This trial will evaluate the use of an evidence-based environmental cleaning bundle intervention in eleven major Australian hospitals.
Objective 1 is to evaluate the effectiveness of the environmental cleaning bundle.
Primary outcome: the number of healthcare associated Staphylococcus aureus Bacteraemia (SAB) infections, number of healthcare associated Clostridium difficule Infections (CDI) and the number of positive clinical isolates of Vancomycin Resistant Enterococci (VRE).
Objective 2 is to estimate the cost-effectiveness of adopting the environmental cleaning bundle for Australian hospitals.
Primary outcome: Changes in costs associated with implementing the bundle relative to changes in health benefits (incremental cost effectiveness ratio).
Ethics and trial registration
Research ethics approval has been obtained from the UnitingCare Health Human Research Ethics Committee (Approval 1413) and the QUT Human Research Ethics Committee (Approval 1400000828). The trial is registered with the Australian New Zealand Clinical Trial Registry (ACTRN12615000325505).
The randomised controlled trial study design
The REACH trial used a stepped-wedge randomised trial design. This design meant that all participating hospitals received the bundle intervention and acted as their own control, with analysis undertaken of the change within each hospital before and after the intervention. The timing (and hence duration) of the intervention was randomised by hospital to minimise bias. All hospitals had a 4 week establishment period, followed by an 8 week control period for baseline data collection, and a varying intervention period of between 20 and 50 weeks.
Recruitment & enrolment
The recruitment process purposively selected eligible hospitals to optimise the feasibility and practicality of completing the trial. Recruitment of trial sites was completed in April 2016.
The cleaning bundle
The REACH study cleaning bundle comprises five components that emphasise education, support and empowerment of hospital cleaning staff.
The REACH Project commenced in 2014 and will conclude in 2018.