Background and rationale {6a}
infection, infections, healthcare-associated infections
INFECTION, INFECTIONS, EMERGING INFECTIOUS DISEASE
One in 10 patients in an Australian hospital will acquire an infection while in the hospital (1). This equates to approximately 170,000 infections each year (2). These hospital-acquired infections represent just a subset of the total number of healthcare-associated infections (HAIs), which include infections associated with receiving healthcare in all settings. The burden of HAIs is significant, with increased levels of morbidity and mortality and, for those acquired in hospitals, increased length of stay (2,3). However, there is little level 1 evidence into the role of environmental cleaning to reduce HAIs (4,5). Prevention of infections through practical, implementable and translatable interventions is of critical importance in the era of antimicrobial resistance. These strategies will not only reduce the burden and impact for patients and health services in the short term, but also contribute to limiting antimicrobial resistance and better prepare healthcare settings for emerging infectious disease threats.Contaminated healthcare environments provide a reservoir for pathogens to be transmitted to patients. Admission to a hospital room previously occupied by a patient infected and/or colonised with a specific pathogen is a major risk factor for acquisition (6). This means that a primary transmission route of pathogens is via the patient environment. A seminal study published in 2020, conducted in 11 Australian hospitals (REACH study), demonstrated improvements in routine hospital cleaning being associated with a reduction in infections (7). This research was the first cluster randomised control trial (RCT) to evaluate the effect of a cleaning and disinfection bundle that focuses on routine and discharge hospital cleaning on the incidence of HAIs. The REACH study did not, however, focus on the cleaning of shared medical equipment. This is a significant lacuna because infectious pathogens have been identified on shared medical equipment (8). Another Australian study published in 2018 demonstrated through whole genome sequencing that shared medical equipment also plays a critical role in the transmission of infection (8). This proposed trial builds on the REACH study findings, including important implementation strategies, and focuses on improving the cleaning and disinfection of shared medical equipment as a key strategy in the reduction of HAIs.