Researching Effective Approaches to Cleaning in Hospitals (REACH) Trial results

Nicholas Graves1, Brett Mitchell2, Lisa Hall1,3, Nicole White1, Adrian Barnett1, Kate Halton1, David Paterson4, Thomas Riley5 , Anne Gardner1, Katie Page1, Alison Farrington1, Christian Gericke3,6

1Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001
2 Faculty of Nursing and Health, Avondale College, 185 Fox Valley Road, Wahroonga, NSW 2076
3 School of Public Health, University of Queensland, Herston, QLD 4006
4 University of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital, Herston, QLD 4029
5 School of Biomedical Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009
6 College of Public Health, Medical and Veterinary Sciences and College of Medicine and Dentistry, James Cook University, Cairns, QLD 4870


BACKGROUND: The Researching Effective Approaches to Cleaning in Hospitals (REACH) trial was designed to generate evidence about the effectiveness and cost-effectiveness of a novel cleaning initiative to improve the environmental cleanliness of hospitals. The intervention is: training, technique, product, audit and communication. It was implemented with environmental services staff.

METHODS/DESIGN: A stepped-wedge randomised controlled design was used to test the intervention in 11 Australian hospitals. All sites received the intervention and acted as their own control, with analysis undertaken of the change within each site based on data collected in the control and intervention periods. Each site was 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 completed the trial in 2017. The primary outcome is the monthly number of Staphylococcus aureus bacteraemia, Clostridium difficile infections and vancomycin resistant enterococci infections, per 10,000 bed days. Secondary outcomes 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 was completed to determine the second key outcome.

RESULTS: There were improvements in cleaning and reductions in risk of infections.

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.

The REACH trial was funded by an NHMRC partnership grant GNT1076006