Concerns regarding Hospital Acquired Infections (HAIs) have recently brought up an urgency in preventing the spread of germs throughout healthcare environments. A new report has revealed a large gap in knowledge when finding the most effective ways of cleaning surfaces.
Bed rails, toilets and light switches are all popular surfaces for transmitting germs between patients and healthcare workers. But the current concern, highlighted in a systematic overview published in the Annals of Internal Medicine, is that there is a shortage of evidence as to which cleaning method is most effective.
The overview, conducted by the University of Pennsylvania School of Medicine, examined 80 studies conducted between 1998 and 2004 and concluded that comparative effectiveness studies were rare. These studies would have compared several ways of cleaning, disinfecting and monitoring how clean hard surfaces were to find out which were most effective.
There were also very few studies that had a focus on measuring reactions of most interest to patients, like changes in HAI rates or the existence of pathogens on patients. There were just five studies that were randomized controlled trials.
The existing studies were mostly before and after experiments, comparing the significance of surface contamination after cleaning with a certain agent to the significance of contamination before cleaning. Over 65% of the studies examined surface contamination as the main outcome, whereas less than 35% reported on patient-centred outcomes, like HAI rates or the acquirement of a particular organism in the body.
The researchers looked at three main categories of evidence; which agents and methods were used to clean hard surfaces, what systems-level factors are required for cleaning and monitoring to see success, and what approaches were available to monitor the effectiveness of cleaning. Along with this they also interviewed various national experts.
Throughout its discoveries, the team found several studies which concluded that rates of C.difficile, the most common cause of hospital-acquired gastrointestinal infections, decreased when using bleach-based disinfectants but that a chlorine dioxide-based product was not effective in reducing C.diff contamination and rates of infection.
Patients who take antibiotics are at major risk of succumbing to C.diff since antibiotics can disturb the regular bacteria of the bowel. Along with this, six studies integrating several different hydrogen peroxide and other chemicals into preventive strategies reported positive results, including reduced HAIs. Seventeen studies using ‘no touch’ methods to clean hard surfaces reported positive results.
Seven studies that evaluated enhanced coatings on hospital room surfaces reported positive results. Surfaces made from solid, copper-based metals or alloys were found to constantly kill bacteria that cause infections.
The researchers also flagged several particular areas for future research, based on their findings from the evidence and interviews with leading experts. There are several questions that should be emphasised in further studies, including:
· Which surfaces pose the biggest risk of infection towards patients?
· What standard should be created for measuring cleanliness?
· What factors affect the quality of regular disinfection practices?
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