Best practices to clean hospital rooms may not be enough to control infections

Further study is needed to determine the best method to clean hospital rooms and prevent the spread of infections, according to a new study published in the Annals of Internal Medicine.

Researchers, led by Craig A. Umscheid, M.D., an assistant professor of medicine and epidemiology at the University of Pennsylvania's Perelman School of Medicine, conducted a systematic overview of 80 studies published between 1998 and 2014. They found little data on the comparative effectiveness of cleaning techniques or that measured outcomes that would most directly impact patients, such as changes in hospital-acquired infection rates or the presence of pathogens. Only 6.25 percent of the studies were randomized and controlled.

The majority of the reviewed research took the form of experiments comparing surface contamination before or after cleaning with a particular product, with less than 35 percent measuring patient-centered outcomes. The review focused on three evidence categories: agents/methods used to clean hard surfaces; methods of monitoring the effectiveness of cleaning; and system-wide factors necessary for success in cleaning and monitoring.

"While there is a clear need for more patient-centered and comparative effectiveness research, the findings that do exist provide a good place to start in terms of a hospital or healthcare entity seeking information on ways to mitigate healthcare-associated infections," Umscheid said in a statement. The rise of these types of infections and antibiotic-resistant superbugs that threaten patient safety have dominated recent headlines. 

For example, Umscheid and his team found numerous research indicating that while bleach-based disinfectants cut C. difficile, the most common cause of hospital-acquired gastrointestinal infections, chlorine dioxide-based products were ineffective. A recent study found only 6 percent of 3,000 hospitals effectively controlled C. diff and MRSA rates, FierceHealthcare previously reported, and nearly a quarter of hospitals fell short of the Leapfrog Group's hand-hygiene standards.

Going forward, Umscheid and his team wrote, research must address more patient-centered measures as well as establishing concrete benchmarks for cleanliness.

To learn more:
- here's the study abstract
- read the statement

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