Improving hospital environmental hygiene with the use of a targeted multi-modal bundle strategy.

Abstract

Improving hospital environmental hygiene can reduce environmental contamination and cross-transmission risk, a precursor to healthcare associated infections (HAI). With poor cleaning practice a demonstrated problem, the process of converting evidence into practice requires investigation. The aim of this study was to assess the effectiveness of an environmental hygiene bundle in terms of changes to HAI rates, cleaning performance and environmental services workers (ESW) knowledge and attitudes. A multi-modal bundle was designed and implemented with ESW in eight wards, in a 400-bed metropolitan teaching hospital, using a prospective, before-and-after study design. This consisted of a three-month pre-intervention phase and six-month intervention phase. This research used an implementation science framework to guide the transition from evidence into practice, with data collected in the pre-intervention phase synthesised to design the implementation strategy. There was no statistically significant change in infection rates in the six-month period. Significant improvements in cleaning performance were observed, with the average proportion of ultraviolet markers removed during cleaning across the wards increasing from 61.1% to 95.4%. Results also demonstrate improvements to both the knowledge and attitudes of ESW. By combining infection prevention and implementation science, this bundle was an effective way to engage environmental services staff and improve hospital cleaning.