The CLEaning and Enhanced disiNfection (CLEEN) study

Healthcare-associated infections (HAIs) are a common, costly, yet largely preventable complication impacting patients in healthcare settings globally. Improving routine cleaning and disinfection of the hospital environment has been shown to reduce the risk of HAIs.¹

Contaminated shared medical equipment, such as IV poles, infusion pumps, blood pressure machines, computer on wheels, commodes and blood glucose machines present a primary transmission route for infectious pathogens yet is rarely studied.

The CLEEN study

The CLEaning and Enhanced disiNfection (CLEEN) study investigated the effect of improving the cleaning and disinfection of shared medical equipment on HAIs. The study used a stepped-wedge randomised controlled design in ten wards across Gosford Hospital over 36 weeks. The design allowed each ward to act as their own control. To our knowledge, the CLEEN study is the first randomised clinical trial to evaluate the effectiveness of improving the cleaning of shared medical equipment on the prevalence of HAIs. Our intervention requires no new technology.

In hospitals globally, lack of clarity about who is responsible for cleaning of shared medical equipment is common and translates to infrequent cleaning. Our study provides evidence for the first time that improving cleaning of shared medical equipment reduces HAIs. The findings from this pragmatic study provide novel evidence that dedicated cleaning time, auditing and providing feedback to cleaning staff improved the quality of cleaning for shared medical equipment and resulted in a reduction of HAIs.

The role of shared medical equipment in the transmission process

During the control phase, the cleaning and disinfection of shared medical equipment was undertaken by patient support assistants (PSAs) according to hospital policies. The intervention phase introduced:

• three additional hours per weekday, per ward, for the cleaning and disinfection of shared medical equipment and education on cleaning and disinfection techniques
• auditing of cleaning efficacy
• feedback on cleanliness to staff.

The Environmental Services staff underwent training in environmental cleaning practices, helping to sustain the improved cleaning seen in the study. The study also aimed to improve communication between environmental services and clinical staff, building a supportive team environment.

A fortnightly point prevalence survey recorded patients with a HAI. The cleaning and disinfection bundle led to a 34.5% reduction in HAIs and improvements in cleaning performance.² These findings highlight the importance of cleaning shared medical equipment and will inform hospital cleaning policy and practice globally.

Considerable reduction in hospital acquired infection following intervention

In this study, 433 of 2497 (17.3%) patients in the control period, and 301 of 2508 patients in the intervention period (12.0%) acquired a HAI. This is a statistically significant reduction in all HAIs and corresponds to a relative reduction of 34.5% in HAIs following the intervention.

The intervention was associated with reduced infections in all subgroups analysed including combined bloodstream infections, urinary tract infections, pneumonias, and surgical site infections. The thoroughness of cleaning was greatly improved and there were no adverse events reported.

The findings of this RCT underscore the profound impact that a multimodal intervention can have on reducing HAIs, thereby significantly enhancing patient experience and outcomes. Through systematic changes, targeted education, and diligent audit and feedback mechanisms, we not only improved the thoroughness of shared medical equipment cleaning but also achieved a remarkable reduction in HAI prevalence.

The shift from one in seven patients experiencing an HAI during the control period to less than one in 10 patients during the cleaning intervention is a testament to the tangible benefits of this approach. Beyond the statistical figures lie stories of fewer complications, shorter hospital stays, and ultimately, improved quality of life for patients. These results highlight the critical importance of infection prevention strategies in healthcare settings and reaffirm our commitment to continually advancing patient safety and well-being.

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