Document Type
Journal Article
Publication Title
Antimicrobial resistance and Infection Control
Publisher
BioMed Central
School
School of Medical and Health Sciences
RAS ID
31425
Grant Number
NHMRC Number : GNT1076006
Grant Link
http://purl.org/au-research/grants/nhmrc/GNT1076006
Abstract
BACKGROUND: Implementing sustainable practice change in hospital cleaning has proven to be an ongoing challenge in reducing healthcare associated infections. The purpose of this study was to develop a reliable framework-based approach to implement and quantitatively evaluate the implementation of evidence-based practice change in hospital cleaning. DESIGN/METHODS: The Researching Effective Approaches to Cleaning in Hospitals (REACH) trial was a pragmatic, stepped-wedge randomised trial of an environmental cleaning bundle implemented in 11 Australian hospitals from 2016 to 2017. Using a structured multi-step approach, we adapted the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to support rigorous and tailored implementation of the cleaning bundle intervention in eleven diverse and complex settings. To evaluate the effectiveness of this strategy we examined post-intervention cleaning bundle alignment calculated as a score (an implementation measure) and cleaning performance audit data collected using ultraviolet (UV) gel markers (an outcome measure). RESULTS: We successfully implemented the bundle and observed improvements in cleaning practice and performance, regardless of hospital size, intervention duration and contextual issues such as staff and organisational readiness at baseline. There was a positive association between bundle alignment scores and cleaning performance at baseline. This diminished over the duration of the intervention, as hospitals with lower baseline scores were able to implement practice change successfully. CONCLUSION: Using a structured framework-based approach allows for pragmatic and successful implementation of clinical trials across diverse settings, and assists with quantitative evaluation of practice change. TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry ACTRN12615000325505, registered on 4 September 2015.
DOI
10.1186/s13756-020-0694-0
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Comments
Hall, L., White, N. M., Allen, M., Farrington, A., Mitchell, B. G., Page, K., ... & Gardner, A. (2020). Effectiveness of a structured, framework-based approach to implementation: The Researching Effective Approaches to Cleaning in Hospitals (REACH) Trial. Antimicrobial Resistance & Infection Control, 9, Article 35. https://doi.org/10.1186/s13756-020-0694-0