conducted retrospectively , measuring real-world implementation of a quality improvement program . It did not control for baseline infection rates , trends , patient population and sample size or variables such as other infection prevention initiatives that may have impacted the results over the 10-year time span . Such is the nature of measuring any infection prevention strategy , especially over a long period of time – it is hard to tease out the independent impact of one initiative when we often implement multiple strategies at the same time to ensure the best patient outcome . In the case of this study , the 10-year length of the study adds strength to the findings . Optimized Product AND Process In June , 2022 , a multi-center , controlled study measuring the impact of an optimized environmental hygiene program on hospital-onset C . difficile was published . 3 In this study , eight hospitals that had implemented a program to improve environmental cleaning measured their C . difficile infection rates before and after implementation of the program . The program consisted of daily cleaning with a hydrogen peroxide / peroxyacetic acid sporicidal disinfectant , training on a standardized , evidence-based process , monitoring and feedback on thoroughness of cleaning with a made-for-purpose fluorescent gel marker , and actionable data to drive improvement via a digital dashboard . Thoroughness of cleaning was improved and sustained over the 18 months following implementation of the program . The result was a sustained 50 percent decrease in HO-CDIs in the hospitals that implemented the program versus control hospitals that had not implemented the program . This study met the rigor needed for a Level V study , thus demonstrating that the intervention reduced infections . To do this , the researchers addressed the following variables and confounders that can impact patient outcomes .
● They addressed baseline infection rates and trends . The intervention site patient acuity was stable over 39 months . The endemic HO-CDI SIRs before the intervention were stable .
● They included hospital controls . They compared the C . difficile infection rates in the intervention hospitals to rates in hospitals in the same hospital system that had not implemented the program and found that CDI rates did not decline as much in the hospitals that had not implemented the program .
● They controlled for other key infection prevention interventions . They surveyed infection preventionists from the eight intervention hospitals and found that other hospital-level factors that could have driven lower C . difficile rates showed no identifiable changes between the pre-intervention and post-intervention periods that would have impacted the outcome .
● Lastly , the researchers utilized a “ removed treatment design ” to show that a nonequivalent dependent variable of catheter-associated urinary tract infection ( an HAI for which the environment does not play a key role in infection transmission ) did not change during the intervention period in intervention hospitals whereas the HO-CDI rate declined .
UV-C disinfection as an adjunct to standard cleaning and disinfection
In the past decade , as hospitals look for ways to further improve environmental hygiene , decrease HAIs and instill confidence in patients that the hospital environment is as clean as possible , ultraviolet light technology has been introduced into the workflow to augment standard cleaning and disinfection practices upon patient discharge or transfer . Although UV-C technologies have shown microbicidal efficacy in laboratory studies , assessment of their effectiveness and ability to augment physical cleaning and disinfection in the clinical setting has been challenging . Well-designed , independent , controlled , comparative studies are needed to objectively quantify the cost and potential added value of such technologies when routine cleaning and disinfection has been optimized . 4
A new multi-center study evaluated the effectiveness of ultraviolet-C ( UV-C ) disinfection as an adjunct to standard chlorine-based disinfection for terminal room cleaning in the reduction of multidrug-resistant organisms -- MRSA , VRE , CRE , ESBL and C . difficile . 5 Researchers compared acquisition of these five pathogens between patients exposed to them in rooms that had been terminally cleaned with chlorine-based disinfectant versus patients who had been exposed in rooms that had been terminally cleaned with chlorine-based disinfectant plus UV-C disinfection . The authors found that that adjunct UV-C disinfection did not provide incremental value in reducing transfer of MDRO above and beyond standard cleaning and disinfection . They concluded that “ our analysis does not support the use of UV-C in addition to post-discharge cleaning with chlorine-based disinfectant to lower risk of prior occupant pathogen transfer .” This study meets the criteria for a Level IV study . It demonstrates reduced pathogen transmission via admission-discharge active surveillance testing or clinical incidence .
Reduction of HAIs is the goal of all environmental hygiene strategies , and the CDC has outlined the hierarchy of evidence needed to demonstrate the impact of a product , process or technology on HAI reduction . The level of scientific rigor required to demonstrate a clear connection between a strategy and HAI reduction is considerable and there are relatively few studies that have met this criteria to date . In today ’ s environment of limited resources for environmental hygiene , it is more important than ever to weigh the evidence before investing in a product , process or technology . The three recently published studies discussed here provide important insights into the clinical impact of environmental cleaning and disinfection products , processes and technologies to help EVS leaders make informed decisions on where to focus limited resources .
Linda Homan , RN , BSN , CIC , is director of clinical affairs for Ecolab Healthcare .
References :
1 . McDonald LC and Arduino M . Climbing the Evidentiary Hierarchy for Environmental Infection Control . Clin Infect Dis . 2013 ; 56 ( 1 ): 36-9 . DOI :
10.1093 / cid / cis845
2 . Parry MF , et al . ( 2022 ). Environmental cleaning and disinfection : Sustaining changed practice and improving quality in the community hospital . Antimicrobial Stewardship & Healthcare Epidemiology . 2022 ; 2 ( e113 ): 1-7 .
https :// doi . org / 10.1017 / ash . 2022.257
3 . Carling PC , et al . ( 2022 ). Mitigating hospital-onset Clostridioides difficile : The impact of an optimized environmental hygiene program in eight hospitals . Infect Control & Hosp Epidemiol . 2022 Jun 20:1-7
https :// doi . org / 10.1017 / ice . 2022.84
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