Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.
Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
J Hosp Infect. 2023 Apr;134:50-56. doi: 10.1016/j.jhin.2022.11.025. Epub 2023 Feb 7.
Multidrug-resistant organisms (MDROs) are prevalent on high-touch surfaces in multi-patient rooms.
To quantify the impact of hanging single-use cleaning/disinfecting wipes next to each bed. Pre-specified outcomes were: (1) hospital-acquired infections (HAIs), (2) cleaning frequency, (3) MDRO room contamination, (4) new MDRO acquisitions, and (5) mortality.
Clustered randomized crossover trial at Shamir Medical Center, Israel (October 2016 to January 2018). Clusters were randomly assigned to use for cleaning either single-use quaternary ammonium wipes (Clinell) or standard practices (reusable cloths and buckets with bleach). Six-month intervention periods were implemented in alternating sequence, separated by a washout period. Five high-touch surfaces were monitored by fluorescent markers. Study outcomes were compared between periods using generalized estimating equations, Poisson regression, and Cox proportional hazards models.
Overall, 7725 patients were included (47,670 person-days), 3793 patients in rooms with intervention cleaning and 3932 patients in rooms with standard practices. During the intervention, there was no significant difference in HAI rates (incidence rate ratio: 1.6; 95% confidence interval (CI): 0.7-3.5; P = 0.3). However, in intervention rooms, the frequency of environmental cleaning was higher (odds ratio: 3.73; 95% CI: 2.0-7.1; P < 0.0001), MDRO environmental contamination rate was insignificantly lower (odds ratio: 0.7; 95% CI: 0.5-1.0; P = 0.06), new MDRO acquisition rate was lower (hazard ratio: 0.4; 95% CI: 0.2-1.0; P = 0.04), and in-hospital mortality rate was lower (incidence rate ratio: 0.8; 95% CI: 0.7-1.0; P = 0.03).
Hanging single-use cleaning/disinfecting wipes next to each bed did not affect the HAI rates but did improve the frequency of cleaning, reduce MDRO environmental contamination, and was associated with reduced incidence of new MDRO acquisitions and reduced mortality. This is a feasible, recommended practice to improve patient outcomes in multi-patient rooms.
多药耐药菌（MDROs）在多人间的高接触表面普遍存在。
量化在每张床边悬挂一次性清洁/消毒擦拭巾的影响。预先规定的结果是：（1）医院获得性感染（HAI），（2）清洁频率，（3）MDRO 房间污染，（4）新 MDRO 获得，以及（5）死亡率。
在以色列 Shmair 医疗中心进行的集群随机交叉试验（2016 年 10 月至 2018 年 1 月）。集群被随机分配用于清洁，要么使用一次性季铵盐擦拭巾（Clinell），要么使用标准做法（可重复使用的布和带漂白剂的桶）。以交替顺序实施为期 6 个月的干预期，中间有清洗期。使用荧光标记监测 5 个高接触表面。使用广义估计方程、泊松回归和 Cox 比例风险模型比较干预期和标准做法期之间的研究结果。
共纳入 7725 名患者（47670 人日），其中 3793 名患者在干预清洁房间，3932 名患者在标准做法房间。在干预期间，HAI 发生率没有显著差异（发病率比：1.6；95%置信区间（CI）：0.7-3.5；P=0.3）。然而，在干预病房中，环境清洁的频率更高（优势比：3.73；95%CI：2.0-7.1；P<0.0001），MDRO 环境污染率无显著降低（优势比：0.7；95%CI：0.5-1.0；P=0.06），新 MDRO 获得率较低（风险比：0.4；95%CI：0.2-1.0；P=0.04），住院死亡率较低（发病率比：0.8；95%CI：0.7-1.0；P=0.03）。
在每张床边悬挂一次性清洁/消毒擦拭巾不会影响 HAI 发生率，但确实提高了清洁频率，降低了 MDRO 环境污染，并与新 MDRO 获得率降低和死亡率降低相关。这是一种可行的、推荐的做法，可以改善多人间患者的预后。
