Abstract
BackgroundImplementing sustainable practice change in hospital cleaning has proven to be an ongoing challenge in reducing healthcare associated infections. The purpose of this study was to develop a reliable framework-based approach to implement and quantitatively evaluate the implementation of evidence-based practice change in hospital cleaning.Design/methodsThe Researching Effective Approaches to Cleaning in Hospitals (REACH) trial was a pragmatic, stepped-wedge randomised trial of an environmental cleaning bundle implemented in 11 Australian hospitals from 2016 to 2017. Using a structured multi-step approach, we adapted the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to support rigorous and tailored implementation of the cleaning bundle intervention in eleven diverse and complex settings. To evaluate the effectiveness of this strategy we examined post-intervention cleaning bundle alignment calculated as a score (an implementation measure) and cleaning performance audit data collected using ultraviolet (UV) gel markers (an outcome measure).ResultsWe successfully implemented the bundle and observed improvements in cleaning practice and performance, regardless of hospital size, intervention duration and contextual issues such as staff and organisational readiness at baseline. There was a positive association between bundle alignment scores and cleaning performance at baseline. This diminished over the duration of the intervention, as hospitals with lower baseline scores were able to implement practice change successfully.ConclusionUsing a structured framework-based approach allows for pragmatic and successful implementation of clinical trials across diverse settings, and assists with quantitative evaluation of practice change.Trial registrationAustralia New Zealand Clinical Trial Registry ACTRN12615000325505, registered on 4 September 2015.
Highlights
Hospital cleaning is complex [1]
The mean total alignment score improved by 3.5 points to 18.5 points in the intervention period
When we examined the number and percentage of hospitals who improved after implementation the biggest changes were observed for the technique (75%) and training (56%) components
Summary
Implementing sustainable practice change in this area has proven to be an ongoing challenge in reducing healthcare-associated infections (HAIs) internationally. There is increasing evidence of the importance the hospital environment plays in the transmission of infections [2], there is disagreement on how best to improve cleaning [3] and the “wicked problem” [4] of implementation. The use of implementation science in infection prevention is a rapidly changing field. Implementation science frameworks have been rarely used in clinical trials evaluating infection prevention interventions. Implementing sustainable practice change in hospital cleaning has proven to be an ongoing challenge in reducing healthcare associated infections. The purpose of this study was to develop a reliable framework-based approach to implement and quantitatively evaluate the implementation of evidence-based practice change in hospital cleaning
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