Intervention for cleaning shared healthcare equipment could significantly reduce the number of healthcare-associated infections

Cleaning shared medical equipment at least once a day – even with a disinfectant wipe – can significantly reduce infections in hospitals and potentially save lives, new research shows.

The finding is based on results from the CLEEN trial, a randomized control trial led by Professor Brett Mitchell of Avondale University at a hospital on the central coast of New South Wales, with colleagues including fellow principal investigator and Professor Philip Russo at the Monash University.

Published in The Lancet Infectious Diseasesthe study introduced an intervention that consisted of extra cleaning, education about techniques and an audit of and feedback on cleanliness.

Dedicated cleaners, instead of healthcare workers usually responsible for cleaning, cleaned for an additional three hours every day on shared equipment such as commodes, IV stands and walking aids.

To measure cleanliness, the researchers placed fluorescent marker gel dots on the surface of the equipment. When the dots dried, they only became visible under special light and were resistant to dry abrasion, meaning they could only be removed by a thorough cleaning.

“We observed relatively low levels of thoroughness during the control phase,” the researchers wrote, suggesting that “routine cleaning is not performed or is performed ineffectively.”

Before the intervention, the hospital removed about 25% of the dots. After the intervention this was 65% – a 35% reduction in all healthcare-associated infections.

The finding is important because 165,000 infections occur in Australian hospitals every year – the most comprehensive estimate in decades according to previous research by Professor Mitchell and other colleagues. Because infections not only cost money but also cost lives, the burden is significant.

Professor Mitchell said the findings made the case for more – not less – cleaning in hospitals. He said that before the CLEEN trial, there were still about 100 infections before the intervention. “Some of them would have suffered major complications as a result of their infection, including death,” he said.

Professor Russo, research director at Monash Nursing and Midwifery, said the research shows the crucial role of dedicated cleaners. “Infection prevention relies on multiple interventions, not just one. We now have strong evidence that cleaning can save lives,” he said.

Despite associated increases in morbidity, mortality and antimicrobial resistance – not to mention length of stay – strategies to prevent healthcare-acquired infections are based on low-quality evidence.

Professor Mitchell is aware of only six high-quality randomized control trials around cleaning and healthcare infections, “and we have published two of them.”

He said there were so few because control over factors that could influence results was difficult and the number of participants needed to build trust was large.

Trial coordinator Dr. Kate Browne, from Avondale University, said it was a worthwhile investment. “Robust, evidence-based research is the foundation of modern medicine,” said Dr. Browne. “The data generated helps inform clinical policies and guidelines that ultimately improve the quality of patient care.”