Researching effective approaches to cleaning in hospitals: Protocol of the REACH study, a multi-site stepped-wedge randomised trial

Background The Researching Effective Approaches to Cleaning in Hospitals (REACH) study will generate evidence about the effectiveness and cost-effectiveness of a novel cleaning initiative that aims to improve the environmental cleanliness of hospitals. The initiative is an environmental cleaning bundle, with five interdependent, evidence-based components (training, technique, product, audit and communication) implemented with environmental services staff to enhance hospital cleaning practices. Methods/design The REACH study will use a stepped-wedge randomised controlled design to test the study intervention, an environmental cleaning bundle, in 11 Australian hospitals. All trial hospitals will receive the intervention and act as their own control, with analysis undertaken of the change within each hospital based on data collected in the control and intervention periods. Each site will be randomised to one of the 11 intervention timings with staggered commencement dates in 2016 and an intervention period between 20 and 50 weeks. All sites complete the trial at the same time in 2017. The inclusion criteria allow for a purposive sample of both public and private hospitals that have higher-risk patient populations for healthcare-associated infections (HAIs). The primary outcome (objective one) is the monthly number of Staphylococcus aureus bacteraemias (SABs), Clostridium difficile infections (CDIs) and vancomycin resistant enterococci (VRE) infections, per 10,000 bed days. Secondary outcomes for objective one include the thoroughness of hospital cleaning assessed using fluorescent marker technology, the bio-burden of frequent touch surfaces post cleaning and changes in staff knowledge and attitudes about environmental cleaning. A cost-effectiveness analysis will determine the second key outcome (objective two): the incremental cost-effectiveness ratio from implementation of the cleaning bundle. The study uses the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework to support the tailored implementation of the environmental cleaning bundle in each hospital. Discussion Evidence from the REACH trial will contribute to future policy and practice guidelines about hospital environmental cleaning. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in hospitals. Trial registration Australia New Zealand Clinical Trial Registry ACTRN12615000325​505

Vírus da hepatite B: avaliação da resposta sorológica à vacina em funcionários de limpeza de hospital-escola

A hepatite viral B constitui um dos mais importantes problemas de saúde pública em todos os continentes. O vírus da hepatite B se transmite por via parenteral e, sobretudo, por via sexual. O objetivo foi avaliar a população ativa dos funcionários de limpeza do hospital da Faculdade de Medicina de Botucatu-UNESP, que receberam esquema completo de vacinação contra a hepatite B, medir os níveis de anticorpo contra o AgHBs (anti-HBs) e avaliar a sua relação com as condições epidemiológicas gerais, de vida pessoal e profissional e de risco de infecção pelo vírus da hepatite B.

Implantação e análise de sistema de captação de acidentes do trabalho no Hospital Escola da Faculdade de Medicina de Botucatu

Pós-graduação em Saúde Coletiva - FMB

Descrição bacteriológica de brinquedo utilizado em unidade de internação pediátrica

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Valutazione dei criteri ambientali minimi del pan gpp per i servizi di pulizia e loro applicazione al piano di riduzione degli impatti ambientali del presidio ospedaliero di Conegliano

The subject of my thesis is to develop an assessment of minimum environmental criteria of the Plan National Action of Green Public Procurement for the cleaning service in the Conegliano’s hospital, used as case of study, through the Life Cycle Assessment methodology, to improve the hospital cleaning service.

Hospital surfaces contamination with antineoplastic drugs: influence of cleaning procedures

Introduction: The raising frequency of cancer diseases is leading to a widespread application of antineoplastic drugs, thus increasing the probability of workplace surfaces contamination. Most of these drugs are classified by the International Agency for Research on Cancer as known or suspected human carcinogens. Skin absorption is the main route for antineoplastic drugs exposure in occupational settings, therefore cleaning protocols have paramount influence in surfaces contamination and, consequently, in exposure. The aim of this study was to assess surfaces contamination in a Portuguese chemotherapy unit before and during drug administration, in both preparation and administration facilities. Methods: Samples were collected by wipe-sampling from potentially contaminated surfaces selected by previous protocol observation. Samples were analyzed by HPLCDAD. Cyclophosphamide (CP), 5-fluorouracil (5FU), and paclitaxel (PTX) were used as surrogate markers for surfaces contamination for all cytotoxic drugs. Results: From the 34 samples collected before any preparation and administration activities, 41.2% were contaminated with 5-FU (4.0-84.7 ng/cm2) and 23.5% of the samples were contaminated with CP (19.8-139.6 μg/cm2). Only 2 samples presented contamination by PTX (5.9%) with a maximum value of 3.7 ng/cm2. Of the 37 samples collected during preparation and administration of antineoplastic drugs, 48.7% were contaminated with 5-FU (1.9-88.7 ng/cm2) and 24.3% with CP (12.0-93.9 μg/cm2). None of the samples showed contamination with PTX. Discussion: Data showed differences in contamination levels before and after the handling of antineoplastic drugs in preparation and in administration settings. These results point out the importance of cleaning procedures. This is well in accordance to previous studies that showed how the type of cleaning procedures and products used can be determinant for surfaces decontamination.

Environmental contamination and hospital-acquired infection: factors that are easily overlooked

There is an ongoing debate about the reasons for and factors contributing to healthcare-associated infection (HAI). Different solutions have been proposed over time to control the spread of HAI, with more focus on hand hygiene than on other aspects such as preventing the aerial dissemination of bacteria. Yet, it emerges that there is a need for a more pluralistic approach to infection control; one that reflects the complexity of the systems associated with HAI and involves multidisciplinary teams including hospital doctors, infection control nurses, microbiologists, architects, and engineers with expertise in building design and facilities management. This study reviews the knowledge base on the role that environmental contamination plays in the transmission of HAI, with the aim of raising awareness regarding infection control issues that are frequently overlooked. From the discussion presented in the study, it is clear that many unknowns persist regarding aerial dissemination of bacteria, and its control via cleaning and disinfection of the clinical environment. There is a paucity of good-quality epidemiological data, making it difficult for healthcare authorities to develop evidence-based policies. Consequently, there is a strong need for carefully designed studies to determine the impact of environmental contamination on the spread of HAI.

Outsourcing and benchmarking in a rural public hospital : does economic theory provide the complete answer?

INTRODUCTION: The ideology and pronouncements of the Australian Government in introducing 'competitive neutrality' to the public sector has improved efficiency and resource usage. In the health sector, the Human Services Department directed that non-clinical and clinical areas be market tested through benchmarking services against the private sector, with the possibility of outsourcing. These services included car parking, computing, laundry, engineering, cleaning, catering, medical imaging (radiology), pathology, pharmacy, allied health and general practice. Managers, when they choose between outsourcing, and internal servicing and production, would thus ideally base their decision on economic principles. Williamson's transaction cost theory studies the governance mechanisms that can be used to achieve economic efficiency and proposes that the optimal organisation structure is that which minimises transaction costs or the costs of exchange. Williamson proposes that four variables will affect such costs, namely: (i) frequency of exchange; (ii) asset specificity; (iii) environmental uncertainty; and (iv) threat of opportunism. This paper provides evidence from a rural public hospital and examines whether Williamson's transaction cost theory is applicable. d into an analysis that relies solely on transaction

Satisfação dos Usuários do Ambulatório Geral do Hospital das Clínicas de Botucatu

The searches for a health service it’s a part of a process, searches for a qualified evaluation can arise the perception, in form of irritating factors taking for an alert state. The personal expectation, it makes influence in its perceptions, too. The objective was to evaluate the satisfaction degree of the users of “Seção Técnica de Ambulatório Geral do Hospital das Clínicas de Botucatu”. The work is about a quantitative and transversal study, with calculated sample of 366 users, chosen randomly and invited to participate through a questionnaire. The population was compounded by a majority of women (64,5%), between 50 to 59 years old and average degree of education (38,3%). 25 specialties were cited. The evaluate about comfort, cleaning, reception, waiting time, medical attention and nursing vary between “very good” and “good”. Obtained significant “regular” assessment, the comfort in the waiting rooms (24%), silence (25%) and cleaning bathroom (63%). Others negative evaluation was the reception about the waiting time (26%), waiting time between arrival and the consultation (34%), waiting time between the request and consultation (27%). 30,6% report to know the place for complaints and 79,4% of these pointed to the ombudsman. 62% consider their problems solved, 84,4% would indicate the hospital, 57,4% would consider the hospital better than imagined. 42,62% used the opened area for thanking, critical for staff, suggestion infrastructure improvements, cleaning and waiting time. The biggest complaint was the staff turnover in the treatment. There was disharmony between the objective and subjective questions, but, all of them must be considered to propose improvements. The satisfaction evaluation makes the service more effective, bringing credibility to the health service and the patients adhere better to the treatment

The efficacy of chemical agents in cleaning and disinfection programs

Abstract Background Due to the growing number of outbreaks of infection in hospital nurseries, it becomes essential to set up a sanitation program that indicates that the appropriate chemical agent was chosen for application in the most effective way. Method For the purpose of evaluating the efficacy of a chemical agent, the minimum inhibitory concentration (MIC) was reached by the classic method of successive broth dilutions. The reference bacteria utilized were Bacillus subtilis var. globigii ATCC 9372, Bacillus stearothermophilus ATCC 7953, Escherichia coli ATCC 25922, Staphylococcus aureus ATCC 25923. The strains of Enterobacter cloacae IAL 1976 (Adolfo Lutz Institute), Serratia marcescens IAL 1478 and Acinetobactev calcoaceticus IAL 124 (ATCC 19606), were isolated from material collected from babies involved in outbreaks of infection in hospital nurseries. Results The MIC intervals, which reduced bacteria populations over 08 log10, were: 59 to 156 mg/L of quaternarium ammonium compounds (QACs); 63 to 10000 mg/L of chlorhexidine digluconate; 1375 to 3250 mg/L of glutaraldehyde; 39 to 246 mg/L of formaldehyde; 43750 to 87500 mg/L of isopropanol or ethanol; 1250 to 6250 mg/L of iodine in polyvinyl-pyrolidone complexes, 150 to 4491 mg/L of chlorine-releasing-agents (CRAs); 469 to 2500 mg/L of hydrogen peroxide; and, 2310 to 18500 mg/L of peracetic acid. Conclusions Chlorhexidine showed non inhibitory activity over germinating spores. A. calcoaceticus, was observed to show resistance to the majority of the agents tested, followed by E. cloacae and S. marcescens.

Lifecycle analysis for surgery instruments at a hospital

Gli strumenti chirurgici sono importanti “devices” utilizzati come supporto indi-spensabile nella cura di pazienti negli ospedali. Essi sono caratterizzati da un intero ciclo di vita che inizia convenzionalmente nello “Store”, dove gli strumenti sterilizzati sono prelevati per essere utilizzati all’interno delle sale operatorie, e termina nuovamente nello “Store”, dove gli strumenti vengono immagazzinati per essere riutilizzati in un nuovo ciclo. Può accadere che le singole fasi del ciclo subiscano ritardi rispetto ai tempi previ-sti, non assicurando, pertanto, nelle sale operatorie, il corretto numero degli stru-menti secondo i tempi programmati. Il progetto che vado ad illustrare ha come obiettivo l’ottimizzazione del ciclo degli strumenti chirurgici all’interno di un nuovo ospedale, applicando i principi della Lean philosophy ed in particolare i metodi: “Poke Yoke, 5S e tracciabilità”. Per raggiungere tale scopo, il progetto è stato articolato come segue. In un primo momento si è osservato l’intero ciclo di vita degli strumenti nei due principali ospedali di Copenhagen (Hervel e Gentofte hospital). Ciò ha permesso di rilevare gli steps del ciclo, nonché di riscontrare sul campo i principali problemi relativi al ciclo stesso quali: bassa flessiblità, decentramento dei differenti reparti di cleaning e di store rispetto alle operation theatres ed un problema nel solleva-mento degli strumenti pesanti. Raccolte le dovute informazioni, si è passati alla fase sperimentale, in cui sono stati mappati due cicli di vita differenti, utilizzando tre strumenti di analisi: • Idef0 che consente di avere una visione gerarchica del ciclo; • Value stream Mapping che permette di evidenziare i principali sprechi del ciclo; • Simulator Tecnomatix che favorisce un punto di vista dinamico dell’analisi. Il primo ciclo mappato è stato creato con il solo scopo di mettere in risalto gli steps del ciclo e alcuni problemi rincontrati all’interno degli ospedali visitati. Il secondo ciclo, invece, è stato creato in ottica Lean al fine di risolvere alcuni tra i principali problemi riscontrati nei due ospedali e ottimizzare il primo ciclo. Si ricordi, infatti, che nel secondo ciclo le principali innovazioni introdotte sono state: l’utilizzo del Barcode e Rfid Tag per identificare e tracciare la posizione degli items, l’uso di un “Automatic and Retrievial Store” per minimizzare i tempi di inserimento e prelievo degli items e infine l’utilizzo di tre tipologie di carrello, per consentire un flessibile servizio di cura. Inoltre sono state proposte delle solu-zioni “Poke-Yoke” per risolvere alcuni problemi manuali degli ospedali. Per evidenziare il vantaggio del secondo ciclo di strumenti, è stato preso in consi-derazione il parametro “Lead time”e le due simulazioni, precedentemente create, sono state confrontate. Tale confronto ha evidenziato una radicale riduzione dei tempi (nonché dei costi associati) della nuova soluzione rispetto alla prima. Alla presente segue la trattazione in lingua inglese degli argomenti oggetto di ri-cerca. Buona lettura.

Role of copper in reducing hospital environment contamination

The environment may act as a reservoir for pathogens that cause healthcare-associated infections (HCAIs). Approaches to reducing environmental microbial contamination in addition to cleaning are thus worthy of consideration. Copper is well recognised as having antimicrobial activity but this property has not been applied to the clinical setting. We explored its use in a novel cross-over study on an acute medical ward. A toilet seat, set of tap handles and a ward entrance door push plate each containing copper were sampled for the presence of micro-organisms and compared to equivalent standard, non-copper-containing items on the same ward. Items were sampled once weekly for 10 weeks at 07:00 and 17:00. After five weeks, the copper-containing and non-copper-containing items were interchanged. The total aerobic microbial counts per cm2 including the presence of ‘indicator micro-organisms’ were determined. Median numbers of microorganisms harboured by the copper-containing items were between 90% and 100% lower than their control equivalents at both 07:00 and 17:00. This reached statistical significance for each item with one exception. Based on the median total aerobic cfu counts from the study period, five out of ten control sample points and zero out of ten copper points failed proposed benchmark values of a total aerobic count of <5 cfu/cm2. All indicator micro-organisms were only isolated from control items with the exception of one item during one week. The use of copper-containing materials for surfaces in the hospital environment may therefore be a valuable adjunct for the prevention of HCAIs and requires further evaluation.