An environmental disinfection intervention to prevent C. difficile transmission

描述(由申请人提供)： 受污染的表面是艰难梭菌传播的一个重要的潜在来源，一些改善环境清洁的干预措施与减少CDI有关。然而，很少有干预措施包括监测以确认根除孢子的效果，而且关于环境消毒的最佳战略也存在不确定性。这项建议的目标是开发基于证据的环境消毒策略，并测试其在降低与医疗保健相关的CDI发生率方面的有效性。我们的具体目标是：目标1。确定包括持续监测和反馈在内的干预措施是否会改善客房部员工的环境消毒。我们的工作假设是，包括客房部工作人员的积极参与和持续的监测和反馈(即加强清洁)在内的干预措施将导致根除孢子的持续改善。我们将在试验前和试验后进行荧光标记方法，以提供监测和反馈。主要的结果衡量标准将是CDI房间消毒的有效性。与医疗保健相关的CDI的发生率将是次要的结果指标。目标2.确定辅助使用移动式自动UV-C辐射设备是否会进一步加强环境消毒。我们的工作假设是，与加强清洁相比，辅助使用自动UV-C设备将进一步改善孢子的根除和减少CDI的发生率。为了实现这一目标，我们将使用交叉设计在克利夫兰退伍军人医学中心对12个病房进行为期2年的随机试验。主要的结果指标将是与医疗保健相关的CDI的发生率。目标3：确定加强清洁干预是否会降低多家退伍军人医院医疗保健相关CDI的发生率。我们的工作假设是，加强清洁干预，包括客房服务人员的积极参与，以及使用荧光标记方法进行持续监测和反馈，将降低与医疗保健相关的CDI的发生率。为了实现这一目标，我们将对多家退伍军人医院进行为期一年的随机试验，以比较标准清洁(即仅通过观察监测清洁)和强化清洁(即使用荧光标记方法进行监测和反馈)。主要的结果指标将是与医疗保健相关的CDI的发生率。。

DESCRIPTION (provided by applicant): Contaminated surfaces are an important potential source for transmission of Clostridium difficile, and some interventions to improve environmental cleaning have been associated with reductions in CDI. However, few interventions have included monitoring to confirm the efficacy of spore eradication and there is uncertainty regarding optimal strategies for environmental disinfection. The goal of this proposal is to develop evidence-based environmental disinfection strategies and test their effectiveness in reducing rates of healthcare-associated CDI. Our specific objectives are: Objective 1. Determine if an intervention that includes ongoing monitoring and feedback will improve environmental disinfection by housekeeping staff. Our working hypothesis is that an intervention including active participation by housekeeping staff and ongoing monitoring and feedback (i.e., enhanced cleaning) will result in sustained improvement in eradication of spores. We will perform a before and after trial of a fluorescent marker method to provide monitoring and feedback. The primary outcome measure will be effectiveness of CDI room disinfection. Incidence of healthcare-associated CDI will be a secondary outcome measure. Objective 2. Determine if adjunctive use of a mobile, automated UV-C radiation device will further enhance environmental disinfection. Our working hypothesis is that adjunctive use of an automated UV-C device will result in further improvement in eradication of spores and reduction of CDI incidence in comparison to enhanced cleaning. To accomplish this objective, we will perform a 2-year randomized trial of 12 wards at the Cleveland VA Medical Center using a cross-over design. The primary outcome measure will be incidence of healthcare-associated CDI. Objective 3. Determine if an enhanced cleaning intervention will reduce rates of healthcare-associated CDI in multiple VA hospitals. Our working hypothesis is that an enhanced cleaning intervention that includes active participation by housekeeping staff and ongoing monitoring and feedback using the fluorescent marker method will reduce rates of healthcare-associated CDI. To accomplish this objective, we will perform a 1-year randomized trial of multiple VA hospitals to compare standard cleaning (i.e., monitoring of cleaning through observation only) versus enhanced cleaning (i.e., including monitoring and feedback using the fluorescent marker method). The primary outcome measure will be incidence of healthcare-associated CDI. .