The CLEAN study
Infection prevention and control is crucial to minimizing healthcare associated infections (HAIs). These are currently estimated to affect 10-15% of patients in Eastern Africa – a similar prevalent to that found in other low and middle-income countries (LMICs). An important but often-neglected aspect of preventing HAIs is basic environmental hygiene. Achieving microbiological cleanliness of hospital surfaces prevents direct bacterial contamination of patients and indirect contamination via the hands of healthcare workers, medical equipment or the air. The importance of preventative measures for reducing HAIs is now even more important given the misuse of antibiotics which leads to proliferation of resistant strains of bacteria in hospital environments.
The CLEAN study (August 2018 – May 2019), funded by the Joint Global Health Trials scheme (MR/R019274/1), is a before-and-after study piloting the effectiveness of an environmental hygiene bundle on cleaning behaviour and microbiological cleanliness. The study was carried out in 2018 -19 in three high-volume maternity and newborn units in Tanzania. The study showed substantial improvement in microbiological cleanliness and other process outcomes (papers in preparation).
The intervention relies on the TEACH CLEAN training package developed by the Soapbox Collaborative, and designed for low resource settings and cadres with low literacy levels. Key features of the package include participatory techniques, hands-on exercises, and visual guidelines. The training package is currently the only recommended in the new international guidelines for cleaning in healthcare facilities one for LMICs.
The multi-disciplinary partnership, composed of researchers from London School of Hygiene and Tropical Medicine (LSHTM), NHS Lanarkshire, Ifakara Health Institute (IHI) and The Soapbox Collaborative, is led by Drs Alexander Aiken and Giorgia Gon. Lessons learnt from this pilot study are now being used to design a large cluster-randomised trial which will assess the intervention’s effectiveness in relation to environmental hygiene on maternity and newborn units in Eastern Africa and to the prevalence of HAIs in mothers and newborns.
- TEACH CLEAN training package: https://www.lshtm.ac.uk/research/centres/march-centre/soapbox-collaborative/teach-clean
- A paper on the role of cleaners in low resource settings written by the Soapbox team: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6338282/
- Best practices guidelines for cleaning in healthcare facilities in low resourced- settings: https://www.cdc.gov/hai/pdfs/resource-limited/environmental-cleaning-508.pdf.