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 减少艰难梭菌感染(CDI)的发生率。此外，还有相当多的 关于监测环境有效性的最佳战略的不确定性 消毒。这个应用程序的目标是开发基于证据的策略，以改善 环境消毒并测试它们在降低医疗保健率方面的有效性- 关联的CDI。我们的中心假设是，以证据为基础的干预措施 环境消毒将降低与医疗保健相关的CDI的发生率。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情况。为了实现这一目标，我们将 从CDI房间的高接触表面移除荧光标记与移除 基于B毒素基因培养和聚合酶链式反应的孢子。2)。确定日常消毒是否高- CDI治疗期间的接触表面将减少医护人员的手污染。至 为了达到这一目的，我们将进行一项前瞻性随机试验，以比较标准 CDI房间的清洁(即，只有在被污染的情况下才清洁高触摸面)与标准清洁相比 加上高触感表面的日常去污处理。主要结果衡量标准将是 医护人员手被污染。和3)。确定是否需要采取干预措施来改善 客房部员工的环境消毒将降低与医疗保健相关的CDI的发生率。 为了实现这一目标，我们将在16个克利夫兰地区进行为期12个月的随机试验 医院将标准内务清洁与强化清洁与持续清洁进行比较 监控和反馈。主要的结果指标将是医疗保健的发生率- 关联的CDI。我们的实验室完全有能力完成拟议的研究，因为 我们有丰富的研究环境在病原体中的作用的经验。 传播和消毒方法的评价。结果将是意义重大的，因为 CDI是发病率和死亡率的重要原因，因为有必要 制定最佳环境消毒策略以防止传播。这个 卫生与公众服务部预防保健行动计划--相关 艰难梭状芽胞杆菌感染的识别发展和影响的评估 环境清洁捆绑作为一项重要的未得到满足的需求。

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.