利用环境服务（SHINE）停止医院感染：一项针对重症监护病房终端房间清洁强化监测方法对多药耐药菌发生率的集群随机试验。
Stopping Hospital Infections With Environmental Services (SHINE): A Cluster-randomized Trial of Intensive Monitoring Methods for Terminal Room Cleaning on Rates of Multidrug-resistant Organisms in the Intensive Care Unit.
机构信息
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
出版信息
Clin Infect Dis. 2022 Sep 30;75(7):1217-1223. doi: 10.1093/cid/ciac070.
BACKGROUND
Multidrug-resistant organisms (MDROs) frequently contaminate hospital environments. We performed a multicenter, cluster-randomized, crossover trial of 2 methods for monitoring of terminal cleaning effectiveness.
METHODS
Six intensive care units (ICUs) at 3 medical centers received both interventions sequentially, in randomized order. Ten surfaces were surveyed each in 5 rooms weekly, after terminal cleaning, with adenosine triphosphate (ATP) monitoring or an ultraviolet fluorescent marker (UV/F). Results were delivered to environmental services staff in real time with failing surfaces recleaned. We measured monthly rates of MDRO infection or colonization, including methicillin-resistant Staphylococcus aureus, Clostridioides difficile, vancomycin-resistant Enterococcus, and MDR gram-negative bacilli (MDR-GNB) during a 12-month baseline period and sequential 6-month intervention periods, separated by a 2-month washout. Primary analysis compared only the randomized intervention periods, whereas secondary analysis included the baseline.
RESULTS
The ATP method was associated with a reduction in incidence rate of MDRO infection or colonization compared with the UV/F period (incidence rate ratio [IRR] 0.876; 95% confidence interval [CI], 0.807-0.951; P = .002). Including the baseline period, the ATP method was associated with reduced infection with MDROs (IRR 0.924; 95% CI, 0.855-0.998; P = .04), and MDR-GNB infection or colonization (IRR 0.856; 95% CI, 0.825-0.887; P < .001). The UV/F intervention was not associated with a statistically significant impact on these outcomes. Room turnaround time increased by a median of 1 minute with the ATP intervention and 4.5 minutes with UV/F compared with baseline.
CONCLUSIONS
Intensive monitoring of ICU terminal room cleaning with an ATP modality is associated with a reduction of MDRO infection and colonization.
背景
多药耐药菌（MDROs）经常污染医院环境。我们进行了一项多中心、集群随机、交叉试验，以监测两种终端清洁效果监测方法。
方法
三个医疗中心的六个重症监护病房（ICUs）按随机顺序先后接受两种干预措施。每周，在终端清洁后，对 5 个房间的 10 个表面进行腺苷三磷酸（ATP）监测或紫外线荧光标记（UV/F）的调查。结果实时传递给环境服务人员，不合格的表面进行重新清洁。在 12 个月的基线期和随后的 6 个月干预期内（中间间隔 2 个月洗脱期），我们测量了每月 MDRO 感染或定植的发生率，包括耐甲氧西林金黄色葡萄球菌、艰难梭菌、万古霉素耐药肠球菌和多药耐药革兰氏阴性杆菌（MDR-GNB）。主要分析仅比较随机干预期，而次要分析则包括基线期。
结果
与 UV/F 期相比，ATP 方法与 MDRO 感染或定植的发病率降低相关（发病率比[IRR]0.876；95%置信区间[CI]，0.807-0.951；P=0.002）。包括基线期，ATP 方法与 MDRO 感染减少相关（IRR 0.924；95%CI，0.855-0.998；P=0.04），以及 MDR-GNB 感染或定植（IRR 0.856；95%CI，0.825-0.887；P<0.001）。UV/F 干预与这些结果无统计学显著影响相关。与基线相比，ATP 干预使房间周转时间中位数增加了 1 分钟，而 UV/F 干预则增加了 4.5 分钟。
结论
采用 ATP 模式对 ICU 终端房间清洁进行强化监测与 MDRO 感染和定植减少有关。
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