• Wilson A Peter R AP Departments of Microbiology and Infection Control, University College London Hospitals, London, United Kingdom. peter.wilson@uclh.nhs.uk, Deborah Smyth, Ginny Moore, Julie Singleton, Richard Jackson, Vanya Gant, Annette Jeanes, Steven Shaw, Edward James, Ben Cooper, George Kafatos, Barry Cookson, Mervyn Singer, and Geoffrey Bellingan.
• Departments of Microbiology and Infection Control, University College London Hospitals, London, United Kingdom. peter.wilson@uclh.nhs.uk
• Crit. Care Med. 2011 Apr 1; 39 (4): 651-8.

ObjectivesTo determine the effect of enhanced cleaning of the near-patient environment on the isolation of hospital pathogens from the bed area and staff hands.DesignProspective randomized crossover study over the course of 1 yr.SettingIntensive care units at two teaching hospitals.PatientsThere were 1252 patients staying during enhanced cleaning and 1331 staying during standard cleaning.InterventionsIn each of six 2-month periods, one unit was randomly selected for additional twice-daily enhanced cleaning of hand contact surfaces.Measurements And Main ResultsAgar contact samples were taken at five sites around randomly selected bed areas, from staff hands, and from communal sites three times daily for 12 bed days per week. Patients admitted in the year commencing April 2007 were analyzed for hospital-acquired colonization and infection. Over the course of 1152 bed days, 20,736 samples were collected. Detection of environmental methicillin-resistant Staphylococcus aureus per bed-area day was reduced during enhanced cleaning phases from 82 of 561 (14.6%) to 51 of 559 (9.1%) (adjusted odds ratio, 0.59; 95% confidence interval, 0.40-0.86; p = .006). Other targeted pathogens (Acinetobacter baumannii, extended-spectrum β-lactamase-producing Gram-negative bacteria, vancomycin-resistant enterococci, and Clostridium difficile) were rarely detected. Subgroup analyses showed reduced methicillin-resistant Staphylococcus aureus contamination on doctors' hands during enhanced cleaning (3 of 425; 0.7% vs. 11 of 423; 2.6%; adjusted odds ratio, 0.26; 95% confidence interval, 0.07-0.95; p = .025) and a trend to reduction on nurses' hands (16 of 1647; 1.0% vs. 28 of 1694; 1.7%; adjusted odds ratio 0.56; 95% confidence interval, 0.29-1.08; p = .077). All 1252 critical care patients staying during enhanced and 1,331 during standard cleaning were included, but no significant effect on patient methicillin-resistant Staphylococcus aureus acquisition was observed (adjusted odds ratio, 0.98; 95% confidence interval, 0.58-1.65; p = .93).ConclusionsEnhanced cleaning reduced environmental contamination and hand carriage, but no significant effect was observed on patient acquisition of methicillin-resistant Staphylococcus aureus.Trial RegistryISRCTN. Identifier: 06298448. http://www.controlled-trials.com/isrctn/.

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