Effectiveness of targeted enhanced terminal room disinfection on hospital-wide acquisition and infection with multidrug-resistant organisms and Clostridium difficile: a secondary analysis of a multicentre cluster randomised controlled trial with crossover design (BETR Disinfection)

Details

• Journal Article:
  Lancet Infect Dis
• Personal Author:
  Anderson, Deverick J ; Moehring, Rebekah W ; Weber, David J ; Lewis, Sarah S ; Chen, Luke F ; Schwab, J Conrad ; Becherer, Paul ; Blocker, Michael ; Triplett, Patricia F ; Knelson, Lauren P ; Lokhnygina, Yuliya ; Rutala, William A ; Sexton, Daniel J
  More +
• Corporate Authors:
  CDC Prevention Epicenters Program
• Description:
  Background ; The hospital environment is a source of pathogen transmission. The effect of enhanced disinfection strategies on the hospital-wide incidence of infection has not been investigated in a multicentre, randomised controlled trial. We aimed to assess the effectiveness of four disinfection strategies on hospital-wide incidence of multidrug-resistant organisms and Clostridium difficile in the Benefits of Enhanced Terminal Room (BETR) Disinfection study. ; Methods ; We did a prespecified secondary analysis of the results from the BETR Disinfection study, a pragmatic, multicentre, crossover cluster-randomised trial that assessed four different strategies for terminal room disinfection in nine hospitals in the southeastern USA. Rooms from which a patient with a specific infection or colonisation (due to the target organisms C difficile, meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci (VRE), or multidrug-resistant Acinetobacter spp) was discharged were terminally disinfected with one of four strategies: standard disinfection (quaternary ammonium disinfectant, except for C difficile, for which 10% hypochlorite bleach was used; reference); standard disinfection and disinfecting ultraviolet light (UV-C), except for C difficile, for which bleach and UV-C was used (UV strategy); 10% hypochlorite (bleach strategy); and bleach and UV-C (bleach and UV strategy). We randomly assigned the sequence of strategies for each hospital (1:1:1:1), and each strategy was used for 7 months, including a 1-month wash-in period and 6 months of data collection. The prespecified secondary outcomes were hospital-wide, hospital-acquired incidence of all target organisms (calculated as number of patients with hospital-acquired infection with a target organism per 10 000 patient days), and hospital-wide, hospital-acquired incidence of each target organism separately. BETR Disinfection is registered with ClinicalTrials.gov, number NCT01579370. ; Findings ; Between April, 2012, and July, 2014, there were 271 740 unique patients with 375 918 admissions. 314 610 admissions met all inclusion criteria (n=73 071 in the reference study period, n=81 621 in the UV study period, n=78 760 in the bleach study period, and n=81 158 in the bleach and UV study period). 2681 incidenct cases of hospital-acquired infection or colonisation occurred during the study. There was no significant difference in the hospital-wide risk of target organism acquisition between standard disinfection and the three enhanced terminal disinfection strategies for all target multidrug-resistant organisms (UV study period relative risk RR 0.89, 95% CI 0.79–1.00; p=0.052; bleach study period 0.92, 0.79–1.08; p=0.32; bleach and UV study period 0.99, 0.89–1.11; p=0.89). The decrease in risk in the UV study period was driven by decreases in risk of acquisition of C difficile (RR 0.89, 95% CI 0.80–0.99; p=0.031) and VRE (0.56, 0.31–0.996; p=0.048). ; Interpretation ; Enhanced terminal room disinfection with UV in a targeted subset of high-risk rooms led to a decrease in hospital-wide incidence of C difficile and VRE. Enhanced disinfection overcomes limitations of standard disinfection strategies and is a potential strategy to reduce the risk of acquisition of multidrug-resistant organisms and C difficile.
• Subjects:
  • Clostridioides difficile
  • Clostridium Infections
  • Cross Infection
  • Cross-Over Studies
  • Disinfectants
  • Disinfection
  • Drug Resistance, Multiple, Bacterial
  • Hospitals
  • Humans
  • Quaternary Ammonium Compounds
  More +
• Keywords:
  • Chlorination
  • Household water treatment
  • Safe water storage
• Source:
  Lancet Infect Dis. 18(8):845-853
• DOI:
  http://dx.doi.org/10.1016/S1473-3099(18)30278-0
• Pubmed ID:
  29880301
• Pubmed Central ID:
  PMC6487496
• Document Type:
  Text ; Journal Article
• Funding:
  K08 HS023866/HS/AHRQ HHSUnited States/ ; K23 AI095357/AI/NIAID NIH HHSUnited States/ ; U54 CK000164/CK/NCEZID CDC HHSUnited States/ ; U54 CK000483/CK/NCEZID CDC HHSUnited States/
• Genre:
  Journal Article
• Volume:
  18
• Issue:
  8
• Download URL:
  https://stacks.cdc.gov/view/cdc/78277/cdc_78277_DS1.pdf
• File Type:
  [PDF - 183.55 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:f0a9ef7236c86d2082146e88bae385b8244af84b9a38d082a8e92a75876580084b375a9d0a95e1cd73f775d5edefcee4cf40ef8122cbb5a326424dbcbe2c4bb7