Healthcare-associated infections (HAIs) remain a major problem in intensive care units (ICUs), driven by environmental contamination with multidrug-resistant organisms that persist despite routine manual cleaning. While hydrogen peroxide aerosolization and ultraviolet-C light devices have shown promise in reducing surface contamination, current evidence is inconsistent, mostly derived from single-center studies, and rarely linked to patient-centered outcomes.
The investigators will conduct this cluster-randomized, crossover trial in 12 Brazilian ICUs. Each ICU will sequentially implement three strategies: (1) usual surface disinfection; (2) usual surface disinfection followed by hydrogen peroxide aerosolization at 7.9% concentration, applied through a dedicated device inside a protective tent during terminal cleaning of patient beds; and (3) usual surface disinfection followed by automated ultraviolet-C irradiation, also applied under the same tent to shield adjacent occupied beds.
The primary outcome will be the antimicrobial utilization, measured as daily defined doses (DDD) of antimicrobials at the ICU level per 100 patient-days, with secondary outcomes including HAI incidence rate, environmental contamination with multidrug-resistant organisms, specific HAIs incidence rate (associated-ventilator pneumonia, central-line associated bloodstream infection, and catheter-associated urinary tract infection), and ICU length of stay costs.
All patients aged 18 years and older who will be admitted to the participating ICUs
Patients under 18 years
ICUs that use peroxide hydrogen or ultraviolet light for surface disinfection as part of their protocol
Crossover
Aerosol of hydrogen peroxide
Other interventionSpray of aerosolized peroxide hydrogen using a specific device when performing terminal cleaning of the ICU bed after the patient's discharge.
Irradiation of ultraviolet light
Other interventionIrradiation of UV light for the purpose of disinfecting beds and surfaces near beds during terminal cleaning.
Antimicrobial utilization at the ICU level
Antimicrobial utilization, measured as daily defined doses (DDD) of antimicrobials at the ICU level per 100 patient-days
Healthcare-associated infections
Incidence rate of device healthcare-associated infections during ICU admission
Contamination of environmental surfaces by multi-resistant microorganisms
We will collect environmental samples from 4 surfaces highly touched by the patient, health team and family (bed rails, monitor and infusion pump buttons, meal table or procedure table, and IV drip stand) before and after the intervention. For analysis of the environmental samples, characterization of the density and microbiological profile of biofilms on the different surfaces of the ICU beds will be performed using large-scale DNA sequencing techniques associated with bioinformatics analysis.
Incidence density of ventilator-associated pneumonia
Incidence density of central line-associated bloodstream infections
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Hospital Israelita Albert Einstein
Lead sponsor
Hospital Sirio-Libanes
Collaborator
Hospital do Coracao
Collaborator
Beneficência Portuguesa de São Paulo
Collaborator
