing organisms. Respiratory viruses include influenza and SARS-CoV-2.
To assess effectiveness of cleaning and disinfecting surfaces in hospitals and LTCFs.
CINAHL, Cochrane CENTRAL Register of Controlled Trials, Embase, Medline, and Scopus searched inception to June 28, 2021, no language restrictions, for randomized controlled trials (RCTs), cleaning, disinfection, hospitals, LTCFs. Abstracts and titles were assessed and data abstracted independently by two authors.
Of 14 cluster (c)-RCTs in hospitals and LTCFs, interventions in ten were focused on reducing patient infections of four MDROs and/or healthcare-associated infections (HAIs). In four c-RCTs patient MDRO and/or HAI rates were significantly reduced with cleaning and disinfection strategies including bleach-, quaternary ammonium detergent-, ultraviolet irradiation-, hydrogen peroxide vapour- and copper-treated surfaces or fabrics. Of three c-RCTs focused on reducing MRSA rates, one had significant results and one on Clostridioides difficile had no significant results. Heterogeneity of populations, methods, outcomes and data reporting precluded meta-analysis. Overall risk of bias assessment was low but high for allocation concealment, and GRADE assessment was low risk. No study assessed biofilms.
Ten c-RCTs focused on reducing multiple MDROs and/or HAIs and four had significant reductions. Three c-RCTs reported only patient MRSA colonization rates (one significant reductions), and one focused on C. difficile (no significant differences). Standardized primary and secondary outcomes are required for future c-RCTs including detailed biofilm cleaning/disinfection interventions.
医院和长期护理机构（LTCF）中特别值得关注的多重耐药菌（MDRO）包括耐甲氧西林金黄色葡萄球菌（MRSA）、耐万古霉素肠球菌、多重耐药不动杆菌属以及产超广谱β-内酰胺酶的细菌。呼吸道病毒包括流感病毒和严重急性呼吸综合征冠状病毒2（SARS-CoV-2）。
评估医院和长期护理机构中表面清洁和消毒的效果。
检索CINAHL、Cochrane对照试验中央注册库、Embase、Medline和Scopus，检索时间从建库至2021年6月28日，无语言限制，检索随机对照试验（RCT）、清洁、消毒、医院、长期护理机构。由两位作者独立评估摘要和标题并提取数据。
在医院和长期护理机构的14项整群随机对照试验（c-RCT）中，10项试验的干预措施聚焦于降低4种多重耐药菌的患者感染率和/或医疗相关感染（HAI）。在4项c-RCT中，通过清洁和消毒策略，包括使用含氯消毒剂、季铵盐洗涤剂、紫外线照射、过氧化氢蒸汽处理以及铜处理的表面或织物，患者多重耐药菌和/或医疗相关感染率显著降低。在3项聚焦于降低MRSA感染率的c-RCT中，1项有显著结果，而1项针对艰难梭菌的试验没有显著结果。由于研究人群、方法、结果和数据报告的异质性，无法进行荟萃分析。总体偏倚风险评估为低，但分配隐藏方面风险高，GRADE评估为低风险。没有研究评估生物膜。
10项c-RCT聚焦于降低多种多重耐药菌和/或医疗相关感染率，4项试验有显著降低。3项c-RCT仅报告了患者MRSA定植率（1项有显著降低），1项聚焦于艰难梭菌（无显著差异）。未来的c-RCT需要标准化的主要和次要结局，包括详细的生物膜清洁/消毒干预措施。
