REACH: Researching Effective Approaches to Cleaning in Hospitals
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.