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Researchers at Johns Hopkins Medicine are studying how human factors impact patient room cleaning.

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Resources have been in short supply to fund research on the role the environment plays in health care-associated infections, but the Centers for Disease Control and Prevention (CDC) has developed a fast-track program to accelerate progress on this issue. The CDC’s Prevention Epicenters Program is a unique operation in which the CDC’s Division of Healthcare Quality Promotion teams up with academic investigators to conduct innovative and timely infection control and prevention research.

“It’s a way for us to engage with our partners in these academic centers to really push the needle. These studies are the first of their kind,” says Sujan Reddy, M.D., medical director of the Prevention Epicenters Program.

Among the 10 CDC epicenter locations, researchers are studying issues that could provide valuable insights to those who design, clean and disinfect hospital environments of care. Below are snapshots of some of the programs.

Human factors research. Johns Hopkins Medicine researchers have begun studying through observation, interviews and focus groups with environmental cleaning associates (EVCAs) how human factors impact patient room cleaning. Although the project is still in its early stages, researchers shared some preliminary findings in late October.

They observed seven EVCAs perform 70 room cleanings, which lasted an average of 15.7 minutes, each with an average of 30.4 surfaces processed per room. Observers found that frequent interruptions by staff and others of EVCA workers hampered cleaning efforts. In addition, the findings noted that some surfaces were infrequently cleaned. For example, bedrails were touched only 42 percent of the time. In interviewing the EVCAs for context, researchers found that the workers were not cleaning items that were covered by patient belongings or in use by patients or other health care workers. These findings will inform future interviews and focus groups with EVCAs, the next step in the human factors engineering process.

Hand-hygiene compliance. A multidisciplinary team at the Prevention Epicenter of Emory and Atlanta Consortium Hospitals is early in its work of studying the effectiveness of automated systems to record and provide feedback on whether health care workers follow hand-hygiene protocols, and analyzing ways to minimize risk of self-contamination to health care workers when removing personal protective equipment.

Disease transmission. In a multisite study targeting intensive care units, researchers from the University of Maryland, Baltimore Epicenter, and three other institutions are examining which health care worker interactions lead to greater risk of disease transmission in both acute and long-term care settings. Randomized trials will be used to determine alternative approaches to improve compliance with glove use and hand hygiene during patient care. The research also will try to better understand patient movement and how diseases travel from one patient to another.

UV disinfection. Complete findings from the Duke University-University of North Carolina Epicenter research on the efficacy of using ultraviolet light disinfection in terminal room cleaning will be published soon in a peer-reviewed scientific journal. Preliminary findings from this study were presented in the fall of 2015 and showed that using a combination of traditional cleaning chemicals, such as quaternary ammonium and bleach, along with UV light to disinfect patient rooms, reduced the risk of acquisition and infection caused by four targeted multidrug-resistant organisms.