Hostname: page-component-848d4c4894-sjtt6 Total loading time: 0 Render date: 2024-06-13T15:47:33.925Z Has data issue: false hasContentIssue false
  • English
  • Français

The Iowa Disinfection Cleaning Project: Opportunities, Successes, and Challenges of a Structured Intervention Program in 56 Hospitals

Published online by Cambridge University Press:  31 July 2017

Philip Carling  and
Loreen A. Herwaldt
Philip Carling*
Affiliation:
Infectious Diseases Section, Caritas Carney Hospital, Dorchester, Massachusetts Boston University School of Medicine, Boston, Massachusetts
Loreen A. Herwaldt
Affiliation:
Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa Program in Hospital Epidemiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa College of Public Health, The University of Iowa, Iowa City, Iowa
*
Address correspondence to Philip C. Carling, MD, Infectious Diseases Section, Carney Hospital, 2100 Dorchester Avenue, Boston, MA 02124 (pcarling@comcast.net).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

A diverse group of hospitals in Iowa implemented a program to objectively evaluate and improve the thoroughness of disinfection cleaning of near-patient surfaces. Administrative benefits of, challenges of, and impediments to the program were also evaluated.

METHODS

We conducted a prospective, quasi-experimental pre-/postintervention trial to improve the thoroughness of terminal room disinfection cleaning. Infection preventionists utilized an objective cleaning performance monitoring system (DAZO) to evaluate the thoroughness of disinfection cleaning (TDC) expressed as a proportion of objects confirmed to have been cleaned (numerator) to objects to be cleaned per hospital policy (denominator)×100. Data analysis, educational interventions, and objective performance feedback were modeled on previously published studies using the same monitoring tool. Programmatic analysis utilized unstructured and structured information from participants irrespective of whether they participated in the process improvement aspects to the program.

RESULTS

Initially, the overall TDC was 61% in 56 hospitals. Hospitals completing 1 or 2 feedback cycles improved their TDC percentages significantly (P<.0001; P<.005). Overall, 22 hospitals (39.3%) completed all 3 study phases and significantly increased their TDC percentages to a mean of 89%. Moreover, 6 hospitals maintained the program beyond the planned study period and sustained TDC percentages >90% for at least 38 months. A survey of infection preventionists found that lack of time and staff turnover were the most common reasons for terminating the study early.

CONCLUSION

The study confirmed that hospitals using this program can improve their TDC percentages significantly. Hospitals must invest resources to improve cleaning and to sustain their gains.

Infect Control Hosp Epidemiol 2017;38:960–965

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 8 , August 2017 , pp. 960 - 965
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. Weber, D, Rutala, W, Miller, M, Huslage, K, Sickbert-Bennett, E. Role of hospital surfaces in the transmission of emerging health care-associated pathogens: Norovirus, Clostridium difficile, and Acinetobacter species. Am J Infect Control 2010;38:S25–S33.Google Scholar
2. Otter, JA, Yezli, S, French, GL. The role played by contaminated surfaces in the transmission of nosocomial pathogens. Infect Control Hosp Epidemiol 2011;32:687–699.Google Scholar
3. Centers for Disease Control and Prevention/Healthcare Infection Control Advisory Committee (HICPAC). Guidelines for environmental infection control in healthcare facilities. Centers for Disease Control and Prevention website. http://www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf. Published 2003. Accessed December 10, 2015.Google Scholar
4. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L. Healthcare infection control practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings. Centers for Disease Prevention and Control website. www.cdc.gov/infectioncontrol/guidelines/mdro/index.html. Published 2006. Accessed December 10, 2015.Google Scholar
5. Dancer, SJ. How do we assess hospital cleaning? A proposal for microbiological standards for surface hygiene in hospitals. J Hosp Infect 2004;56:10–15.Google Scholar
6. Carling, PC, Bartley, JM. Evaluating hygienic cleaning in healthcare settings: what you do not know can harm your patients. Am J Infect Control 2010;38:S41–S50.CrossRefGoogle Scholar
7. Carling, PC, Briggs, J, Hylander, D, Perkins, J. Evaluation of patient area cleaning in 3 hospitals using a novel targeting methodology. Am J Infect Control 2006;34:513–519.Google Scholar
8. Carling, PC, Parry, MF, Von Beheren, SM. Identifying opportunities to enhance environmental cleaning in 23 acute care hospitals. Infect Control Hosp Epidemiol 2008;29:1–7.Google Scholar
9. Carling, PC, Eck, EK. Achieving sustained improvement in environmental hygiene using coordinated benchmarking in 12 hospitals. Abstracts of the SHEA 5th Decennial Meeting; Atlanta, GA; March 18–22, 2010.Google Scholar
10. Carling, P, Briggs, J, Perkins, J, Hylander, D. Improving cleaning of patient rooms using a new targeting method. Clin Infect Dis 2006;42:385–388.CrossRefGoogle ScholarPubMed
11. Carling, PC, Parry, MM, Rupp, ME, Po, JL, Dick, B, Von Beheren, S. Improving cleaning of the environment surrounding patients in 36 acute care hospitals. Infect Control Hosp Epidemiol 2008;29:1035–1041.Google Scholar
12. Ostrowski, VE, Trick, WE, Sohn, AH, et al. Control of vancomycin-resistant enterococcus in health care facilities in a region. N Engl J Med 2001;344:1427–1433.Google Scholar
13. Lee, BY, Bartsch, SM, Wong, KF, et al. Simulation shows hospitals that cooperate on infection control obtain better results than hospitals acting alone. Health Affairs 2012;31:2295–2301.Google Scholar
14. Ward, MM, Clabaugh, G, Evans, TC, Herwaldt, L. A successful, voluntary, multicomponent statewide effort to reduce health care-associated infections. Am J Med Qual 2012;27:66–73.CrossRefGoogle ScholarPubMed
15. Herwaldt, LA, Applegate, D, Kuntz, J, Chen, Y, Pottinger, JM. Infection control resources in Iowa. AM J Infect Control 2007;35(10):662–665.Google Scholar
16. McDanel, JS, Ward, MA, Leder, L, et al. Methicillin-resistant staphylococcus aureus prevention practices in hospitals throughout a rural state. Am J Infect Control 2014;42:868–873.Google Scholar
17. Carling, PC, Po, JL, Bartley, J, Herwaldt, L. Healthcare Environmental Hygiene Group. Identifying opportunities to improve environmental hygiene in multiple healthcare settings. Abstract 908. 5th Decennial International Conference on Healthcare-Associated Infections. Atlanta, GA; March 2010.Google Scholar
18. Carling, PC, Eck, EK. Achieving sustained improvement in environmental hygiene using coordinated benchmarking in 12 hospitals. Abstracts of the SHEA 5th Decennial Meeting; Atlanta, GA; March 18–22, 2010.Google Scholar
19. Rupp, ME, Fitzgerald, T, Sholtz, L, Lyden, E, Carling, P. Maintain the gain: program to sustain performance improvement in environmental cleaning. Infect Control Hosp Epidem 2014;35:866–868.CrossRefGoogle ScholarPubMed
20. Holmer, L, Russel, D, Steger, P, Speer, R, Lakhanpal, A, Chen, S. Sustainability of an environmental cleaning program in small and critical access hospitals. Am J Infect Control 2014;42:S101–S102.Google Scholar
21. Conway, L, Riley, L, Saiman, L, Cohen, B, Alper, P, Larson, E. Implementation and impact of an automated group monitoring and feedback system to promote hand hygiene among health care personnel. Jt Comm J Qual Patient Saf 2014;40:408–417.Google Scholar
22. Conway, LJ, Raveis, VH, Pogorzelska-Maziarz, M, Uchida, M, Stone, PW, Larson, EL. Tensions inherent in the evolving role of the infection preventionist. Am J Infect Control 2013;41:959–964.Google Scholar
23. Guh, A, Carling, P. for the Environmental Evaluation Workgroup. Options for evaluating environmental cleaning. Centers for Disease Prevention and Control website. https://cdc.gov/HAI/toolkits/Evaluating-Environmental-Cleaning.html. Published 2010. Accessed December 10, 2015.Google Scholar
24. National action plan to prevent health care-associated infections: roadmap to elimination. 2012. Office of Disease Prevention and Health Promotion website. https://health.gov/hcq/prevent-hai-action-plan.asp. Published 2012. Accessed August 20, 2016.Google Scholar
25. Technical Brief 22. Environmental Cleaning for the Prevention of Healthcare-Associated Infections (HAI). Agency for Healthcare Research and Quality website. http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=2103. Published 2015. Accessed December 10, 2015.Google Scholar
26. Pronovost, PJ, Cardo, DM, Goechel, CA, Berenholtz, SM, Saint, S, Jernigan, JA. A research framework for reducing preventable patient harm. Clin Infect Dis 2011;52:507–513.CrossRefGoogle ScholarPubMed
Supplementary material: File

Carling and Herwaldt supplementary material

Carling and Herwaldt supplementary material

Download Carling and Herwaldt supplementary material(File)
File 78.8 KB