Researchers Push for Hospital Cleaning, Infection Control Best Practices

A study by University of Pennsylvania researchers identifying several favorable ways “high-touch surfaces” in hospitals can be cleaned also claimed there was insufficient evidence pointing to which method was the best to help decrease healthcare-associated infections (HAIs).

Though several studies have looked into hospital patient outcomes and technological advances, studies analyzing and comparing different cleaning methods is lacking despite 75,000 HAI-related mortalities in the US each year, according to a statement released by the University of Pennsylvania.

Their study published in the Annals of Internal Medicine included 76 primary studies and four systematic reviews to find research which touched on comparative cleaning strategies. The investigators also included reports on surface contamination, colonization, or infection with Clostridium difficile (C. difficile), methicillin-resistant Staphylococcus aureus, or vancomycin-resistant enterococci.

In addition to interviewing national experts, their assessment included evidence, which was separated into the following three themes:

● Products and techniques implemented in cleaning hard surfaces

● If and how to cleaning was supervised

● What factors are necessary for effective cleaning and monitoring techniques

The investigators highlighted several studies that determined hospital-acquired gastrointestinal infections were mainly caused by C. difficile and its risk was decreased by bleach-based disinfectants and unaffected by dioxide-based products. Furthermore, patients who were prescribed antibiotics were susceptible to C. diff gastrointestinal infection.

The writers also found six studies that indicated wipes covered in hydrogen peroxide and other chemicals led to a reduction of HAIs, while seven of eight articles fond specializes coatings on surfaces also has favorable results; with some actually killing problematic bacteria.

However, the team pinpointed a mere five studies that were randomized, controlled trials. However, most of these trials were investigating surface contamination. There was also a sparse research, which compared the success rate disinfecting methods and monitoring methods.

“In addition to expanding the use of comparative effectiveness research and placing greater emphasis on patient-centered outcomes, future research should investigate the effectiveness of a number of promising new technologies and approaches,” the study author, Jennifer Han, MD, MSCE, an assistant professor of Medicine and Epidemiology, said. “These include self-disinfecting coatings and increasingly used surface markers for monitoring the presence of pathogens. Other challenges include identifying high-touch surfaces that confer the greatest risk of pathogen transmission and developing standard thresholds for defining cleanliness.”

The team also pressed for more information on which types of surfaces are hotbeds for pathogens; the creation of cleanliness guidelines; and adjusting for factors when investigating the effects of disinfecting methods.

“Our goal was to provide a comprehensive review of evidence in all three domains,” the study’s senior author, Craig A. Umscheid, MD, MSCE, an assistant professor of Medicine and Epidemiology in the Perelman School of Medicine, said in a statement.

“While there is a clear need for more patient-centered and comparative effectiveness research, the findings that do exist provide a good place to start in terms of a hospital or health care entity seeking information on ways to mitigate healthcare-associated infections.”