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

Matthew J. Ziegler, Hilary H. Babcock, Sharon F. Welbel, David K. Warren, William E. Trick, Pam Tolomeo, Jacqueline Omorogbe, Diana Garcia, Tracy Habrock-Bach, Onofre Donceras, Steven Gaynes, Leigh Cressman, Jason P. Burnham, Warren Bilker, Sujan C. Reddy, David Pegues, Ebbing Lautenbach, Brendan J. Kelly, Barry Fuchs, Niels D. MartinJennifer H. Han

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Background: Multidrug-resistant organisms (MDROs) frequently contaminate hospital environments. We performed a multicenter, cluster-randomized, crossover trial of 2 methods for monitoring of terminal cleaning effectiveness. Methods: Six intensive care units (ICUs) at 3 medical centers received both interventions sequentially, in randomized order. Ten surfaces were surveyed each in 5 rooms weekly, after terminal cleaning, with adenosine triphosphate (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, whereas secondary analysis included the baseline. Results: The ATP method was associated with a reduction in incidence rate of MDRO infection or colonization compared with the UV/F period (incidence rate ratio [IRR] 0.876; 95% confidence interval [CI], 0.807-0.951; P = .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 = .04), and MDR-GNB infection or colonization (IRR 0.856; 95% CI, 0.825-0.887; P < .001). The UV/F intervention was not associated with a statistically significant impact on these outcomes. Room turnaround time increased by a median of 1 minute with the ATP intervention and 4.5 minutes with UV/F compared with baseline. Conclusions: Intensive monitoring of ICU terminal room cleaning with an ATP modality is associated with a reduction of MDRO infection and colonization.

Original languageEnglish
Pages (from-to)1217-1223
Number of pages7
JournalClinical Infectious Diseases
Volume75
Issue number7
DOIs
StatePublished - Oct 1 2022

Keywords

  • bacterial
  • cross infection/prevention & control
  • cross infection/transmission
  • disinfectants
  • drug resistance
  • intensive care units
  • multiple

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