requires a multi-modal , tailored approach that considers the local setting . By using a bundle approach to improve routine and discharge cleaning , improved cleaning performance and a reduction in the number of VRE infections is possible . Since VRE is a useful surrogate for other bacteria , there are potential benefits of a tailored cleaning bundle for other pathogens that survive in the environment . However , we found no effect of the cleaning bundle on Staphylococcus aureus bacteremia and Clostridium difficile .”
The REACH bundle — created via a review of peer-reviewed publications and guidelines , prioritization of evidence by an expert panel ( with a focus on interventions that were easy to implement and low cost ) — makes recommendations on optimal types of cleaning agents , frequency of cleaning , cleaning techniques , auditing strategies , environmental cleaning staff training , and creating a hospital-wide commitment to improved cleaning .
Mitchell explains that “ The bundle is about a range of important initiatives needed to improve hospital cleaning . They can be applied in any scenario regarding of the pathogen of concern .” Mitchell adds , “ Cleaning is a complex activity and our study showed that a range of things need to be applied to improve cleanliness and reduce infection rates . Education and training alone , for example , has been shown in some studies to have benefit , but it is not necessarily sustained .”
Education of healthcare workers was an essential component of the bundle . As the researchers emphasized , “ Core training content included cleaning roles and responsibilities , components of the cleaning bundle , and effect of environmental cleaning on healthcare-associated infections . The cleaning technique included a defined and consistent cleaning sequence , daily cleaning of the high-risk frequent touch points , use of sufficient pressure and movement , and adherence to manufacturers ’ instructions for product use ( dilutions and contact time ). Tailored training activities and content reflected the context of the respective hospitals , including existing cleaning products and schedules . Communication was a key strategy to sustaining a hospital-wide commitment to improved cleaning and bundle components . Hospital-wide promotional activities were used to raise the profile and importance of cleaning in reducing infections and to support a culture shift in environmental services staff . Daily contact between cleaning staff and ward leaders or managers was encouraged , with cleaning staff representation on relevant clinical governance committees .”
The REACH trial ’ s secondary outcome — thoroughness of hospital cleaning – was measured by a fluorescent marking gel and ultraviolet light system . Data collection of cleaning audits occurred during the control and intervention period , and the outcome was the probability that a dot was completely removed . During the study , 25,443 individual frequent touch points ( 5,134 control , 20,309 intervention ) were audited ; 690 of available beds
The REACH bundle — created via a review of peerreviewed publications and guidelines , prioritization of evidence by an expert panel ( with a focus on interventions that were easy to implement and low cost ) — makes recommendations on optimal types of cleaning agents , frequency of cleaning , cleaning techniques , auditing strategies , environmental cleaning staff training , and creating a hospital-wide commitment to improved cleaning .” were audited every quarter . The proportion of frequent touch points cleaned increased in both the bathroom and patient room . The percentages of frequent touch points cleaned before and after the intervention increased from 55 percent to 76 percent for the patient room , and from 64 percent to 86 percent for the bathroom .
The researchers report that implementation of the REACH cleaning bundle resulted in improved thoroughness of cleaning that continued to improve over the intervention period . The thoroughness of cleaning at baseline ( control ) was low . As the researchers note , “ We would expect variation in cleaning practices to also be present in hospitals excluded from our study . Our results are similar to previous findings demonstrating the benefit of using a fluorescent gel to assess cleaning with provision of feedback to staff ; however , our intervention included other elements , such as a focus on cleaning technique , training , communication , and correct product use . Using this bundled intervention , we previously reported changes in knowledge , practice , and attitudes in environmental services staff , improvement in the thoroughness of cleaning , and an overall reduction in healthcare-associated infections .”
The Multi-modal Strategies In the 2023 paper , Browne and Mitchell outlined five key interventions ; let ’ s review them briefly :
➊ The product and approach to cleaning
The researchers explain , “ The patient risk profile refers to the vulnerability of patients or clients . The surface risk profile is the likelihood of contamination with pathogens and the risk for further transmission . The pathogen risk profile category refers to the persistence of viable pathogens , antimicrobial resistance considerations and main modes of pathogen transmission .” In the paper , there is also a list of key considerations in choosing your product and / or approach to cleaning .
➋ Technique
As the researchers explain , “ The process of cleaning involves several important components . These include the direction of cleaning and the wiping action . The principles involved in the direction of cleaning include cleaning from high to low , clean sites nearest to the patient first , prioritizing hand-touch and frequent touched sites , and cleaning sites from least visually dirty to obviously dirty . The process of wiping a surface involves using one wipe / cloth for each site , unfolding the wipe / cloth and using it flat on the surface , wiping in the one direction and using an S-shaped pattern when wiping . The principle of the ‘ one wipe ; one site ; one direction ’ is a useful way to help remember important concepts .”
➌ Education and training As the researchers explain , “ A successful intervention or initiative requires education and training of those involved . In
14 october 2023 • www . healthcarehygienemagazine . com