Impact of a multi-component training intervention (Clean Frontline) on microbiological cleanliness in Cambodian referral hospitals: a stepped wedge, cluster randomised, trial
Tracks
Meeting Room 1.61 - 1.62
| Tuesday, July 1, 2025 |
| 4:01 PM - 4:15 PM |
Overview
Speaker: Dr Giorgia Gon
Speaker
Dr Giorgia Gon
London School of Hygiene and Tropical Medicine
Impact of a multi-component training intervention (Clean Frontline) on microbiological cleanliness in Cambodian referral hospitals: a stepped wedge, cluster randomised, trial.
Abstract
Background
Surfaces cleanliness in the hospital environment is an important contributor to healthcare-associated infections and the spread of antimicrobial resistance. No previous randomized evaluations of cleaning interventions have been conducted in low-income countries. We assessed the effectiveness of a hospital-based multi-component intervention using a train-the-trainers format (Clean Frontline) to improve microbiological cleanliness.
Methods
We conducted a stepped wedge cluster-randomised trial in 13 Cambodian referral hospitals with four steps or intervention delivery points. Three wards in each hospital, maternity, paediatrics and general wards, were part of the trial evaluation. Prior to the intervention, there were no changes to environmental cleaning practices. The team collecting the primary outcome data and analysing it were masked to the treatment allocation. The multi-component intervention primarily selected, trained, and supervised facility cleaning champions who, in turn, trained and supervised cleaners at their facility. The primary outcome was near-patient surface microbiological cleanliness evaluated using dipslides. Secondary outcomes examined average colony-forming units (CFU) on dipslides and presence of Staphylococcus aureus, an indicator organism. We estimated intention-to-treat intervention effects and adjusted for a priori confounders.
Findings
Thirteen participating hospitals had monthly outcome measurement between May 2022 and March 2023. There was evidence that the intervention improved the odds of a surface being clean by 39% (OR=1.39, 95% CI=0 .95-2.03). Secondary analysis showed an average 4.5 CFU (CI= 0.05,8.98) per dipslide reduction in contamination; S.aureus was detected too infrequently for formal analyses. Qualitative analyses showed the intervention was well-received and that health system challenges posed challenges in the full implementation.
Surfaces cleanliness in the hospital environment is an important contributor to healthcare-associated infections and the spread of antimicrobial resistance. No previous randomized evaluations of cleaning interventions have been conducted in low-income countries. We assessed the effectiveness of a hospital-based multi-component intervention using a train-the-trainers format (Clean Frontline) to improve microbiological cleanliness.
Methods
We conducted a stepped wedge cluster-randomised trial in 13 Cambodian referral hospitals with four steps or intervention delivery points. Three wards in each hospital, maternity, paediatrics and general wards, were part of the trial evaluation. Prior to the intervention, there were no changes to environmental cleaning practices. The team collecting the primary outcome data and analysing it were masked to the treatment allocation. The multi-component intervention primarily selected, trained, and supervised facility cleaning champions who, in turn, trained and supervised cleaners at their facility. The primary outcome was near-patient surface microbiological cleanliness evaluated using dipslides. Secondary outcomes examined average colony-forming units (CFU) on dipslides and presence of Staphylococcus aureus, an indicator organism. We estimated intention-to-treat intervention effects and adjusted for a priori confounders.
Findings
Thirteen participating hospitals had monthly outcome measurement between May 2022 and March 2023. There was evidence that the intervention improved the odds of a surface being clean by 39% (OR=1.39, 95% CI=0 .95-2.03). Secondary analysis showed an average 4.5 CFU (CI= 0.05,8.98) per dipslide reduction in contamination; S.aureus was detected too infrequently for formal analyses. Qualitative analyses showed the intervention was well-received and that health system challenges posed challenges in the full implementation.
Biography
