In the era of “superbugs,” cleanliness in hospitals is more important than ever. However, a systematic overview of studies investigating cleaning methods in hospitals has revealed a worrying lack of evidence on the best ways to protect patients’ health.
The study – published in Annals of Internal Medicine – saw researchers from Penn University, PA, investigate what knowledge we have on cleaning methods in hospitals.
Senior author Dr. Jennifer Han, assistant professor of medicine and epidemiology, explains:
“We found that the research to date does provide a good overall picture of the before and after results of particular cleaning agents and approaches to monitoring cleanliness. Researchers now need to take the next step and compare the various ways of cleaning these surfaces and monitoring their cleanliness in order to determine which are the most effective in driving down the rate of hospital-acquired infections.”
According to the Centers for Disease Control and Prevention (CDC), 1 in 25 hospital patients suffer from health care-associated infections (HAIs) during their hospital stay. This figure was only updated last year and saw the CDC highlight the need to improve patient safety and reduce the risk of HAIs.
Although the CDC describe MRSA as a “major patient threat,” a study has revealed the number of life-threatening cases of MRSA declined by 54% between 2005-2011.
In the study, the team’s research focused on three categories:
- Which agents and methods were used to clean hard surfaces
- What approaches were available to monitor the effectiveness of cleaning
- What systems-level factors are needed for cleaning and monitoring to be successful.
Researchers also conducted interviews with a number of national experts.
A total of 80 studies published between 1998-2014 were identified and analyzed, made up of 76 primary studies and four systematic reviews.
It was found the majority of studies included in the review largely focused on the before and after results of experiments using a single agent. More than 65% of studies focused on surface contamination as the primary outcome, including bacteria burden and colony counts.
There were very few comparative effectiveness studies and even fewer that measured the outcomes of the most interest to patients. Less than 35% of studies reported on patient-centered outcomes, such as HAI rates. In addition, only five of the studies were randomized controlled trials.
Many experts also believed that only half of surfaces in a patient’s room are typically disinfected during cleaning.
Researchers were able to identify several studies that showed how the rates of the HAI Clostridium difficile fell with the use of bleach-based disinfectants. C. difficile is a common cause of gastrointestinal infections acquired in hospitals and can be life-threatening if not treated quickly.
According to the CDC, almost half a million cases of infections were caused by C. difficile in 2011. Of these, 29,000 cases were fatal, with patients passing away within 30 days of the initial diagnosis.
The research team also found six studies that implemented various cleaning wipes moistened with hydrogen peroxide and other chemicals were effective and achieved a sustained reduction in HAIs.
Other more experimental cleaning methods were explored in 17 studies that analyzed “no-touch” means to clean hard surfaces, including the use of ultraviolet light or hydrogen peroxide vapor, which all reported positive findings.
The use of enhanced copper coatings in hospital rooms was also found to help kill bacteria and reduce the risk of infections.
The study highlighted several areas for future research, including the need to investigate the effectiveness of new technologies and approaches. Other areas of focus include the need to identify high-touch surfaces that confer the greater risk of infection and the development of standard thresholds for defining cleanliness.
In the authors’ insight video, study author Dr. Craig A. Umscheid, assistant professor of medicine and epidemiology, hopes this review will register the importance of hospital cleanliness:
“Many of my clinician colleagues do not necessary have an appreciation for the complexity of environmental cleaning in hospitals. My hope would be reviewing this article would help them have a better understanding of those approaches.”
Recently, Medical News Today reported how a common hospital soap could be effective to limit the spread of MRSA.
According to the most recent statistics provided by the CDC, there were an estimated 722,000 cases of HAIs in US acute care hospitals in 2011, with 75,000 deaths as a result.