Stopping Hospital Infections With Environmental Services (SHINE): A Cluster-randomized Trial of Intensive Monitoring Methods for Terminal Room Cleaning on Rates of Multidrug-resistant Organisms in the Intensive Care Unit

Abstract

Background Multidrug-resistant organisms (MDROs) frequently contaminate hospital environments. We performed a multicenter, cluster-randomized, crossover trial of two methods for monitoring of terminal cleaning effectiveness. Methods Six intensive care units (ICUs) at three medical centers received both interventions sequentially, in randomized order. Ten surfaces were surveyed each in five rooms weekly, after terminal cleaning, with ATP monitoring or an ultraviolet fluorescent marker (UV/F). Results were delivered to environmental services staff in real-time with failing surfaces recleaned. We measured monthly rates of MDRO infection or colonization, including methicillin-resistant Staphylococcus aureus, Clostridioides difficile, vancomycin-resistant Enterococcus, and MDR gram-negative bacilli (MDR-GNB) during a 12-month baseline period and sequential 6-month intervention periods, separated by a 2-month washout. Primary analysis compared only the randomized intervention periods, while secondary analysis included the baseline. Results The ATP method was associated with a reduction in incidence rate of MDRO infection or colonization compared to the UV/F period (incidence rate ratio (IRR) 0.876, 95% confidence-interval (CI) 0.807 – 0.951, P=0.002). Including the baseline period, the ATP method was associated with reduced infection with MDROs (IRR 0.924, 95% CI 0.855 – 0.998, P=0.04), and MDR-GNB infection or colonization (IRR 0.856, 95% CI 0.825 – 0.887, P<0.001). The UV/F intervention was not associated with a statistically significant impact on these outcomes. Room turn-around time increased by a median of one minute with the ATP intervention and 4.5 minutes with UV/F compared to baseline. Conclusions Intensive monitoring of ICU terminal room cleaning with an ATP modality is associated with a reduction of MDRO infection and colonization.

Genomic characterization and outbreak investigations of methicillin-resistant Staphylococcus aureus in a county-level hospital in China

“…ICUs are among the departments most vulnerable to MRSA infections and colonization. MRSA-contaminated patients and the hospital environment, particularly high-touch surfaces in patient rooms, serve as potential reservoirs for MRSA transmission ( Ziegler et al, 2022 ). ICUs are major sources for the creation, transmission, and spread of multidrug-resistant bacteria.…”

Bacterial Cross-Transmission between Inanimate Surfaces and Patients in Intensive Care Units under Real-World Conditions: A Repeated Cross-Sectional Study

“…Presently, there is no standard method for measuring the cleanliness of surfaces and achievement of certain cleaning parameters or defining the level of microbial contamination that correlates with good or poor environmental cleaning practices. The standardization and improvement of disinfection practices [ 16 ], as well as the full respect of hygiene measures, are necessary to minimize the risk of environmental contamination and healthcare-associated infections.…”

Research agenda for transmission prevention within the Veterans Health Administration, 2024–2028

“…Barker (2020) 76 Conduct comparative-effectiveness studies to identify optimal methods for audit and feedback to improve cleaning and disinfection. Scaria (2021) 77 Ziegler (2022) 78 What is the role of enhanced terminal cleaning using novel technology on HAI and MDRO infection rates? Rock (2022) 71 Determine the frequency and sites of UV-C room device use in VA facilities and develop effective strategies to monitor use.…”