TY - JOUR
T1 - Stopping Hospital Infections With Environmental Services (SHINE)
T2 - A Cluster-randomized Trial of Intensive Monitoring Methods for Terminal Room Cleaning on Rates of Multidrug-resistant Organisms in the Intensive Care Unit
AU - Ziegler, Matthew J.
AU - Babcock, Hilary H.
AU - Welbel, Sharon F.
AU - Warren, David K.
AU - Trick, William E.
AU - Tolomeo, Pam
AU - Omorogbe, Jacqueline
AU - Garcia, Diana
AU - Habrock-Bach, Tracy
AU - Donceras, Onofre
AU - Gaynes, Steven
AU - Cressman, Leigh
AU - Burnham, Jason P.
AU - Bilker, Warren
AU - Reddy, Sujan C.
AU - Pegues, David
AU - Lautenbach, Ebbing
AU - Kelly, Brendan J.
AU - Fuchs, Barry
AU - Martin, Niels D.
AU - Han, Jennifer H.
N1 - Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
PY - 2022/10/1
Y1 - 2022/10/1
N2 - 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.
AB - 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.
KW - bacterial
KW - cross infection/prevention & control
KW - cross infection/transmission
KW - disinfectants
KW - drug resistance
KW - intensive care units
KW - multiple
UR - http://www.scopus.com/inward/record.url?scp=85137117382&partnerID=8YFLogxK
U2 - 10.1093/cid/ciac070
DO - 10.1093/cid/ciac070
M3 - Article
C2 - 35100614
AN - SCOPUS:85137117382
SN - 1058-4838
VL - 75
SP - 1217
EP - 1223
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 7
ER -