Wiping infections away

World-first CLEEN study shows how even one disinfectant wipe can save lives

Cleaning shared medical equipment at least once a day—even with a disinfectant wipe—can save lives by reducing infections in hospitals, new world-first research shows.

The finding is based on results from the CLEEN study, a randomised control trial led by Professor Brett Mitchell from Avondale University in a hospital on the Central Coast.

Brett and research colleagues introduced an intervention that consisted of additional cleaning, education on techniques and an audit of and feedback on cleanliness. Dedicated cleaners rather than healthcare workers usually responsible for cleaning completed three extra hours of cleaning each day on shared equipment such as commodes, drip stands and walking aids.

To measure cleanliness, the researchers placed fluorescent marker gel dots on the surface of the equipment. When the dots dried, they became visible only under special light and resisted dry abrasion, which meant they could be removed only by a thorough clean. “We identified relatively low levels of cleaning thoroughness during the control phase,” write the researchers, which suggests “routine cleaning is either not performed or is ineffectively performed.” Before the intervention, the hospital removed about 25 per cent of the dots. After the intervention: 65 per cent of the dots. The result? A 35 per cent reduction in all healthcare-associated infections.

The finding is important because 165,000 infections—the most comprehensive estimate in decades according to previous research by Brett and other colleagues—occur in Australian hospitals each year. With infections not only costing money but taking lives, the burden is significant. In the CLEEN study, “we had about 100 more infections before the intervention,” says Brett. “A proportion of these would have had major complications resulting from their infection, including death.”

Despite the associated increase in morbidity, mortality and antimicrobial resistance—not to mention length of stay—strategies to prevent healthcare-acquired infections are informed by low-quality evidence. Brett is aware of only half a dozen high-quality randomised control trials around cleaning and healthcare-acquired infections, “and we’ve published two.” He says there are so few because control of factors that could contaminate results is difficult and number of participants needed to build confidence is large. Overcoming the challenges requires significant funding—Brett is using a $1.5 million grant he received from the National Health and Medical Research Council acknowledging his emerging leadership as an investigator. It is a worthy investment, says trial coordinator Dr Kate Browne. “Robust, evidence-based trials are the foundation of modern medicine. The data generated helps inform clinical policies and guidelines that ultimately improve the quality of patient care.”

Brett says the findings support more—not less—cleaning in hospitals. “Cleaning is a cost-saving activity, but if cuts are made it means, potentially, more harm to patients as they are more likely to acquire an infection.” A fellow chief investigator, Professor Philip Russo, Director of Research at Monash Nursing and Midwifery, says the study demonstrates the critical role of dedicated cleaners. “Infection prevention relies on multiple interventions, not just one. We now have strong evidence that cleaning can save lives.”

Brett and Kate are first and senior authors of a paper appearing in The Lancet Infectious Diseases on August 14. They worked with colleagues such as Philip from Avondale and Monash Universities, Queensland University of Technology and clinicians from the Central Coast Local Health District and Alfred, Cabrini and Monash Health.