Leistner Rasmus, Kohlmorgen Britta, Brodzinski Annika, Schwab Frank, Lemke Elke, Zakonsky Gregor, Gastmeier Petra
Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Division of Gastroenterology, Infectious Diseases and Rheumatology, Medical Department, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
EClinicalMedicine. 2023 Apr 6;59:101958. doi: 10.1016/j.eclinm.2023.101958. eCollection 2023 May.
The impact of environmental hygiene on the occurrence of hospital-acquired infections (HAIs) remains a subject of debate. We determined the effect of three different surface-cleaning strategies on the incidence of HAIs.
Between June 2017 and August 2018 we conducted a pragmatic, cluster-randomized controlled crossover trial at 18 non-ICU wards in the university hospital of Berlin, Germany. Surfaces in patient rooms on the study wards were routinely cleaned using one of three agents: Soap-based (reference), disinfectant and probiotic. Each strategy was used on each ward for four consecutive months (4m-4m-4m). There was a one-month wash-in period at the beginning of the study and after each change in strategy. The order of strategies used was randomized for each ward. Primary outcome was the incidence of HAIs. The trial was registered with the German Clinical Trials Register, DRKS00012675.
13,896 admitted patients met the inclusion criteria, including 4708 in the soap-based (reference) arm, 4535 in the disinfectant arm and 4653 in the probiotic arm. In the reference group, the incidence density of HAIs was 2.31 per 1000 exposure days. The incidence density was similar in the disinfectant arm 2.21 cases per 1000 exposure days (IRR 0.95; 95% CI 0.69-1.31; p = 0.953) and the probiotic arm 2.21 cases per 1000 exposure days (IRR 0.96; 95% CI 0.69-1.32; p = 0.955).
In non-ICU wards, routine surface disinfection proved not superior to soap-based or probiotic cleaning in terms of HAI prevention. Thus, probiotic cleaning could be an interesting alternative, especially in terms of environmental protection.
Federal Ministry of Education and Research of Germany (03Z0818C). Bill and Melinda Gates Foundation (INV-004308).
环境卫生对医院获得性感染（HAIs）发生的影响仍是一个有争议的话题。我们确定了三种不同的表面清洁策略对HAIs发生率的影响。
2017年6月至2018年8月期间，我们在德国柏林大学医院的18个非重症监护病房进行了一项实用的整群随机对照交叉试验。研究病房内患者房间的表面常规使用三种清洁剂之一进行清洁：皂基清洁剂（对照）、消毒剂和益生菌清洁剂。每种策略在每个病房连续使用四个月（4个月-4个月-4个月）。研究开始时以及每次更换策略后有一个月的导入期。每个病房使用策略的顺序是随机的。主要结局是HAIs的发生率。该试验已在德国临床试验注册中心注册，注册号为DRKS00012675。
13896名入院患者符合纳入标准，其中皂基清洁剂（对照）组4708例，消毒剂组4535例，益生菌清洁剂组4653例。在对照组中，HAIs的发病密度为每1000暴露日2.31例。消毒剂组的发病密度相似，为每1000暴露日2.21例（发病率比值比0.95；95%置信区间0.69-1.31；p = 0.953），益生菌清洁剂组为每1000暴露日2.21例（发病率比值比=0.96；95%置信区间0.69-1.32；p = 0.955）。
在非重症监护病房，就预防HAIs而言，常规表面消毒并不优于皂基清洁或益生菌清洁。因此，益生菌清洁可能是一个有趣的替代方案，尤其是在环境保护方面。
德国联邦教育与研究部（03Z0818C）。比尔及梅琳达·盖茨基金会（INV-004308）。
