Researching effective approaches to cleaning in hospitals: protocol of the REACH study, a multi-site stepped-wedge randomised trial

Hall, Lisa, Farrington, Alison, Mitchell, Brett G., Barnett, Adrian G., Halton, Kate, Allen, Michelle, Page, Katie, Gardner, Anne, Havers, Sally, Bailey, Emily, Dancer, Stephanie J., Riley, Thomas V., Gericke, Christian A., Paterson, David L. and Graves, Nicholas (2016) Researching effective approaches to cleaning in hospitals: protocol of the REACH study, a multi-site stepped-wedge randomised trial. Implementation Science, 11 1: . doi:10.1186/s13012-016-0406-6

Author Hall, Lisa
Farrington, Alison
Mitchell, Brett G.
Barnett, Adrian G.
Halton, Kate
Allen, Michelle
Page, Katie
Gardner, Anne
Havers, Sally
Bailey, Emily
Dancer, Stephanie J.
Riley, Thomas V.
Gericke, Christian A.
Paterson, David L.
Graves, Nicholas
Title Researching effective approaches to cleaning in hospitals: protocol of the REACH study, a multi-site stepped-wedge randomised trial
Journal name Implementation Science   Check publisher's open access policy
ISSN 1748-5908
Publication date 2016-03-24
Year available 2016
Sub-type Article (original research)
DOI 10.1186/s13012-016-0406-6
Open Access Status DOI
Volume 11
Issue 1
Total pages 10
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2017
Language eng
Formatted abstract
Background: The Researching Effective Approaches to Cleaning in Hospitals (REACH) study will generate evidence about the effectiveness and cost-effectiveness of a novel cleaning initiative that aims to improve the environmental cleanliness of hospitals. The initiative is an environmental cleaning bundle, with five interdependent, evidence-based components (training, technique, product, audit and communication) implemented with environmental services staff to enhance hospital cleaning practices.

Methods/design: The REACH study will use a stepped-wedge randomised controlled design to test the study intervention, an environmental cleaning bundle, in 11 Australian hospitals. All trial hospitals will receive the intervention and act as their own control, with analysis undertaken of the change within each hospital based on data collected in the control and intervention periods. Each site will be randomised to one of the 11 intervention timings with staggered commencement dates in 2016 and an intervention period between 20 and 50 weeks. All sites complete the trial at the same time in 2017. The inclusion criteria allow for a purposive sample of both public and private hospitals that have higher-risk patient populations for healthcare-associated infections (HAIs). The primary outcome (objective one) is the monthly number of Staphylococcus aureus bacteraemias (SABs), Clostridium difficile infections (CDIs) and vancomycin resistant enterococci (VRE) infections, per 10,000 bed days. Secondary outcomes for objective one include the thoroughness of hospital cleaning assessed using fluorescent marker technology, the bio-burden of frequent touch surfaces post cleaning and changes in staff knowledge and attitudes about environmental cleaning. A cost-effectiveness analysis will determine the second key outcome (objective two): the incremental cost-effectiveness ratio from implementation of the cleaning bundle. The study uses the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework to support the tailored implementation of the environmental cleaning bundle in each hospital.

Discussion: Evidence from the REACH trial will contribute to future policy and practice guidelines about hospital environmental cleaning. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in hospitals.

Trial registration: Australia New Zealand Clinical Trial Registry ACTRN12615000325505
Keyword Cleaning bundle
Healthcare-associated infection
Hospital cleaning
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
HERDC Pre-Audit
School of Public Health Publications
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