Significant impact of terminal room cleaning with bleach on reducing nosocomial Clostridium difficile
Significant impact of terminal room cleaning with bleach on reducing nosocomial Clostridium difficile
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DOI：
10.1016/j.ajic.2009.11.003
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发表时间：
2010-06-01
影响因子：
4.9
通讯作者：
Peterson, Lance R.
中科院分区：
文献类型：
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作者：
Hacek, Donna M.;Ogle, Anna Marie;Peterson, Lance R.
背景资料：MedMined Data Mining Surveillance Service，CareFusion（San Diego，CA）提醒我们，我们医疗保健系统中所有3家医院的艰难梭菌阳性检测率均有所增加。作为回应，终端室清洁稀释漂白剂的干预措施，制定了减少艰难梭菌感染（CDI）患者的艰难梭菌环境孢子污染的量：干预措施包括更换季铵化合物作为房间清洁剂稀释漂白剂消毒CDI患者出院后的房间。所有表面，从地板到天花板，均用稀释漂白剂擦拭，并用毛巾彻底润湿表面。每日房间清洁保持不变。患者继续接受艰难梭菌接触隔离预防措施，直至出院。为了确定该计划的有效性，使用MedMined虚拟监测界面确定了所有3家医院在清洁干预前10个月和清洁干预后2年的院内CDI率。统计学显著性采用Poisson回归分析确定。结果：漂白干预后艰难梭菌的患病密度降低了48%（95%置信区间：36%-58%，P < .0001）。在CDI患者的房间中实施彻底的、所有表面的终端漂白剂清洁计划，对降低我们医疗保健系统的院内CDI率产生重大影响。关键词：艰难梭菌;漂白剂;终端清洗。
Background: We were alerted to increased rates of Clostridium difficile-positive tests at all 3 hospitals in our health care system by MedMined Data Mining Surveillance Service, CareFusion (San Diego, CA). In response, an intervention of terminal room cleaning with dilute bleach was instituted to decrease the amount of C difficile environmental spore contamination from patients with C difficile infection (CDI).Methods: The intervention consisted of replacing quaternary ammonium compound as a room cleaning agent with dilute bleach to disinfect rooms of patients with CDI upon discharge. All surfaces, floor to ceiling were wiped with dilute bleach applied with towels to thoroughly wet the surfaces. Daily room cleaning remained unchanged. Patients remained on C difficile contact isolation precautions until discharge. To determine the effectiveness of this program, rates of nosocomial CDI for all 3 hospitals were determined using the MedMined Virtual Surveillance Interface for 10 months prior to and 2 years after the cleaning intervention. Statistical significance was determined using Poisson regression analysis.Results: There was a 48% reduction in the prevalence density of C difficile after the bleaching intervention (95% confidence interval: 36%-58%, P < .0001).Conclusion: The implementation of a thorough, all-surface terminal bleach cleaning program in the rooms of patients with CDI has made a sustained, significant impact on reducing the rate of nosocomial CDI in our health care system. Key Words: Clostridium difficile, bleach; terminal cleaning.