Effectiveness of Enhanced Terminal Room Disinfection to Prevent Healthcare-associated Infections (HAIs)

Meticulous and consistent use of hand hygiene before and after patient care remains the
cornerstone of infection prevention in all health care settings. However, clean hands are
not sufficient to prevent all healthcare-associated infections (HAIs), as 1) hands of
healthcare workers easily become contaminated from contact with contaminated environmental
surfaces in patient rooms after appropriate hand hygiene has been performed and before
direct patient care and 2) direct contact by patients with preexisting contaminated
environmental surfaces in their hospital rooms can lead to colonization or infection. Thus,
novel strategies are needed to prevent HAIs, particularly those caused by
multidrug-resistant (MDR) pathogens that persist in the environment such as
methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE),
Clostridium difficile, and Acinetobacter.

Enhanced environmental disinfection methods may lead to reduced risk of exposure to or
acquisition of HAIs and MDR-pathogens and overcome a critical issue facing healthcare today
- hospitals rooms are often poorly cleaned and disinfected. Enhanced terminal room
disinfection strategies using bleach and/or UV-C emitting devices have been investigated
only in experimental conditions; the efficacy, effectiveness, and feasibility of enhanced
terminal room disinfection to prevent HAIs are unknown. Thus, the scientific evidence for
such interventions currently is insufficient for their inclusion in evidence-based
guidelines.

This study will investigate the hypothesis that enhanced terminal room disinfection
protocols (using chlorine-based cleaning agents with or without UV-C light-emitting devices)
will decrease the overall risk of HAIs in the hospital and, more specifically, in subsequent
patients who are cared for in the same room. This prospective investigation will employ a
crossover design utilizing four room cleaning/disinfection protocols in 9 hospitals,
including 2 tertiary care, 1 VA, and 6 community hospitals. Phase T2 data from this study
will be useful in assessing the clinical efficacy and feasibility of individual disinfection
strategies. Thus, the goals of the investigators proposed research are to 1) determine the
efficacy and feasibility of enhanced terminal room disinfection strategies to prevent HAIs
and 2) determine the impact of environmental contamination on acquisition of MDR-pathogens
among hospitalized patients.

Inclusion Criteria:

- Any seed room (ie., room from which a patient with one of the target organisms has
been transferred or discharged)

Exclusion Criteria:

- None, intervention is at level of the room, not the patient

- Patient outcomes will be excluded if clinical cultures are obtained within 48 hours
of admission to the room of interest.