Hostname: page-component-745bb68f8f-mzp66 Total loading time: 0 Render date: 2025-01-08T11:30:50.422Z Has data issue: false hasContentIssue false
  • English
  • Français

A Multicenter Randomized Trial to Determine the Effect of an Environmental Disinfection Intervention on the Incidence of Healthcare-Associated Clostridium difficile Infection

Part of: BARRY FARR AWARD RECIPIENTS

Published online by Cambridge University Press:  02 May 2017

Amy J. Ray ,
Abhishek Deshpande ,
Dennis Fertelli ,
Brett M. Sitzlar ,
Priyaleela Thota ,
Thriveen Sankar C ,
Annette L. Jencson ,
Jennifer L. Cadnum ,
Robert A. Salata  and
Richard R. Watkins
...Show all authors
Amy J. Ray
Affiliation:
Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio Case Western Reserve University School of Medicine, Cleveland, Ohio
Abhishek Deshpande
Affiliation:
Cleveland Clinic Foundation, Cleveland, Ohio
Dennis Fertelli
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Brett M. Sitzlar
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Priyaleela Thota
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Thriveen Sankar C
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Annette L. Jencson
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Jennifer L. Cadnum
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Robert A. Salata
Affiliation:
Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio Case Western Reserve University School of Medicine, Cleveland, Ohio
Richard R. Watkins
Affiliation:
Department of Medicine, Akron General Medical Center, Akron, Ohio
Ajay K. Sethi
Affiliation:
Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin
Philip C. Carling
Affiliation:
Carney Hospital and Boston University School of Medicine, Boston, Massachusetts
Brigid M. Wilson
Affiliation:
Geriatric Research, Education and Clinical Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Curtis J. Donskey*
Affiliation:
Case Western Reserve University School of Medicine, Cleveland, Ohio Geriatric Research, Education and Clinical Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
*
Address correspondence to Curtis J. Donskey, MD, Geriatric Research, Education, and Clinical Center 1110W, Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, Ohio 44106 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To determine the impact of an environmental disinfection intervention on the incidence of healthcare-associated Clostridium difficile infection (CDI).

DESIGN

A multicenter randomized trial.

SETTING

In total,16 acute-care hospitals in northeastern Ohio participated in the study.

INTERVENTION

We conducted a 12-month randomized trial to compare standard cleaning to enhanced cleaning that included monitoring of environmental services (EVS) personnel performance with feedback to EVS and infection control staff. We assessed the thoroughness of cleaning based on fluorescent marker removal from high-touch surfaces and the effectiveness of disinfection based on environmental cultures for C. difficile. A linear mixed model was used to compare CDI rates in the intervention and postintervention periods for control and intervention hospitals. The primary outcome was the incidence of healthcare-associated CDI.

RESULTS

Overall, 7 intervention hospitals and 8 control hospitals completed the study. The intervention resulted in significantly increased fluorescent marker removal in CDI and non-CDI rooms and decreased recovery of C. difficile from high-touch surfaces in CDI rooms. However, no reduction was observed in the incidence of healthcare-associated CDI in the intervention hospitals during the intervention and postintervention periods. Moreover, there was no correlation between the percentage of positive cultures after cleaning of CDI or non-CDI rooms and the incidence of healthcare-associated CDI.

CONCLUSIONS

An environmental disinfection intervention improved the thoroughness and effectiveness of cleaning but did not reduce the incidence of healthcare-associated CDI. Thus, interventions that focus only on improving cleaning may not be sufficient to control healthcare-associated CDI.

Infect Control Hosp Epidemiol 2017;38:777–783

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 7 , July 2017 , pp. 777 - 783
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Donskey, CJ. Does improving surface cleaning and disinfection reduce health care-associated infections? Am J Infect Control 2013;41:S12–S19.Google Scholar
2. Rutala, WA, Weber, DJ. The role of the environment in transmission of Clostridium difficile infection in healthcare facilities. Infect Control Hosp Epidemiol 2011;32:207–209.Google Scholar
3. Dubberke, ER, Carling, P, Carrico, R, et al. Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 Update. Infect Control Hosp Epidemiol 2014;35:628–645.Google Scholar
4. Sitzlar, B, Deshpande, A, Fertelli, D, Kundrapu, S, Sethi, AK, Donskey, CJ. An environmental disinfection odyssey: evaluation of sequential interventions to improve disinfection of Clostridium difficile isolation rooms. Infect Control Hosp Epidemiol 2013;34:459–465.Google Scholar
5. Carling, PC, Briggs, JL, Perkins, J, Highlander, D. Improved cleaning of patient rooms using a new targeting method. Clin Infect Dis 2006;42:385–388.Google Scholar
6. Hayden, MK, Bonten, MJ, Blom, DW, Lyle, EA, van de Vijver, DA, Weinstein, RA. Reduction in acquisition of vancomycin-resistant Enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis 2006;42:1552–1560.CrossRefGoogle ScholarPubMed
7. Eckstein, BC, Adams, DA, Eckstein, EC, Aron, DC, Yadavalli, G, Donskey, CJ. Reduction of Clostridium Difficile and vancomycin-resistant Enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods. BMC Infect Dis 2007;7:61.Google Scholar
8. Boyce, JM, Havill, NL, Otter, JA, et al. Impact of hydrogen peroxide vapor room decontamination on Clostridium difficile environmental contamination and transmission in a healthcare setting. Infect Control Hosp Epidemiol 2008;29:723–729.Google Scholar
9. Nerandzic, MM, Cadnum, JL, Pultz, MJ, Donskey, CJ. Evaluation of an automated ultraviolet radiation device for decontamination of Clostridium difficile and other healthcare-associated pathogens in hospital rooms. BMC Infect Dis 2010;10:197.Google Scholar
10. Cooper, T, O’Leary, M, Yezli, S, Otter, JA. Impact of environmental decontamination using hydrogen peroxide vapour on the incidence of Clostridium difficile infection in one hospital Trust. J Hosp Infect 2011;78:238–240.Google Scholar
11. Nagaraja, A, Visintainer, P, Haas, JP, Menz, J, Wormser, GP, Montecalvo, MA. Clostridium difficile infections before and during use of ultraviolet disinfection. Am J Infect Control 2015;43:940–945.CrossRefGoogle ScholarPubMed
12. Miller, R, Simmons, S, Dale, C, Stachowiak, J, Stibich, M. Utilization and impact of a pulsed-xenon ultraviolet room disinfection system and multidisciplinary care team on Clostridium difficile in a long-term acute care facility. Am J Infect Control 2015;43:1350–1353.Google Scholar
13. Levin, J, Riley, LS, Parrish, C, English, D, Ahn, S. The effect of portable pulsed xenon ultraviolet light after terminal cleaning on hospital-associated Clostridium difficile infection in a community hospital. Am J Infect Control 2013;41:746–748.CrossRefGoogle Scholar
14. Valiquette, L, Cossette, B, Garant, MP, Diab, H, Pepin, J. Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile-associated disease caused by the hypervirulent NAP1/027 strain. Clin Infect Dis 2007;45(Suppl 2):S112–S121.Google Scholar
15. McDonald, LC, Coignard, B, Dubberke, E, Song, X, Horan, T, Kutty, PK. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol 2007;28:140–145.Google Scholar
16. Kundrapu, S, Sunkesula, V, Jury, LA, Sitzlar, BM, Donskey, CJ. Daily disinfection of high-touch surfaces in isolation rooms to reduce contamination of healthcare workers’ hands. Infect Control Hosp Epidemiol 2012;33:1039–1042.Google Scholar
17. Bates, D, Maechler, M, Bolker, B, Walker, S. Fitting linear mixed-effects models using lme4. J Stat Softw 2015;67:1–48.CrossRefGoogle Scholar
18. Otter, JA, Havill, NL, Adams, NM, Cooper, T, Tauman, A, Boyce, JM. Environmental sampling for Clostridium difficile: swabs or sponges. Am J Infect Control 2009;37:517–518.CrossRefGoogle ScholarPubMed
19. Koganti, S, Alhmidi, H, Tomas, ME, Cadnum, JL, Jencson, A, Donskey, CJ. Evaluation of hospital floors as a potential source of pathogen dissemination using a nonpathogenic virus as a surrogate marker. Infect Control Hosp Epidemiol 2016;37:1374–1377.Google Scholar
20. Donskey, CJ, Kundrapu, S, Deshpande, A. Colonization versus carriage of Clostridium difficile . Infect Dis Clin North Am 2015;29:13–28.Google Scholar
21. Curry, SR, Muto, CA, Schlackman, JL, et al. Use of multilocus variable number of tandem repeats analysis genotyping to determine the role of asymptomatic carriers in Clostridium difficile transmission. Clin Infect Dis 2013;57:1094–1102.CrossRefGoogle ScholarPubMed
22. Longtin, Y, Paquet-Bolduc, B, Gilca, R, et al. Effect of detecting and isolating Clostridium difficile carriers at hospital admission on the incidence of C. difficile infections: a quasi-experimental controlled study. JAMA Intern Med 2016;176:796–804.Google Scholar
23. Dingle, KE, Didelot, X, Phuong Quan, T, et al. Effects of control interventions on Clostridium difficile infection in England: an observational study. Lancet Infect Dis 2017;pii:S1473–S3099; (16)30514-X.Google Scholar
24. Donskey, CJ. Fluoroquinolone restriction to control fluoroquinolone-resistant Clostridium difficile . Lancet Infect Dis 2017;pii:S1473–S3099; (17)30052-X.Google Scholar
25. Eyre, DW, Cule, ML, Wilson, DJ, et al. Diverse sources of C. difficile infection identified on whole-genome sequencing. N Engl J Med 2013;369:1195–1205.CrossRefGoogle ScholarPubMed
26. Tschudin-Sutter, S, Carroll, KC, Tamma, PD, et al. Impact of toxigenic Clostridium difficile colonization on the risk of subsequent C. difficile infection in ICU patients. Infect Control Hosp Epidemiol 2015;36:1324–1329.Google Scholar
27. Kamboj, M, Sheahan, A, Sun, J, et al. Transmission of Clostridium difficile During Hospitalization for Allogeneic Stem Cell Transplant. Infect Control Hosp Epidemiol 2016;37:8–15.Google Scholar
28. Anderson, D, Chen, LF, Weber, DJ, et al. Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study. Lancet 2017;389:805–814.Google Scholar
29. Mitchell, BG, Dancer, SJ, Anderson, M, Dehn, E. Risk of organism acquisition from prior room occupants: a systematic review and meta-analysis. J Hosp Infect 2015;91:211–217.Google Scholar
30. Datta, R, Platt, R, Yokoe, DS, Huang, SS. Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants. Arch Intern Med 2011;171:491–494.Google Scholar
31. Wilson, AP, Smyth, D, Moore, G, et al. The impact of enhanced cleaning within the intensive care unit on contamination of the near-patient environment with hospital pathogens: a randomized crossover study in critical care units in two hospitals. Crit Care Med 2011;39:651–658.Google Scholar