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A Randomized Controlled Trial of Enhanced Cleaning to Reduce Contamination of Healthcare Worker Gowns and Gloves with Multidrug-Resistant Bacteria

Published online by Cambridge University Press:  02 January 2015

Aaron S. Hess ,
Michelle Shardell ,
J. Kristie Johnson ,
Kerri A. Thom ,
Mary-Claire Roghmann ,
Giora Netzer ,
Sania Amr ,
Daniel J. Morgan  and
Anthony D. Harris
Aaron S. Hess*
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Michelle Shardell
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
J. Kristie Johnson
Affiliation:
Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
Kerri A. Thom
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Mary-Claire Roghmann
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Giora Netzer
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Sania Amr
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Daniel J. Morgan
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
*
Department of Epidemiology and Public Health, University of Maryland School of Medicine, MSTF 362, 685 West Baltimore Street, Baltimore, MD 21201 (aaron.hess@som.umaryland.edu)
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Abstract

Objective.

To determine whether enhanced daily cleaning would reduce contamination of healthcare worker (HCW) gowns and gloves with methicillin-resistant Staphylococcus aureus (MRSA) or multidrug-resistant Acinetobacter baumannii (MDRAB).

Design.

A cluster-randomized controlled trial.

Setting.

Four intensive care units (ICUs) in an urban tertiary care hospital.

PARTICIPANTS.

ICU rooms occupied by patients colonized with MRSA or MDRAB.

INTERVENTION.

Extra enhanced daily cleaning of ICU room surfaces frequently touched by HCWs.

Results.

A total of 4,444 cultures were collected from 132 rooms over 10 months. Using fluorescent dot markers at 2,199 surfaces, we found that 26% of surfaces in control rooms were cleaned and that 100% of surfaces in experimental rooms were cleaned (P < .001). The mean proportion of contaminated HCW gowns and gloves following routine care provision and before leaving the rooms of patients with MDRAB was 16% among control rooms and 12% among experimental rooms (relative risk, 0.77 [95% confidence interval, 0.28-2.11]; P = .23). For MRSA, the mean proportions were 22% and 19%, respectively (relative risk, 0.89 [95% confidence interval, 0.50-1.53]; P = .16).

Discussion.

Intense enhanced daily cleaning of ICU rooms occupied by patients colonized with MRSA or MDRAB was associated with a nonsignificant reduction in contamination of HCW gowns and gloves after routine patient care activities. Further research is needed to determine whether intense environmental cleaning will lead to significant reductions and fewer infections.

Trial Registration.

ClinicalTrials.gov identifier: NCT01481935.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 5: Special Topic Issue: The Role of the Environment in Infection Prevention , May 2013 , pp. 487 - 493
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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