An Enhanced Strategy for Daily Disinfection in Acute Care Hospital Rooms : A Randomized Clinical Trial

Abstract

This randomized clinical trial compares the efficacy of a quaternary ammonium, salt-based, 24-hour continuously active germicidal wipe vs routine disinfection in inpatient rooms.

Key Points

Question

How does a quaternary ammonium, salt-based, 24-hour continuously active germicidal wipe compare with standard disinfection in acute care hospital rooms?

Findings

In this randomized clinical trial of inpatient rooms occupied by 50 unique patients, the median total bioburden for the intervention group was statistically significantly lower than that for the control group on study day 1. Enhanced daily disinfection decreased the environmental bioburden in acute care hospital rooms compared with routine disinfection.

Meaning

Findings of this study support performing large-scale randomized clinical trials to ascertain whether enhanced daily disinfection strategies can decrease patient acquisition of infection and adverse patient outcomes.

Abstract

Importance

Environmental contamination is a source of transmission between patients, health care practitioners, and other stakeholders in the acute care setting.

Objective

To compare the efficacy of an enhanced daily disinfection strategy vs standard disinfection in acute care hospital rooms.

Design, Setting, and Participants

This randomized clinical trial (RCT) was conducted in acute care hospital rooms at Duke University Hospital in Durham, North Carolina, from November 2021 to March 2022. Rooms were occupied by patients with contact precautions. Room surfaces (bed rails, overbed table, and in-room sink) were divided into 2 sides (right vs left), allowing each room to serve as its own control. Each side was randomized 1:1 to the intervention group or control group.

Interventions

The intervention was a quaternary ammonium, salt-based, 24-hour continuously active germicidal wipe. It was applied in addition to routine disinfection for the intervention group. The control group received no intervention beyond routine disinfection.

Main Outcomes and Measures

The primary outcome was the total contamination, measured in colony-forming units (CFUs) on the bed rails, overbed table, and sink on study day 1. The secondary outcomes were the proportion of sample areas with positive test results for clinically important pathogens, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and carbapenem-resistant Enterobacteriaceae; the similarity in baseline contamination between sample area sides on study day 0 before application of the intervention, and the proportion of sample areas with removed UV luminescent gel on study day 1 .

Results

A total of 50 study rooms occupied by 50 unique patients (median [IQR] age, 61 [45-69] years; 26 men [52%]) with contact precautions were enrolled. Of these patients, 41 (82%) were actively receiving antibiotics, 39 (78%) were bedridden, and 28 (56%) had active infections with study-defined clinically important pathogens. On study day 1, the median (IQR) total CFUs for the intervention group was lower than that for the control group (3561 [1292-7602] CFUs vs 5219 [1540-12 364] CFUs; P = .002). On study day 1, the intervention side was less frequently contaminated with patient-associated clinically important pathogens compared with the control side of the room (4 [14%] vs 11 [39%]; P = .04).

Conclusions and Relevance

Results of this RCT demonstrated that a quaternary ammonium, salt-based, 24-hour continuously active germicidal wipe decreased the environmental bioburden in acute care hospital rooms compared with routine disinfection. The findings warrant large-scale RCTs to determine whether enhanced daily disinfection strategies can decrease patient acquisition and adverse patient outcomes.

Trial Registration

ClinicalTrials.gov Identifier: NCT05560321