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Hospital and long-term care facility environmental service workers' training, skills, activities and effectiveness in cleaning and disinfection: a systematic review

  • R.E. Thomas
    Correspondence
    Corresponding author. Address: G012, Health Sciences Centre, 3330 Hospital Drive NW, Calgary AB, Canada, T2N 4N1. Tel.: +1 403 607 1604.
    Affiliations
    Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • B.C. Thomas
    Affiliations
    Independent Researcher, Calgary, Alberta, Canada
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  • D. Lorenzetti
    Affiliations
    Health Sciences Library, University of Calgary, Calgary, Alberta, Canada

    Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • J. Conly
    Affiliations
    Departments of Medicine, Microbiology, Immunology & Infectious Diseases, Pathology & Laboratory Medicine, Snyder Institute for Chronic Diseases and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada

    Alberta Health Services, Calgary, Alberta, Canada
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Published:March 17, 2022DOI:https://doi.org/10.1016/j.jhin.2022.03.002

      Summary

      Background

      Multi-drug-resistant organisms (MDROs) (meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococcus, MDR Acinetobacter spp., extended-spectrum beta-lactamase-producing Gram-negative organisms), Clostridioides difficile, viral respiratory pathogens and healthcare-associated infections (HAIs) are major concerns in medical facilities.

      Aims

      To assess environmental service workers' (ESWs) training, workload, numbers of surfaces and pieces of medical equipment cleaned per shift, how long they worked on each surface, how they cleaned, supervision, MDRO and HAI status, and measurement of effectiveness in reducing MDROs and HAIs in patients and on surfaces.

      Methods

      CINAHL, Cochrane CENTRAL Register of Controlled Trials, EMBASE, Medline and Scopus were searched from inception to 28th June 2021 (no language/date limits). Searches combined terms from three themes: (a) hospitals and acute/long-term care facilities (e.g. assisted living, long-term care facilities, nursing homes); (b) disinfectants (e.g. antisepsis, bleach, cleaning, copper plating of surfaces and copper impregnation of textiles, disinfection, decontamination, hydrogen peroxide, quaternary ammonium disinfectants, and ultraviolet rays); and (c) randomized controlled trials (RCTs).

      Findings and conclusions

      Fourteen cluster RCTs provided data on a series of interventions. Ten trials focused on reducing patient infections from MDROs/HAIs, and four found significant reductions in patient infection rates with strategies including bleach, quaternary ammonium detergents, ultraviolet light and hydrogen peroxide vapour. Minimal information was provided on ESW numbers, MDRO/HAI status, workload, numbers of surfaces and objects cleaned per shift, and effects of training on improving effectiveness. The findings suggest that there is a need for detailed evaluations of the effects of training and disinfection activities for individuals and teams of ESWs.

      Keywords

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      References

      1. American Hospital Association. Fast facts on US hospitals 2020. Chicago, IL: AHA; 2020. Available at: 2020-aha-hospital-fast-facts-now-JanQ8 2020.pdf [last accessed July 2021].

        • Mody L.
        • Foxman B.
        • Bradley S.
        • McNamara S.
        • Lansing B.
        • Gibson K.
        • et al.
        Longitudinal assessment of multidrug-resistant organisms in newly admitted nursing facility patients: implications for an evolving population.
        Clin Infect Dis. 2018; 67: 837-844
      2. Canadian Institute for Health Information. Hospital stays in Canada. Table 7. Number of hospitalisations 2019e2020. Ottawa: CIHI. Available at: https://www.cihi/ca/en/hospital-stays-in-canada [last accessed February 2022].

        • Wang J.
        • Foxman B.
        • Mody L.
        • Snitkin E.S.
        Network of microbial and antibiotic interactions drive colonization and infection with multidrug-resistant organisms.
        Proc Natl Acad Sci USA. 2017; 114: 10467-10472
        • Wang J.
        • Foxman B.
        • Pirani A.
        • Lapp Z.
        • Mody L.
        • Snitkin E.S.
        Application of combined genomic and transfer analyses to identify factors mediating regional spread of antibiotic-resistant bacterial lineages.
        Clin Infect Dis. 2020; 71: e642-e649
        • Freedberg D.E.
        • Salmasian H.
        • Cohen B.
        • Abrams J.A.
        • Larson E.L.
        Receipt of antibiotics in hospitalized patients and risk for Clostridium difficile infection in subsequent patient who occupy the same bed.
        JAMA Intern Med. 2016; 176: 1801-1808
        • Higgins J.P.T.
        • Thomas J.
        • Chandler J.
        • Cumpston M.
        • Li T.
        • Page M.J.
        • et al.
        Cochrane Handbook for Systematic Reviews of Interventions.
        (updated February 2021) Cochrane Collaboration, Oxford2021 (Version 6.2. Available at: www.training.cochrane.org/handbook [last accessed October 2021])
      3. Covidence systematic review software. Melbourne: Veritas Health Innovation. Available at www.covidence.org and https://get.covidence.org/cochrane [last accessed April 2021].

        • Sterne J.A.C.
        • Savović J.
        • Page M.J.
        • Elbers R.G.
        • Blencowe N.S.
        • Boutron I.
        • et al.
        RoB 2: a revised tool for assessing risk of bias in randomised trials.
        BMJ. 2019; 366: l4898
        • Anderson D.J.
        • Chen L.F.
        • Weber D.J.
        • Moehring R.W.
        • Lewis S.S.
        • Triplett P.F.
        • et al.
        Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study.
        Lancet. 2017; 389: 805-814
        • Anderson D.J.
        • Moehring R.W.
        • Weber D.J.
        • Lewis S.S.
        • Chen L.F.
        • Schwab J.C.
        • et al.
        Effectiveness of targeted enhanced terminal room disinfection on hospital-wide acquisition and infection with multidrug-resistant organisms and Clostridium difficile: a secondary analysis of a multicentre cluster randomised controlled trial with crossover design (BETR Disinfection).
        Lancet Infect Dis. 2018; 18: 845-853
        • Anderson D.J.
        • Knelson L.P.
        • Moehring R.K.
        • Lewis S.S.
        • Weber D.K.
        • Chen L.F.
        • et al.
        Implementation lessons learned from the Benefits of Enhanced Terminal Room (BETR) Disinfection Study: process and perceptions of enhanced disinfection with ultraviolet disinfection devices.
        Infect Control Hosp Epidemiol. 2018; 39: 157-163
        • Knelson L.P.
        • Ramadanovic G.K.
        • Chen L.F.
        • Moehring R.K.
        • Lewis S.S.
        • Rutala W.A.
        • et al.
        Self-monitoring by environmental services may not accurately measure thoroughness of hospital room cleaning.
        Infect Control Hosp Epidemiol. 2017; 38: 1371-1372
        • Kanamori H.
        • Rutala W.A.
        • Gergen M.F.
        • Sickbert-Bennett E.E.
        • Knelson L.P.
        • Anderson D.J.
        • et al.
        Microbial assessment of healthcare-associated pathogens on various environmental sites in patient rooms after terminal room disinfection.
        Open Forum Infect Dis. 2021; 8: ofab008
        • Mitchell B.G.
        • Hall L.
        • White N.
        • Barnett A.G.
        • Halton K.
        • Paterson D.L.
        • et al.
        An environmental cleaning bundle and health-care-associated infections in hospitals (REACH): a multicentre randomised trial.
        Lancet Infect Dis. 2019; 19: 410-418
        • Mitchell B.G.
        • White N.
        • Farrington A.
        • Allen M.
        • Page K.
        • Gardner A.
        • et al.
        Changes in knowledge and attitudes of hospital environmental cleaning staff: the Researching Effectiveness Approaches to Cleaning in Hospitals (REACH) study.
        Am J Infect Control. 2018; 46: 980-985
        • Hall L.
        • White N.
        • Allen M.
        • Farrington A.
        • Mitchell B.G.
        • Page K.
        • et al.
        Effectiveness of a structured, framework-based approach to implementation: the Researching Effective Approaches to Cleaning in Hospitals (REACH) trial.
        Antimicrob Resist Infect Control. 2020; 9: 35
        • Mody L.
        • Krein S.L.
        • Saint S.
        • Min L.M.
        • Montoya A.
        • Symons K.
        • et al.
        A targeted infection prevention intervention in nursing home residents with indwelling catheters. A randomized controlled trial.
        JAMA Intern Med. 2015; 175: 714-723
        • Koo E.
        • McNamara S.E.
        • Lansing B.
        • Olmsted R.N.
        • Rye R.A.
        • Fitzgerald T.
        • et al.
        Making infection prevention interactive can enhance knowledge and improve outcomes: results from the Targeted Infection Prevention study.
        Am J Infect Control. 2016; 44: 1241-1246
        • Peterson L.R.
        • Boehm S.
        • Beaumont J.L.
        • Patel P.A.
        • Schora D.M.
        • Peterson K.E.
        • et al.
        Reduction of methicillin-resistant Staphylococcus aureus infection in long-term care is possible while maintaining patient socialization: a prospective randomized clinical trial.
        Am J Infect Control. 2016; 44: 1622-1627
        • Schora D.M.
        • Boehm S.
        • Das S.
        • Patel P.A.
        • O'Brien J.
        • Hines C.
        • et al.
        Impact of Detection, Education, Research and Decolonization without Isolation in Long-term care (DERAIL) on methicillin-resistant Staphylococcus aureus colonization and transmission at 3 long-term care facilities.
        Am J Infect Control. 2014; 42: S269-S273
        • Salgado C.D.
        • Sepkowitz K.A.
        • John J.F.
        • Cantey J.R.
        • Attaway H.H.
        • Freeman K.D.
        • et al.
        Copper surfaces reduce the rate of healthcare-acquired infections in the intensive care unit.
        Infect Control Hosp Epidemiol. 2013; 34: 479-486
        • Baldwin N.S.
        • Gilpin D.F.
        • Tunney M.M.
        • Kearney M.P.
        • Crymble L.
        • Cardwell C.
        • et al.
        Cluster randomised controlled trial of an infection control education and training intervention programme focusing on meticillin-resistant Staphylococcus aureus in nursing homes for older people.
        J Hosp Infect. 2010; 76: 36-41
        • Bellini C.
        • Petignat C.
        • Masserey E.
        • Bula C.
        • Burnand B.
        • Rousson V.
        • et al.
        Universal screening and decolonization for control of MRSA in nursing homes: a cluster randomized controlled study.
        Infect Control Hosp Epidemiol. 2015; 36: 401-408
        • Boyce J.M.
        • Guercia K.A.
        • Sullivan L.
        • Havill N.L.
        • Fekieta R.
        • Kozakiewicz J.
        • et al.
        Prospective cluster controlled crossover trial to compare the impact of an improved hydrogen peroxide disinfectant and a quaternary ammonium-based disinfectant on surface contamination and health care outcomes.
        Am J Infect Control. 2017; 45: 1006-1010
        • Chami K.
        • Gavazzi G.
        • Bar-Hen A.
        • Carrat F.
        • de Wazières B.
        • Lejeune B.
        • et al.
        A short-term, multicomponent infection control program in nursing homes: a cluster randomized controlled trial.
        J Am Med Dir Assoc. 2012; 13 (569.e9–17)
        • Heredia-Rodríguez M.
        • Álvarez-Fuente E.
        • Bustamante-Munguira J.
        • Poves-Alvarez R.
        • Fierro I.
        • Gómez-Sánchez E.
        • et al.
        Impact of an ultraviolet air sterilizer on cardiac surgery patients: a randomized clinical trial.
        Med Clin. 2018; 151: 299-307
        • Juthani-Mehta M.
        • Van Ness P.H.
        • McGloin J.
        • Argraves S.
        • Chen S.
        • Charpentier P.
        • et al.
        A cluster-randomized controlled trial of a multicomponent intervention protocol for pneumonia prevention among nursing home elders.
        Clin Infect Dis. 2014; 60: 849-857
        • Lautenbach E.
        • Pegues D.
        • Fuchs B.
        • Martin N.
        • Nachamkin I.
        • Bilker W.
        • et al.
        A randomized controlled trial of the effect of accelerated copper textiles on healthcare-associated infections and multidrug-resistant organisms: the ‘Investigating Microbial Pathogen Activity of Copper Textiles’ (IMPACT) Study.
        Open Forum Infect Dis. 2018; 5: S568
        • Marik P.E.
        • Shankaran S.
        • King L.
        The effect of copper-oxide-treated soft and hard surfaces on the incidence of healthcare-associated infections: a two-phase study.
        J Hosp Infect. 2020; 105: 265-271
        • Ray A.J.
        • Deshpande A.
        • Fertelli D.
        • Sitzlar B.M.
        • Thota P.
        • Sankar C.T.
        • et al.
        A multicenter randomized trial to determine the effect of an environmental disinfection intervention on the incidence of healthcare-associated Clostridium difficile infection.
        Infect Control Hosp Epidemiol. 2017; 38: 777-783
        • Thomas R.E.
        • Thomas B.C.
        • Conly J.
        • Lorenzetti D.L.
        Cleaning and disinfecting surfaces in hospitals and long-term care facilities for reducing hospital- and facility-acquired bacterial and viral infections: a systematic review.
        J Hosp Infect. 2022; 122: 9-26