An environmental disinfection intervention to control Clostridium difficile

描述(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。然而，改善环境清洁的干预措施在减少艰难梭菌感染(CDI)方面并不总是有效的。此外，在监测环境消毒效果的最佳战略方面也存在相当大的不确定性。该应用程序的目标是开发基于证据的策略，以改善环境消毒，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。我们的中心假设是，改善环境消毒的循证干预将降低与医疗保健相关的CDI的发生率。我们申请的具体目的是：1)。验证荧光标记法作为CDI房间高接触表面消毒监测手段的有效性。为了实现这一目标，我们将基于培养和B型毒素基因的聚合酶链式反应，将从CDI房间高接触表面去除荧光标记与去除孢子联系起来。2)。确定在CDI治疗期间每天对高接触表面进行消毒是否会减少医护人员的手污染。为了实现这一目标，我们将进行一项前瞻性的随机试验，比较CDI房间的标准清洁(即，只有在被污染的情况下才清洁高接触表面)与标准清洁加上高接触表面的日常去污。主要的结果衡量标准将是医护人员的手污染。和3)。确定客房部员工改善环境消毒的干预措施是否会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16家克利夫兰地区的医院进行为期12个月的随机试验，以比较标准内务清洁以加强清洁与持续监测和反馈。主要的结果指标将是与医疗保健相关的CDI的发生率。我们的实验室非常适合完成拟议的研究，因为我们在调查环境在病原体传播和消毒方法评估中的作用方面拥有丰富的经验。结果将是重大的，因为CDI是发病率和死亡率的重要原因，而且需要制定最佳的环境消毒战略以防止传播。卫生与公众服务部预防保健相关感染行动计划将艰难梭菌环境清洁捆绑包的开发和影响评估确定为一项重要的未得到满足的需要。 公共卫生相关性：卫生与公众服务部预防保健相关感染行动计划将艰难梭菌环境清洁捆绑包的开发和影响评估确定为一项重要的未得到满足的需求。该应用程序的目标是开发以证据为基础的策略，以改善环境消毒，并测试其在降低与医疗保健相关的艰难梭菌感染率(CDI)方面的有效性。我们将首先进行研究，以验证荧光标记方法的有效性，以监测CDI房间内高接触表面的消毒。然后，我们将评估CDI治疗期间对高接触表面的日常消毒，以此作为减少医护人员手污染的策略。最后，我们将对16家医院进行随机试验，以确定客服人员改善环境消毒的干预措施是否会降低与医疗保健相关的CDI的发生率。

DESCRIPTION (provided by applicant): Contaminated surfaces are an important potential source for transmission of Clostridium difficile. 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 application 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 enhance 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. PUBLIC HEALTH RELEVANCE: 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. 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 C. difficile infection (CDI). We will first perform studies to validate the effectiveness of a fluorescent marker method to monitor disinfection of high-touch surfaces in CDI rooms. We will then evaluate daily disinfection of high-touch surfaces during CDI treatment as a strategy to reduce healthcare worker hand contamination. Finally, we will perform a randomized trial of 16 hospitals to determine if an intervention to improve environmental disinfection by housekeeping staff will reduce rates of healthcare-associated CDI.