Division of Infectious Diseases, Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina.
Disinfection, Resistance and Transmission Epidemiology (DiRTE) Lab, Duke University School of Medicine, Durham, North Carolina.
JAMA Netw Open. 2022 Nov 1;5(11):e2242131. doi: 10.1001/jamanetworkopen.2022.42131.
Environmental contamination is a source of transmission between patients, health care practitioners, and other stakeholders in the acute care setting.
To compare the efficacy of an enhanced daily disinfection strategy vs standard disinfection in acute care hospital rooms.
DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial (RCT) was conducted in acute care hospital rooms at Duke University Hospital in Durham, North Carolina, from November 2021 to March 2022. Rooms were occupied by patients with contact precautions. Room surfaces (bed rails, overbed table, and in-room sink) were divided into 2 sides (right vs left), allowing each room to serve as its own control. Each side was randomized 1:1 to the intervention group or control group.
The intervention was a quaternary ammonium, salt-based, 24-hour continuously active germicidal wipe. It was applied in addition to routine disinfection for the intervention group. The control group received no intervention beyond routine disinfection.
The primary outcome was the total contamination, measured in colony-forming units (CFUs) on the bed rails, overbed table, and sink on study day 1. The secondary outcomes were the proportion of sample areas with positive test results for clinically important pathogens, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and carbapenem-resistant Enterobacteriaceae; the similarity in baseline contamination between sample area sides on study day 0 before application of the intervention, and the proportion of sample areas with removed UV luminescent gel on study day 1.
A total of 50 study rooms occupied by 50 unique patients (median [IQR] age, 61 [45-69] years; 26 men [52%]) with contact precautions were enrolled. Of these patients, 41 (82%) were actively receiving antibiotics, 39 (78%) were bedridden, and 28 (56%) had active infections with study-defined clinically important pathogens. On study day 1, the median (IQR) total CFUs for the intervention group was lower than that for the control group (3561 [1292-7602] CFUs vs 5219 [1540-12 364] CFUs; P = .002). On study day 1, the intervention side was less frequently contaminated with patient-associated clinically important pathogens compared with the control side of the room (4 [14%] vs 11 [39%]; P = .04).
Results of this RCT demonstrated that a quaternary ammonium, salt-based, 24-hour continuously active germicidal wipe decreased the environmental bioburden in acute care hospital rooms compared with routine disinfection. The findings warrant large-scale RCTs to determine whether enhanced daily disinfection strategies can decrease patient acquisition and adverse patient outcomes.
ClinicalTrials.gov Identifier: NCT05560321.
环境污染是急性护理环境中患者、医护人员和其他利益相关者之间传播的一个来源。
比较强化日常消毒策略与急性护理病房标准消毒的效果。
设计、地点和参与者：这是一项在北卡罗来纳州达勒姆市杜克大学医院急性护理病房进行的随机临床试验（RCT）。房间被有接触预防措施的患者占用。房间表面（床栏、床上桌和室内水槽）分为两侧（右侧和左侧），允许每个房间作为自己的对照。每侧以 1:1 的比例随机分为干预组或对照组。
干预措施是一种季铵盐、基于盐的、24 小时持续活性杀菌湿巾。它被应用于干预组的常规消毒之外。对照组除常规消毒外无其他干预。
主要结果是研究日 1 时床栏、床上桌和水槽的总污染，以菌落形成单位（CFU）表示。次要结果包括临床重要病原体（包括耐甲氧西林金黄色葡萄球菌、万古霉素耐药肠球菌和耐碳青霉烯肠杆菌科）阳性检测结果的样本区域比例；研究日 0 干预应用前样本区域两侧基线污染的相似性，以及研究日 1 时去除 UV 发光凝胶的样本区域比例。
共纳入 50 间研究病房，入住了 50 名具有接触预防措施的独特患者（中位数[IQR]年龄，61[45-69]岁；26 名男性[52%]）。这些患者中，41 名（82%）正在接受抗生素治疗，39 名（78%）卧床不起，28 名（56%）患有研究定义的临床重要病原体的活动性感染。在研究日 1 时，干预组的总 CFU 中位数低于对照组（3561[1292-7602]CFU 与 5219[1540-12364]CFU；P=0.002）。在研究日 1 时，与房间的对照组相比，干预组的侧表面污染较少，与患者相关的临床重要病原体（4[14%]与 11[39%]；P=0.04）。
这项 RCT 的结果表明，与常规消毒相比，一种季铵盐、基于盐的、24 小时持续活性杀菌湿巾降低了急性护理医院病房的环境生物负荷。这些发现需要进行大规模 RCT，以确定强化日常消毒策略是否可以减少患者的获得和不良的患者结局。
ClinicalTrials.gov 标识符：NCT05560321。
