REACH Study – An environmental cleaning bundle and health-care-associated infections in hospitals

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International Infection Prevention Week (#IIPW), October 13-19, celebrates the importance of infection prevention There are approximately 200,000 healthcare-associated infections (HAIs) in Australian acute healthcare facilities each year.

It is possible to significantly reduce the rate of HAIs through effective infection prevention and control.

The Researching Effective Approaches to Cleaning in Hospitals (REACH) study, partly funded by Welsey Medical Research, aimed to evaluate the effectiveness of an environmental cleaning bundle to reduce healthcare-associated infections in hospitals.

The Lancet | Infectious Disease Volume 19, Issue 4 | 2019-4-1, Pages 339-448

The study looked at touchpoints of the patient journey and improving standard practice in five areas – optimising product use, technique, staff training, auditing with feedback, and communication, for routine cleaning.

The findings from this study were published in the Lancet Journal – one of the world’s oldest, most prestigious, and best known general medical journals. Following is an excerpt from the journal.


The REACH study was a pragmatic, multicentre, randomised trial done in 11 acute care hospitals in Australia.

Eligible hospitals had an intensive care unit, were classified by the National Health Performance Authority as a major hospital (public hospitals) or having more than 200 inpatient beds (private hospitals), and had a health-care-associated infection surveillance programme.

The stepped-wedge design meant intervention periods varied from 20 weeks to 50 weeks. We introduced the REACH cleaning bundle, a multimodal intervention, focusing on optimising product use, technique, staff training, auditing with feedback, and communication, for routine cleaning.

The primary outcomes were incidences of health-care-associated Staphylococcus aureus bacteraemia, Clostridium difficile infection, and vancomycin-resistant enterococci infection.

The secondary outcome was the thoroughness of cleaning of frequent touch points, assessed by a fluorescent marking gel. This study is registered with the Australian and New Zealand Clinical Trial Registry, number ACTRN12615000325505.


Between May 9, 2016, and July 30, 2017, we implemented the cleaning bundle in 11 hospitals. In the pre-intervention phase, there were 230 cases of vancomycin-resistant enterococci infection, 362 of S aureus bacteraemia, and 968 C difficile infections, for 3 534 439 occupied bed-days.

During intervention, there were 50 cases of vancomycin-resistant enterococci infection, 109 of S aureus bacteraemia, and 278 C difficile infections, for 1 267 134 occupied bed-days.

After the intervention, vancomycin-resistant enterococci infections reduced from 0·35 to 0·22 per 10 000 occupied bed-days (relative risk 0·63, 95% CI 0·41–0·97, p=0·0340). The incidences of S aureus bacteraemia (0·97 to 0·80 per 10 000 occupied bed-days; 0·82, 0·60–1·12, p=0·2180) and C difficile infections (2·34 to 2·52 per 10 000 occupied bed-days; 1·07, 0·88–1·30, p=0·4655) did not change significantly.

The intervention increased the percentage of frequent touchpoints cleaned in bathrooms from 55% to 76% (odds ratio 2·07, 1·83–2·34, p<0·0001) and bedrooms from 64% to 86% (1·87, 1·68–2·09, p<0·0001).


The REACH cleaning bundle was successful at improving cleaning thoroughness and showed great promise in reducing vancomycin-resistant enterococci infections. Our work will inform hospital cleaning policy and practice, highlighting the value of an investment in both routine and discharge cleaning practice.

The REACH study was funded by a National Health and Medical Research Council (NHMRC) grant, led by QUT, in partnership with Wesley Medical Research, and supported by Kimberly-Clark Professional, Ecolab Pty Ltd, Whiteley Corporation, the Deeble Institute for Health Policy Research, Australasian College for Infection Prevention and Control and the Australasian Society for Infectious Diseases.

Study investigators were Professor Nick Graves, Professor Adrian Barnett, Associate Professor Lisa Hall, Dr Kate Balcon, Dr Katie Page, Professor Anne Gardner (QUT), Professor Brett Mitchell (Avondale College), Professor David Paterson, Professor Christian Gericke (UQ) and Professor Tom Riley (University of Western Australia).

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