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The Iowa Disinfection Cleaning Project: Opportunities, Successes, and Challenges of a Structured Intervention Program in 56 Hospitals

Published online by Cambridge University Press:  31 July 2017

Philip Carling  and
Loreen A. Herwaldt
Philip Carling*
Affiliation:
Infectious Diseases Section, Caritas Carney Hospital, Dorchester, Massachusetts Boston University School of Medicine, Boston, Massachusetts
Loreen A. Herwaldt
Affiliation:
Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa Program in Hospital Epidemiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa College of Public Health, The University of Iowa, Iowa City, Iowa
*
Address correspondence to Philip C. Carling, MD, Infectious Diseases Section, Carney Hospital, 2100 Dorchester Avenue, Boston, MA 02124 (pcarling@comcast.net).
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Abstract

OBJECTIVE

A diverse group of hospitals in Iowa implemented a program to objectively evaluate and improve the thoroughness of disinfection cleaning of near-patient surfaces. Administrative benefits of, challenges of, and impediments to the program were also evaluated.

METHODS

We conducted a prospective, quasi-experimental pre-/postintervention trial to improve the thoroughness of terminal room disinfection cleaning. Infection preventionists utilized an objective cleaning performance monitoring system (DAZO) to evaluate the thoroughness of disinfection cleaning (TDC) expressed as a proportion of objects confirmed to have been cleaned (numerator) to objects to be cleaned per hospital policy (denominator)×100. Data analysis, educational interventions, and objective performance feedback were modeled on previously published studies using the same monitoring tool. Programmatic analysis utilized unstructured and structured information from participants irrespective of whether they participated in the process improvement aspects to the program.

RESULTS

Initially, the overall TDC was 61% in 56 hospitals. Hospitals completing 1 or 2 feedback cycles improved their TDC percentages significantly (P<.0001; P<.005). Overall, 22 hospitals (39.3%) completed all 3 study phases and significantly increased their TDC percentages to a mean of 89%. Moreover, 6 hospitals maintained the program beyond the planned study period and sustained TDC percentages >90% for at least 38 months. A survey of infection preventionists found that lack of time and staff turnover were the most common reasons for terminating the study early.

CONCLUSION

The study confirmed that hospitals using this program can improve their TDC percentages significantly. Hospitals must invest resources to improve cleaning and to sustain their gains.

Infect Control Hosp Epidemiol 2017;38:960–965

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 8 , August 2017 , pp. 960 - 965
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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