Comparative Effectiveness of a Multimodal Intervention Package on Surface Cleaning and Disinfection in Brazilian Neonatal Intensive Care Units

Caroline Lopes Ciofi Silva¹Verusca Soares de Souza¹Daniel de Macêdo Rocha¹Alvaro Francisco Lopes Sousa^1,2*Adriana M. S. Felix²Aires Garcia dos Santos Junior¹

• ¹Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
• ²Hospital Sirio Libanes, São Paulo, Brazil

Objective: To compare the impact of a package of interventions on surface cleaning and disinfection in two public and private neonatal intensive care units (NICUs). Method: This is a quasi-experimental, quantitative study. The study consisted of three phases: baseline (phase I), implementation of the intervention package without feedback to the team (phase II), and, finally, short-term monitoring with feedback to the team (phase III). A total of 864 evaluations were carried out according to the monitoring methods: adenosine triphosphate, visual inspection, microbial load counting, and detection of Staphylococcus aureus and testing for its methicillin resistance (MRSA) in each unit over four months, evaluating six high-frequency touch surfaces, before and after cleaning and disinfection carried out by nursing and sanitizing professionals. Results: When comparing the effect of the package in the two units (public and private), no significant differences were found in the proportions of MRSA-positive surfaces in all the phases evaluated. The same occurred concerning the ATP method, which showed no significant differences between the hospitals in all study phases. Concerning the microbial count, in phase II of the study, only on one surface (scales) was a significantly lower difference found in the private hospital compared to the public one. Visual inspection indicated that the private NICU had a substantially higher proportion of surfaces with adequate hygiene in phase I: the infusion pump and the armchair; in phase II, the counter and in phase III again the counter surface. Concerning human factors, when comparing the two institutions, there were no statistically significant associations or correlations with job satisfaction. However, the public institution had higher work performance scores than the private one. Conclusion: The study highlights that the rigorous implementation of intervention packages for cleaning in NICUs, even though they are different, still showed similar results in terms of effectiveness for all the methods used, except visual inspection. This study showed that even though the employees had various levels of work performance, there was still a similar effect on the outcome of the intervention package.