Environmental hygiene program halved nosocomial C. difficile infections
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An environmental hygiene program meant to improve cleaning thoroughness led to a sustained 50% decrease in health care-onset Clostridioides difficile infection in eight hospitals, a study found.
“[This study was prompted by] the limited impact of traditional approaches to mitigating C. difficile transmission in acute-care hospitals,” Philip C. Carling, MD, clinical professor of medicine at the Boston University School of Medicine, told Healio.
Carling and colleagues conducted the study at eight acute-care hospitals in six states with stable endemic health care-onset C. difficile infection (HO-CDI) standardized infection ratios (SIRs).
The authors explained the four-component intervention implemented by each hospital after their cleaning thoroughness was covertly evaluated for 1 to 2 months.
Environmental services technicians and managers “participated in a structured and standardized educational program consisting of both classroom and hands-on training,” they explained. “Prior to and during the training they continued to perform traditional disinfection cleaning: general patient zone daily and discharge cleaning of surfaces with a quarternary ammonium disinfectant substituting dilute bleach for cleaning rooms use to isolate patients with CDI.
“Each site independently implemented the intervention protocol at various time points during 2017 and was evaluated over 18 months. During the intervention, daily hospital-wide, patient-zone, surface-disinfection cleaning was implemented using a one-step sporicidal disinfectant cleaner [with] a 5-minute contact time for efficacy against C. difficile spores and a 3-minute contact time for most other bacteria and viruses. Concomitantly, a structured performance monitoring and feedback program using the fluorescent marker system, compliant with CDC guidance level II recommendations, was used to optimize cleaning practice.”
After the wash-in period, the the thoroughness of disinfection cleaning improved steadily for all sites, and by 18 months was 93.6% for the entire group. The mean HO-CDI SIRs decreased from 1.03 to 0.6 (95% CI, 0.13-0.75). In the adjusted difference-in-differences analysis, the study demonstrated that there was a 0.55 reduction (95% CI, 0.77 to 0.32) in HO-CDI, or a 50% relative decrease from baseline in comparison with controls.
“The study results show that optimized daily, hospitalwide, sporicidal disinfectant cleaning of patient-zone surfaces can have a significant impact on HO-CDI rates in a diverse group of hospitals,” Carling said.
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