Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2022 Sep 30;75(7):1217-1223.
doi: 10.1093/cid/ciac070.

Stopping Hospital Infections With Environmental Services (SHINE): A Cluster-randomized Trial of Intensive Monitoring Methods for Terminal Room Cleaning on Rates of Multidrug-resistant Organisms in the Intensive Care Unit

Matthew J Ziegler  1   2   3   4 , Hilary H Babcock  5 , Sharon F Welbel  6   7 , David K Warren  5 , William E Trick  6   7 , Pam Tolomeo  3 , Jacqueline Omorogbe  3 , Diana Garcia  6 , Tracy Habrock-Bach  5 , Onofre Donceras  6 , Steven Gaynes  8 , Leigh Cressman  3 , Jason P Burnham  5 , Warren Bilker  2   3 , Sujan C Reddy  9 , David Pegues  1   4 , Ebbing Lautenbach  1   2   3 , Brendan J Kelly  1   2   3 , Barry Fuchs  10 , Niels D Martin  11 , Jennifer H Han  1   2   3   4
Affiliations
Randomized Controlled Trial

Stopping Hospital Infections With Environmental Services (SHINE): A Cluster-randomized Trial of Intensive Monitoring Methods for Terminal Room Cleaning on Rates of Multidrug-resistant Organisms in the Intensive Care Unit

Matthew J Ziegler et al. Clin Infect Dis. .

Erratum in

Abstract

Background: Multidrug-resistant organisms (MDROs) frequently contaminate hospital environments. We performed a multicenter, cluster-randomized, crossover trial of 2 methods for monitoring of terminal cleaning effectiveness.

Methods: Six intensive care units (ICUs) at 3 medical centers received both interventions sequentially, in randomized order. Ten surfaces were surveyed each in 5 rooms weekly, after terminal cleaning, with adenosine triphosphate (ATP) monitoring or an ultraviolet fluorescent marker (UV/F). Results were delivered to environmental services staff in real time with failing surfaces recleaned. We measured monthly rates of MDRO infection or colonization, including methicillin-resistant Staphylococcus aureus, Clostridioides difficile, vancomycin-resistant Enterococcus, and MDR gram-negative bacilli (MDR-GNB) during a 12-month baseline period and sequential 6-month intervention periods, separated by a 2-month washout. Primary analysis compared only the randomized intervention periods, whereas secondary analysis included the baseline.

Results: The ATP method was associated with a reduction in incidence rate of MDRO infection or colonization compared with the UV/F period (incidence rate ratio [IRR] 0.876; 95% confidence interval [CI], 0.807-0.951; P = .002). Including the baseline period, the ATP method was associated with reduced infection with MDROs (IRR 0.924; 95% CI, 0.855-0.998; P = .04), and MDR-GNB infection or colonization (IRR 0.856; 95% CI, 0.825-0.887; P < .001). The UV/F intervention was not associated with a statistically significant impact on these outcomes. Room turnaround time increased by a median of 1 minute with the ATP intervention and 4.5 minutes with UV/F compared with baseline.

Conclusions: Intensive monitoring of ICU terminal room cleaning with an ATP modality is associated with a reduction of MDRO infection and colonization.

Keywords: bacterial; cross infection/prevention & control; cross infection/transmission; disinfectants; drug resistance; intensive care units; multiple.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. D. K. W. reports payment for consulting made to self from Mölnlycke Health Care AB, Homburg & Partner, and Pursuit Vascular, Inc. H. M. B. reports payment for expert testimony from ACLU for testifying in support of mail-in voting during the pandemic; support for attending meetings and/or travel from SHEA; and leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid from SHEA and HICPAC (CDC). J. H. reports holding shares in and being employee of GSK group of companies. M. Z. reports grants or contracts from the National Institutes for Health (NIH) outside of the submitted work. O. T. D. reports receipt of equipment, materials, drugs, medical writing, gifts, or other services from ATP bioluminescence and UV/F marker. S. F. W. reports grants or contracts from the Centers for Disease Control and Prevention outside of the submitted work and receipt for equipment, materials, drugs, medical writing, gifts, or other services from ATP bioluminescence and UV/F marker. W. E. T. reports being Treasurer as a volunteer board member for Medical Research Analytics and Informatics Alliance. All other authors report no conflicts of interest relevant to this study. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Percentage of cleaning observations failed by study month. Abbreviations: ATP, adenosine triphosphate; MICU, medical intensive care unit; SICU, surgical intensive care unit; UV/F, ultraviolet fluorescent marker.
Figure 2.
Figure 2.
Scatter plot of monthly percentage of cleaning observations failed versus monthly MDRO infection or colonization per 1000 patient days. P value for Spearman’s rank test for correlation. Abbreviations: ATP, adenosine triphosphate; MDRO, multidrug-resistant organisms; UV/F, ultraviolet fluorescent marker.
See this image and copyright information in PMC

References

    1. Akulian JA, Metersky ML.. Antibiotic resistance patterns in medical and surgical patients in a combined medical-surgical intensive care unit. J Crit Care 2013; 28:347–51. - PubMed
    1. Petrosillo N, Capone A, Di Bella S, Taglietti F.. Management of antibiotic resistance in the intensive care unit setting. Expert Rev Anti Infect Ther 2010; 8:289–302. - PubMed
    1. Doyle JS, Buising KL, Thursky KA, Worth LJ, Richards MJ.. Epidemiology of infections acquired in intensive care units. Semin Respir Crit Care Med 2011; 32:115–38. - PubMed
    1. Kollef MH, Fraser VJ.. Antibiotic resistance in the intensive care unit. Ann Intern Med 2001; 134:298–314. - PubMed
    1. Datta R, Platt R, Yokoe DS, Huang SS.. Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants. Arch Intern Med 2011; 171:491–4. - PubMed

Publication types

MeSH terms