Implementation of Hospital-Wide Enhanced Terminal Cleaning of Targeted Patient Rooms and its Impact on Endemic Clostridium Difficile Infection Rates

Background Implementation of a hospital-wide program of terminal cleaning of patient rooms revolving around hydrogen peroxide vapour (HPV) technology and evaluation of its impact on endemic nosocomial Clostridium difficile-associated diarrhoea (CDAD) have not been previously reported.

Methods This was a retrospective quasiexperimental study involving a 900-bed community hospital. During the pre-intervention period (January 2007-November 2008), rooms vacated by patients with CDAD or on-contact precautions for other targeted pathogens underwent 1 or more rounds of cleaning with bleach. During the intervention period (January-December 2009), targeted newly evacuated rooms underwent "enhanced cleaning" consisting of use of bleach followed by HPV decontamination utilising a priority scale based on the pathogen and room location. Rooms vacated by patients with CDAD but for which HPV decontamination was not possible the same day underwent 4 rounds of cleaning with bleach instead.

Results During the intervention period, 1,123 HPV decontamination rounds were performed involving 96.7% of hospital rooms. Of 334 rooms vacated by patients with CDAD (May-December 2009), 180 (54%) underwent HPV decontamination. The rate of nosocomial CDAD rate dropped significantly from 0.88 cases/1,000 patient-days to 0.55 cases/1,000 patient-days (rate ratio, 0.63; 95% confidence interval: 0.50-0.79, P < .0001).

Conclusion A hospital-wide programme of enhanced terminal cleaning of targeted patient rooms revolving around HPV technology was practical and was associated with a significant reduction in CDAD rates.