Environmental cleaning to prevent hospital-acquired infections on non-intensive care units: a pragmatic, single-centre, cluster randomized controlled, crossover trial comparing soap-based, disinfection and probiotic cleaning
Open accessAbstract
Background: The impact of environmental hygiene on the occurrence of hospital-acquired infections (HAIs) remains a subject of debate. We determined the effect of three different surface-cleaning strategies on the incidence of HAIs. Methods: Between June 2017 and August 2018 we conducted a pragmatic, cluster-randomized controlled crossover trial at 18 non-ICU wards in the university hospital of Berlin, Germany. Surfaces in patient rooms on the study wards were routinely cleaned using one of three agents: Soap-based (reference), disinfectant and probiotic. Each strategy was used on each ward for four consecutive months (4m-4m-4m). There was a one-month wash-in period at the beginning of the study and after each change in strategy. The order of strategies used was randomized for each ward. Primary outcome was the incidence of HAIs. The trial was registered with the German Clinical Trials Register, DRKS00012675. Findings: 13,896 admitted patients met the inclusion criteria, including 4708 in the soap-based (reference) arm, 4535 in the disinfectant arm and 4653 in the probiotic arm. In the reference group, the incidence density of HAIs was 2.31 per 1000 exposure days. The incidence density was similar in the disinfectant arm 2.21 cases per 1000 exposure days (IRR 0.95; 95% CI 0.69-1.31; p = 0.953) and the probiotic arm 2.21 cases per 1000 exposure days (IRR 0.96; 95% CI 0.69-1.32; p = 0.955). Interpretation: In non-ICU wards, routine surface disinfection proved not superior to soap-based or probiotic cleaning in terms of HAI prevention. Thus, probiotic cleaning could be an interesting alternative, especially in terms of environmental protection. Funding: Federal Ministry of Education and Research of Germany (03Z0818C). Bill and Melinda Gates Foundation (INV-004308).
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Other PBS formulations including Bacillus probiotics are generally more effective in controlling nosocomial pathogens and AMR than disinfectants or other detergents.
“Similar results were obtained when other PBS formulations, including Bacillus probiotics, were used, revealing their generally greater effectiveness in controlling nosocomial pathogens and AMR [37] than disinfectants or other detergents [38].”
From Profiling the resistome and virulome of Bacillus strains used for probiotic-based sanitation: a multicenter WGS analysis (2025) · cites this paper as [38]
The Discussion (page not provided) says this trial found similar results for probiotic cleaning and the other two strategies, especially disinfection, and no overall significant effect on multidrug-resistant-organism infections. Although it mentions earlier studies showing reductions in surface pathogens or resistance markers, it does not find that probiotic cleaning is generally more effective than disinfectants or detergents. (LLM, conf=0.88)
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“Similar results were obtained when other PBS formulations, including Bacillus probiotics, were used, revealing their generally greater effectiveness in controlling nosocomial pathogens and AMR [37] than disinfectants or other detergents [38].”
- Authors
- Leistner, R., Kohlmorgen, B., Brodzinski, A., Schwab, F., Lemke, E., Zakonsky, G., & Gastmeier, P.
- Affiliations
- Humboldt-Universität zu Berlin (DE)
- Stiftung Charité (DE)
- Corresponding author
- Leistner, Rasmus
- Venue
- eClinicalMedicine
- Publisher
- Elsevier BV
- Published
- 2023-05
- Volume
- 59
- Pages
- 101958
- ISSN
- 2589-5370 (ISSN-L)
- PMC
- PMC10113752
- OpenAlex
- W4362675562
- Cited by
- 48
- References
- 45
- Citations by year
- 2026: 11 · 2025: 19 · 2024: 13 · 2023: 5
- FWCI
- 9.94
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- EClinicalMedicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Federal Ministry of Education and Research Berlin Office (03Z0818C)
- Bill and Melinda Gates Foundation (INV-004308)
- Bundesministerium für Bildung und Forschung (KARMIN – 03Z0818C)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Keywords
- nosocomial infections, environmental cleaning, surface disinfection, environmental hygiene, non-intensive care units, infection control
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