2019-10-09T09:24:19 n7695

REACH: Researching Effective Approaches to Cleaning in Hospitals

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The REACH Project was a randomised controlled study of the effectiveness of a cleaning bundle intervention to reduce healthcare associated infection in 11 major Australian hospitals in 2014-2017.
Previous cleaning research has focused on single interventions, such as a new cleaning product or auditing strategy. There was little evidence on cleaning practices relating to intervention cost, cost-effectiveness, feasibility, and end-user concerns.  In addition, implementing cleaning in a hospital setting is a multifaceted and complex process. Evidence about how to translate positive research findings into improvements in cleaning practice and how to sustain these changes in behaviour was also required.

To address this gap, the REACH study investigated the effectiveness of an evidence-based cleaning bundle intervention in eleven major Australian hospitals.  The findings from this research study show clinicians and decision makers in both public and private healthcare sectors whether investing in the implementation of an environmental cleaning bundle in acute hospitals will improve cleaning performance, improve cost-effectiveness and reduce the risks of HAI.  This is particularly important given the current economic climate and pressure on public spending.

The REACH Project was a randomised controlled trial using a stepped-wedge randomised trial design, with a sequential roll-out of the environmental cleaning bundle to 11 public and private hospitals over 58 weeks. All hospitals received the intervention and acted as their own control, with analysis undertaken of the change within each hospital before and after the intervention.

At each trial site data was collected on:

  • HAI infection rates
  • the effectiveness of cleaning of frequent touch points (using an ultraviolet gel dot system and, in three trial sites, adenosine tri-phosphate luminometry)
  • environmental services and cleaning staff attitudes, educational needs and knowledge related to environmental cleaning at the site
  • resources and costs associated with the bundle intervention, including training costs, audit time, staffing
  • particular information about the trial site, including hospital characteristics, size, environmental services workforce and staffing.

Some of these data were routinely collected by the trial site already.

Geographical area of data collection

Box Hill Hospital, Box Hill, VIC; Fiona Stanley Hospital, Murdoch, WA; Flinders Medical Centre, Bedford Park, SA; Holy Spirit Northside Private Hospital, Chermside, QLD; John Hunter Hospital, Newcastle, NSW; Launceston General Hospital, Launceston, TAS; Northern Hospital, Epping, VIC; Princess Alexandra Hospital, Woolloongabba, QLD; Royal Brisbane & Women’s Hospital, Herston, QLD; St Andrew’s War Memorial Hospital, Spring Hill, QLD; University Hospital Geelong, Geelong, VIC;


Farrington, Alison and Hall, Lisa (2017) The REACH trial: A real-world study of hospital cleaning. In Australasian College for Infection Prevention and Control 2017 Conference (ACIPC 2017), 20-22 November 2017, Canberra, ACT. (Unpublished) https://eprints.qut.edu.au/120865/
Mitchell, Brett G., White, Nicole, Farrington, Alison, Allen, Michelle, Page, Katie, Gardner, Anne, Halton, Kate, Riley, Thomas V., Gericke, Christian A., Paterson, David L., Graves, Nicholas, and Hall, Lisa (2018) Changes in knowledge and attitudes of hospital environmental services staff: The Researching Effective Approaches to Cleaning in Hospitals (REACH) study. American Journal of Infection Control. https://eprints.qut.edu.au/117608/
Hall, Lisa, Farrington, Alison, Mitchell, Brett G., Barnett, Adrian G., Halton, Kate, Allen, Michelle, Page, Katie, Gardner, Anne, Havers, Sally, Bailey, Emily, Dancer, Stephanie J., Riley, Thomas V., Gericke, Christian A., Paterson, David L., and Graves, Nicholas (2016) Researching effective approaches to cleaning in hospitals: Protocol of the REACH study, a multi-site stepped-wedge randomised trial. Implementation Science, 11, Article No. 44. https://eprints.qut.edu.au/94336/
Farrington, Alison (2018) Outcomes of the REACH trial. In 37th IHHC National Conference 2018: Shaping Support Services Strategies for Success, 15-17 October 2018, Sydney, N.S.W. (Unpublished) https://eprints.qut.edu.au/123720/
Mitchell, Brett G., Farrington, Alison, Allen, Michelle, Gardner, Anne, Hall, Lisa, Barnett, Adrian G., Halton, Kate, Page, Katie, Dancer, Stephanie J., Riley, Thomas V., Gericke, Christian A., Paterson, David L., and Graves, Nicholas (2017) Variation in hospital cleaning practice and process in Australian hospitals: A structured mapping exercise. Infection, Disease and Health, 25, pp. 195-202. https://eprints.qut.edu.au/110715/
Farrington, Alison and Mitchell, Brett G. (2018) Implementation lessons from the Researching Effective Approaches to Cleaning in Hospitals (REACH) trial. In Australasian College for Infection Prevention and Control 2018 Conference, 19-21 November 2018, Brisbane, Qld. (Unpublished) https://eprints.qut.edu.au/123723/
Farrington, Alison, Allen, Michelle, and Hall, Lisa (2016) Evaluating a process of change in hospital environmental cleaning - The REACH trial logic model. In Australasian College for Infection Prevention and Control 2016 Conference, 20-23 November 2016, Melbourne, Vic. (Unpublished) https://eprints.qut.edu.au/120375/

Research areas

Health Economics
Hospital cleaning
Cleaning knowledge
Cleaners' attitudes
Public health and health services

Related information

Australian Centre For Health Services Innovation (AusHSI) https://www.aushsi.org.au/

Partner institution

Australian Catholic University https://www.acu.edu.au/
Wesley Medical Research https://www.wesleyresearch.org.au/
University of Western Australia https://www.uwa.edu.au/
Kimberly-Clark Professional https://www.kcprofessional.com.au/
Ecolab Pty Ltd https://www.ecolab.com/
Whiteley Corporation https://www.whiteley.com.au/


Funding scheme:
NHMRC Partnership grant
NHMRC GNT1076006


Has association with
Adrian Barnett  (Researcher)
Alison Farrington  (Administrative position)
Katie Page  (Researcher)
Nicole White  (Researcher)
Has chief investigator
Nicholas Graves  (Researcher)


Name: Ms Alison Farrington
Phone: +61 7 3138 6132


Date record created:
Date record modified:
Record status:
Published - Open Access