{"doi":"10.1093/cid/ciac070","title":"Stopping Hospital Infections With Environmental Services (SHINE): A Cluster-randomized Trial of Intensive Monitoring Methods for Terminal Room Cleaning on Rates of Multidrug-resistant Organisms in the Intensive Care Unit","abstract":"BACKGROUND: Multidrug-resistant organisms (MDROs) frequently contaminate hospital environments. We performed a multicenter, cluster-randomized, crossover trial of 2 methods for monitoring of terminal cleaning effectiveness. METHODS: Six intensive care units (ICUs) at 3 medical centers received both interventions sequentially, in randomized order. Ten surfaces were surveyed each in 5 rooms weekly, after terminal cleaning, with adenosine triphosphate (ATP) monitoring or an ultraviolet fluorescent marker (UV/F). Results were delivered to environmental services staff in real time with failing surfaces recleaned. We measured monthly rates of MDRO infection or colonization, including methicillin-resistant Staphylococcus aureus, Clostridioides difficile, vancomycin-resistant Enterococcus, and MDR gram-negative bacilli (MDR-GNB) during a 12-month baseline period and sequential 6-month intervention periods, separated by a 2-month washout. Primary analysis compared only the randomized intervention periods, whereas secondary analysis included the baseline. RESULTS: The ATP method was associated with a reduction in incidence rate of MDRO infection or colonization compared with the UV/F period (incidence rate ratio [IRR] 0.876; 95% confidence interval [CI], 0.807-0.951; P = .002). Including the baseline period, the ATP method was associated with reduced infection with MDROs (IRR 0.924; 95% CI, 0.855-0.998; P = .04), and MDR-GNB infection or colonization (IRR 0.856; 95% CI, 0.825-0.887; P < .001). The UV/F intervention was not associated with a statistically significant impact on these outcomes. Room turnaround time increased by a median of 1 minute with the ATP intervention and 4.5 minutes with UV/F compared with baseline. CONCLUSIONS: Intensive monitoring of ICU terminal room cleaning with an ATP modality is associated with a reduction of MDRO infection and colonization.","journal":"Clinical Infectious Diseases","year":2022,"id":243260,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":34,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9462,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":875666,"name":"Hilary Babcock","orcid":null,"position":1,"is_corresponding":false},{"id":875667,"name":"Sharon Welbel","orcid":null,"position":2,"is_corresponding":false},{"id":316348,"name":"David K. Warren","orcid":"0000-0001-8679-8241","position":3,"is_corresponding":false},{"id":651268,"name":"William E. Trick","orcid":"0000-0002-3243-5098","position":4,"is_corresponding":false},{"id":460816,"name":"Pam Tolomeo","orcid":"0000-0001-5594-8884","position":5,"is_corresponding":false},{"id":462331,"name":"Jacqueline Omorogbe","orcid":null,"position":6,"is_corresponding":false},{"id":875008,"name":"Diana García-García","orcid":"0000-0003-1681-6074","position":7,"is_corresponding":false},{"id":875668,"name":"Tracy Habrock-Bach","orcid":null,"position":8,"is_corresponding":false},{"id":875669,"name":"Onofre Donceras","orcid":null,"position":9,"is_corresponding":false},{"id":875670,"name":"Steven Gaynes","orcid":null,"position":10,"is_corresponding":false},{"id":523281,"name":"Leigh Cressman","orcid":null,"position":11,"is_corresponding":false},{"id":420202,"name":"Jason P. Burnham","orcid":"0000-0002-4777-3006","position":12,"is_corresponding":false},{"id":356701,"name":"Warren B. Bilker","orcid":"0000-0002-2704-7525","position":13,"is_corresponding":false},{"id":225444,"name":"Sujan Reddy","orcid":"0000-0002-3267-7011","position":14,"is_corresponding":false},{"id":294611,"name":"David A. Pegues","orcid":"0000-0002-5295-0046","position":15,"is_corresponding":false},{"id":287738,"name":"Ebbing Lautenbach","orcid":"0000-0003-4772-2409","position":16,"is_corresponding":false},{"id":522319,"name":"Brendan J. Kelly","orcid":"0000-0003-2023-646X","position":17,"is_corresponding":false},{"id":538160,"name":"Barry D. Fuchs","orcid":null,"position":18,"is_corresponding":false},{"id":698022,"name":"Niels D. Martin","orcid":"0000-0002-2157-0825","position":19,"is_corresponding":false},{"id":287737,"name":"Jennifer Han","orcid":"0000-0003-4744-8067","position":20,"is_corresponding":false},{"id":875007,"name":"Matthew J. Ziegler","orcid":"0000-0002-5723-3927","position":0,"is_corresponding":true}],"reference_count":40,"raw_metadata":null,"created_at":"2026-07-19T00:23:16.032700Z","pmid":"35100614","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}