Researching effective approaches to cleaning in hospitals: protocol of the REACH study, a multi-site stepped-wedge randomised trial

Abstract

BackgroundThe Researching Effective Approaches to Cleaning in Hospitals (REACH) study will generate evidence about the effectiveness and cost-effectiveness of a novel cleaning initiative that aims to improve the environmental cleanliness of hospitals. The initiative is an environmental cleaning bundle, with five interdependent, evidence-based components (training, technique, product, audit and communication) implemented with environmental services staff to enhance hospital cleaning practices.Methods/designThe REACH study will use a stepped-wedge randomised controlled design to test the study intervention, an environmental cleaning bundle, in 11 Australian hospitals. All trial hospitals will receive the intervention and act as their own control, with analysis undertaken of the change within each hospital based on data collected in the control and intervention periods. Each site will be randomised to one of the 11 intervention timings with staggered commencement dates in 2016 and an intervention period between 20 and 50 weeks. All sites complete the trial at the same time in 2017. The inclusion criteria allow for a purposive sample of both public and private hospitals that have higher-risk patient populations for healthcare-associated infections (HAIs). The primary outcome (objective one) is the monthly number of Staphylococcus aureus bacteraemias (SABs), Clostridium difficile infections (CDIs) and vancomycin resistant enterococci (VRE) infections, per 10,000 bed days. Secondary outcomes for objective one include the thoroughness of hospital cleaning assessed using fluorescent marker technology, the bio-burden of frequent touch surfaces post cleaning and changes in staff knowledge and attitudes about environmental cleaning. A cost-effectiveness analysis will determine the second key outcome (objective two): the incremental cost-effectiveness ratio from implementation of the cleaning bundle.The study uses the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework to support the tailored implementation of the environmental cleaning bundle in each hospital.DiscussionEvidence from the REACH trial will contribute to future policy and practice guidelines about hospital environmental cleaning. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in hospitals.Trial registrationAustralia New Zealand Clinical Trial Registry ACTRN12615000325505

Evaluating bio-burden of frequently touched surfaces using Adenosine Triphosphate bioluminescence (ATP): Results from the Researching Effective Approaches to Cleaning in Hospitals (REACH) trial

“…The REACH study, conducted between May 2016 and July 2017, used a prospective, stepped-wedge randomised design [12]. The study intervention was a multi-modal cleaning bundle consisting of training for environmental services staff with a role in ward cleaning, attention to FTPs and cleaning technique, product use, FM audits and communication activities [12,30]. Further details on the study design, intervention and results from primary outcomes have been published [12,13,30e33].…”

“…Cross sectional ATP sampling was conducted at three of the 11 hospitals participating in the REACH study. Each of these hospitals met the inclusion criteria of having a large training-accredited intensive care unit and being classified as a major hospital (public hospitals) or having more than 200 beds (private hospitals) [30].…”

“…The REACH study team aimed to sample up to eight bed and bathroom areas in each hospital every four weeks through the control and intervention periods in any of the wards being used for FM audit activities [30]. Rooms or bed bays were identified through liaising with the environmental services and nursing staff in each hospital.…”

“…At each hospital, during each phase of the study, six FTP sites were sampled: toilet flush, bathroom tap, inside bathroom door handle, patient call button, tray table, and bed rails. These sampled sites were a subset of 15 FTPs audited as part of the REACH study, using FM technology [30]. The ATP sampling rooms were identified from the wards also used for the FM audit activities.…”

“…The aim of this paper is to describe changes in the efficacy of post-discharge cleaning by examining the amount of bio-burden on frequent touch points (FTPs) in patient areas, using a validated ATP sampling method [19]. In so doing, we present findings from a secondary outcome of a recent trial, the Researching Effective Approaches to Cleaning in Hospitals (REACH) study [30].…”