Hospital-acquired infections, also known as nosocomial infections, are a significant concern in healthcare settings. These infections are not present in patients when they are admitted to the hospital but occur during their stay. The most common types of hospital-acquired infections include wound infections after surgery, urinary tract infections, and pneumonia. These infections can have a profound impact on patients, often increasing their hospital stay, requiring additional treatment, and causing discomfort. In severe cases, some patients may not recover from these infections. In Australia, it is estimated that there are approximately 7,500 deaths associated with hospital-acquired infections annually. Preventing hospital-acquired infections is crucial not only for the benefit of patients but also for the cost savings and reduction of antibiotic use. Although patients do not typically come into direct contact with each other in hospitals, there are several ways bacteria can be transmitted between patients.
Medical equipment, such as blood pressure machines, dressing trolleys, and drip stands, can harbor bacteria, making them a common source of infection. Our research suggests that by regularly disinfecting shared medical equipment, we can reduce infections picked up in hospitals and ultimately save the health system money.
Our Approach to Reducing Hospital-Acquired Infections
To address this issue, we introduced a new cleaning package in a New South Wales hospital, which consisted of designated cleaners specifically trained to clean and disinfect sensitive medical equipment. The cleaning of shared equipment was typically the responsibility of clinical staff, but we aimed to improve the cleaning process. The designated cleaners spent three hours a day disinfecting shared medical equipment on the wards, and we also provided regular training and feedback to the cleaners. The start date for the cleaning package on each ward was randomly selected, using a “stepped wedge” trial design.
Monitoring the Effectiveness of the Cleaning Package
We monitored the thoroughness of cleaning before and after introducing the cleaning package by applying a fluorescent gel marker to shared equipment. The gel can only be seen without a special light, but is easily removed if the surface is cleaned well. We also monitored infections in patients on the wards before and after introducing the cleaning package.
Over the course of the experiment, more than 5,000 patients passed through the wards we were studying. We also looked at the economic costs and benefits, calculating how much the cleaning package costs versus the health-care costs that may be saved thanks to any avoided infections.
The Results of Our Study
Before the intervention, we found that the thoroughness of cleaning shared equipment was low, with only 24% of equipment being cleaned well. Once the cleaning package was introduced, the thoroughness of cleaning improved significantly, reaching 66%. After the cleaning package was introduced, hospital-acquired infections dropped by about one-third, from 14.9% to 9.8% of patients. We observed a reduction in various types of infections, including bloodstream infections, urinary tract infections, and surgical wound infections. To illustrate this, for every 1,000 patients admitted to wards with the cleaning package, we estimated there were 30 fewer infections compared to wards before the cleaning package was introduced. This not only benefits patients but also hospitals and the community, by freeing up resources that can be used to treat other patients.
Economic Costs and Benefits
Treating infections in hospital is expensive, with estimated costs of A$2.1 million for a group of 1,000 patients, arising from 130 infections. However, with the introduction of the cleaning package, we estimated the cost of treating infections to be reduced by A$1.5 million, which is a savings of A$642,000 for every 1,000 patients. This study highlights the importance of prioritizing effective cleaning practices for medical equipment in hospitals. By investing in better cleaning practices, we can not only improve patient outcomes but also reduce costs and contribute to a safer healthcare environment.
Limitations of Our Study
Our experiment was limited to several wards at one Australian hospital, which may not be representative of other hospitals. The cleaning was particularly poor at this hospital, and the same intervention at other hospitals may not result in the same benefit. We also found that even with trained designated cleaners, not every piece of equipment was cleaned all the time. This reflects common real-world issues in a busy ward, such as equipment being used and not available for cleaning, and cleaners being absent due to illness.
Future Directions
While our study suggests that improving hospital cleaning can reduce infections and save costs, there are potential limitations to consider. For example, we may not have found the optimal level of cleaning, and more extensive cleaning might have resulted in an even greater reduction in infections. However, our study demonstrates that even with existing cleaning practices, there is room for improvement. We recommend that hospitals prioritize effective cleaning practices, including thorough disinfection, to create a safer healthcare environment.
Conclusion
Hospital-acquired infections are a significant concern in healthcare settings, and preventing them is crucial for patient safety and cost savings. By improving hospital cleaning practices, including the disinfection of shared medical equipment, we can reduce the risk of infections and create a safer healthcare environment. Our study highlights the importance of prioritizing effective cleaning practices and suggests that hospitals should invest in better cleaning practices to improve patient outcomes and reduce costs.
