An environmental disinfection intervention to control Clostridium difficile

受污染的表面是艰难梭菌传播的重要潜在来源。 然而，改善环境清洁的干预措施并不总是有效的 降低C.艰难梭菌感染（CDI）。此外，还有相当多的 关于监测环境影响的有效性的最佳战略的不确定性 消毒该应用程序的目标是制定基于证据的策略，以改善 环境消毒，并测试其在降低医疗保健率方面的有效性- 相关CDI我们的中心假设是，以证据为基础的干预，以改善 环境消毒将降低与卫生保健相关的CDI率。的具体目标 我们的建议是：1）。验证荧光标记方法作为一种手段的有效性， 监测CDI房间内高接触表面的消毒。为达致这个目标，我们会 将CDI室中高接触表面的荧光标记物去除与 孢子的培养和毒素B基因的PCR。2）。确定每日消毒是否高- 在CDI治疗过程中接触表面将减少医护人员的手部污染。到 为了实现这一目标，我们将进行一项前瞻性随机试验， 清洁（即，高接触表面仅在污染时清洁）与标准清洁相比 加上每天对高接触表面的去污。主要结局指标将是 医护人员手部污染。和3）。确定干预措施是否能改善 家政人员进行环境消毒将降低与卫生保健相关的CDI发生率。 为了实现这一目标，我们将进行一项为期12个月的随机试验， 医院将标准客房清洁与持续的强化清洁进行比较 监测和反馈。主要结局指标将是医疗保健的发生率- 相关CDI我们的实验室完全有能力完成这项研究，因为 我们有丰富的经验调查环境在病原体中的作用 传播和评价消毒方法。结果将是显著的，因为 CDI是发病率和死亡率的重要原因， 制定最佳的环境消毒策略，以防止传播。的 卫生与公众服务部预防医疗保健相关疾病行动计划 艰难梭菌感染的发展和影响评估 环境清洁束作为一个重要的未满足的需求。

Contaminated surfaces are an important potential source for transmission of Clostridium difficile. However, interventions to improve environmental cleaning have not consistently been effective in reducing the incidence of C. difficile infection (CDI). Moreover, there is considerable uncertainty regarding optimal strategies to monitor the effectiveness of environmental disinfection. The goal of this application is to develop evidence-based strategies to improve environmental disinfection and to test their effectiveness in reducing rates of healthcare- associated CDI. Our central hypothesis is that an evidence-based intervention to improve environmental disinfection will reduce rates of healthcare-associated CDI. The specific aims of our proposal are: 1). Validate the effectiveness of the fluorescent marker method as a means to monitor disinfection of high-touch surfaces in CDI rooms. To accomplish this aim, we will correlate removal of fluorescent marker from high-touch surfaces in CDI rooms with removal of spores based on culture and PCR of toxin B genes. 2). Determine if daily disinfection of high- touch surfaces during CDI treatment will reduce healthcare worker hand contamination. To accomplish this aim, we will perform a prospective, randomized trial to compare standard cleaning (i.e., high-touch surfaces only cleaned if soiled) of CDI rooms versus standard cleaning plus daily decontamination of high-touch surfaces. The primary outcome measure will be healthcare worker hand contamination. and 3). Determine if an intervention to improve environmental disinfection by housekeeping staff will reduce rates of healthcare-associated CDI. To accomplish this aim, we will perform a 12-month randomized trial of 16 Cleveland area hospitals to compare standard housekeeping cleaning to enhanced cleaning with ongoing monitoring and feedback. The primary outcome measure will be incidence of healthcare- associated CDI. Our laboratory is ideally poised to accomplish the proposed research because we have extensive experience investigating the role of the environment in pathogen transmission and in evaluation of disinfection methods. The results will be significant because CDI is an important cause of morbidity and mortality and because there is a need for development of optimal environmental disinfection strategies to prevent transmission. The Department of Health and Human Services Action Plan to Prevent Healthcare-Associated Infections identified development and assessment of the impact of a Clostridium difficile environmental cleaning bundle as an important unmet need.