NeoCLEAN: a multimodal strategy to enhance environmental cleaning in a resource-limited neonatal unit

A Dramowski,S Coffin,A C Whitelaw,S Pillay,K Moloto,A Bekker,M F Cotton,M Aucamp

doi:10.1186/s13756-021-00905-y

Abstract

BackgroundContamination of the hospital environment contributes to neonatal bacterial colonization and infection. Cleaning of hospital surfaces and equipment is seldom audited in resource-limited settings.MethodsA quasi-experimental study was conducted to assess the impact of a multimodal cleaning intervention for surfaces and equipment in a 30-bed neonatal ward. The intervention included cleaning audits with feedback, cleaning checklists, in-room cleaning wipes and training of staff and mothers in cleaning methods. Cleaning adequacy was evaluated for 100 items (58 surfaces, 42 equipment) using quantitative bacterial surface cultures, adenosine triphosphate bioluminescence assays and fluorescent ultraviolet markers, performed at baseline (P1, October 2019), early intervention (P2, November 2019) and late intervention (P3, February 2020).ResultsEnvironmental swabs (55/300; 18.3%) yielded growth of 78 potential neonatal pathogens with Enterococci, S. marcescens, K. pneumoniae, S. aureus and A. baumannii predominating. Highest aerobic colony counts were noted from moist surfaces such as sinks, milk kitchen surfaces, humidifiers and suction tubing. The proportion of surfaces and equipment exhibiting no bacterial growth increased between phases (P1 = 49%, P2 = 66%, P3 = 69%; p = 0.007). The proportion of surfaces and equipment meeting the ATP “cleanliness” threshold (< 200 relative light units) increased over time (P1 = 40%, P2 = 54%, P3 = 65%; p = 0.002), as did the UV marker removal rate (P1 = 23%, P2 = 71%, P3 = 74%; p < 0.001).ConclusionRoutine environmental cleaning of this neonatal ward was sub-optimal at baseline but improved significantly following a multimodal cleaning intervention. Involving mothers and nursing staff was key to achieving improved environmental and equipment cleaning in this resource-limited neonatal unit.

Highlights

The hospital environment is a reservoir for bacterial pathogens and contributes substantially to the risk of healthcare-associated infections (HAIs) and outbreaks [1]
Study design, setting and population A prospective, quasi-experimental study was conducted in a 30-bed acute neonatal ward in Cape Town, South Africa to assess the impact of a multimodal intervention on surface and equipment cleaning
Ours is the first study to evaluate the potential of environmental cleaning as a standalone HAI prevention intervention, with only one prior study including cleaning in a neonatal infection prevention bundle [20]

Summary

Introduction

The hospital environment is a reservoir for bacterial pathogens and contributes substantially to the risk of healthcare-associated infections (HAIs) and outbreaks [1]. Shortages of cleaning staff, contaminated water supplies [5, 6] and lack of training in decontamination of complex equipment, are additional factors that facilitate pathogen transmission [1, 2]. Interventions targeting these organizational, infrastructural and behavioral aspects of hospital cleaning practices that facilitate pathogen transmission, could reduce HAI rates in African maternity and neonatal units. Cleaning of hospital surfaces and equipment is seldom audited in resource-limited settings

Methods

Results

Conclusion