Clean Trial - Chlorination to Reduce Enteric and Antibiotic Resistant Infections in Neonates

NCT ID: NCT06824350

Last Updated: 2025-05-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

45450 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-01-21

Study Completion Date

2027-07-31

Brief Summary

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The CLEAN (ChLorine to reduce Enteric and Antibiotic resistant infections in Neonates) cluster randomized controlled trial in western Kenya will evaluate the impact of a multi-component chlorination intervention in health care facilities on maternal and neonatal health. Intervention facilities will receive a passive chlorination technology for water supply treatment and a reliable supply of sodium hypochlorite disinfectant. Both intervention and treatment facilities will receive infection prevention and control messaging. The goal of the study is to evaluate the impact of the intervention on bacterial contamination of water supply, on staff hands, and on high-touch surfaces in maternity wards, and the following outcomes among facility-born neonates and their mothers: (1) gut carriage of bacterial pathogens associated with sepsis one week post-birth, (2) gut carriage of antibiotic resistant bacteria one week post-birth, and (3) symptoms of possible serious bacterial infection one week following birth.

Detailed Description

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The proportion of births occurring at healthcare facilities is rising globally, yet healthcare facilities in low-income settings have been found to be highly contaminated with bacterial pathogens, including antibiotic resistant pathogens. There is a need for effective strategies to reduce contamination in healthcare facilities in order to reduce infection risks among facility-born neonates. In this trial, medium-sized public health facilities will be randomized to control or to receive an intervention consisting of passive chlorination for water supply treatment and a reliable supply of chlorine disinfectant. Reliable supply is randomized as either (a) an electrochlorinator for on-site production or (b) bulk chlorine delivery.

This cluster randomized controlled trial will enroll 36 health facilities to generate rigorous evidence on the maternal and neonatal health benefits of chlorinated water supply paired with reliable supplies of chlorine disinfectant. This study has the following aims: 1) determine the impact of the intervention on pathogenic and antibiotic resistant bacterial contamination in water supplies, on high-touch surfaces, and on healthcare worker hands, 2) quantify intervention effects on gut colonization of mothers and neonates by a panel of pathogenic and antibiotic resistant bacteria species linked to serious infection, using molecular and culture-based methods, and 3) follow up with mother-neonate dyads to measure intervention effects on symptoms of possible serious bacterial infection in the week following birth. Data collection will be for a duration of 24 months.

Infection prevention through effective water, sanitation, and hygiene (WASH) has been cited by national action plans as a key tool in the fight against antimicrobial resistance and, while global data show dire WASH conditions in low- and middle-income (LMIC) health facilities, there exists very little guidance for implementing effective interventions. The overarching goal is to generate actionable evidence to inform investments in chlorination at health facilities to improve maternal and neonatal health and reduce the threat of antibiotic resistant infections.

Conditions

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Sepsis Neonatal Mortality Antibiotic Resistant Infection Enteric Infections Serious Bacterial Infection

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Investigators Outcome Assessors
Lab technicians will be masked to intervention status of samples received. A subset of investigators will be masked to outcomes by intervention status until data collection is complete.

Study Groups

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Control

Control group. At the conclusion of the trial, facilities will receive a chlorine doser.

Group Type ACTIVE_COMPARATOR

infection prevention and control messaging

Intervention Type BEHAVIORAL

Infection prevention and control guidance and messaging

Multi-component chlorine intervention

Health care facilities will receive one or more inline chlorine dosers that will automatically chlorinate all water accessed by the maternity wards. Intervention facilities will also be randomized to either receive an electrochlorinator for on-site production of liquid chlorine solution or to receive bulk chlorine deliveries. Chlorine will be use to refill the chlorine dosers and for surface disinfection. Facilities will also receive hardware to facilitate surface disinfection.

Group Type EXPERIMENTAL

chlorination for water disinfection and surface disinfection

Intervention Type DEVICE

* Installation of inline chlorine doser(s) for automated water disinfection.
* Provision of chlorine solution for water and surface disinfection (half of treatment facilities randomized to receive electrochlorinator, half receive bulk chlorine solution deliveries).
* Provision of mop(s), bucket(s), and spray bottles for surface cleaning.

infection prevention and control messaging

Intervention Type BEHAVIORAL

Infection prevention and control guidance and messaging

Interventions

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chlorination for water disinfection and surface disinfection

* Installation of inline chlorine doser(s) for automated water disinfection.
* Provision of chlorine solution for water and surface disinfection (half of treatment facilities randomized to receive electrochlorinator, half receive bulk chlorine solution deliveries).
* Provision of mop(s), bucket(s), and spray bottles for surface cleaning.

Intervention Type DEVICE

infection prevention and control messaging

Infection prevention and control guidance and messaging

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Public health care facility
* 25 live births or more per month
* Infrastructure compatible with inline chlorination device


* Pregnant adults/mature minors arriving at enrolled facilities to give birth and their neonates

Exclusion Criteria

* Existing facility-level chlorination


* Miscarriage (\<28 weeks gestation)
* Stillbirth (for neonatal analysis only)
* Unable to give informed consent/do not consent
* Reside \>2 hours away from facility for enrollment into swab sampling cohort
Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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National Institute of Allergy and Infectious Diseases (NIAID)

NIH

Sponsor Role collaborator

Kenya Medical Research Institute

OTHER

Sponsor Role collaborator

Walter Reed Army Institute of Research (WRAIR)

FED

Sponsor Role collaborator

University of California, Berkeley

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Amy J Pickering, PhD

Role: PRINCIPAL_INVESTIGATOR

University of California, Berkeley

Phelgona Otieno, PhD

Role: PRINCIPAL_INVESTIGATOR

Kenya Medical Research Institute

Lillian Musila, PhD

Role: PRINCIPAL_INVESTIGATOR

Walter Reed Army Institute of Research-Africa

Locations

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University of California, Berkeley

Berkeley, California, United States

Site Status ACTIVE_NOT_RECRUITING

Kenya Medical Research Institute

Nairobi, , Kenya

Site Status RECRUITING

Countries

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United States Kenya

Central Contacts

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Amy J Pickering, PhD

Role: CONTACT

1-510-410-2666

Yoshika Crider, PhD

Role: CONTACT

1-785-550-5227

Facility Contacts

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Phelgona Otieno, PhD

Role: primary

+254-721973971

References

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Lindmark M, Cherukumilli K, Crider YS, Marcenac P, Lozier M, Voth-Gaeddert L, Lantagne DS, Mihelcic JR, Zhang QM, Just C, Pickering AJ. Passive In-Line Chlorination for Drinking Water Disinfection: A Critical Review. Environ Sci Technol. 2022 Jul 5;56(13):9164-9181. doi: 10.1021/acs.est.1c08580. Epub 2022 Jun 14.

Reference Type BACKGROUND
PMID: 35700262 (View on PubMed)

Pickering AJ, Crider Y, Sultana S, Swarthout J, Goddard FG, Anjerul Islam S, Sen S, Ayyagari R, Luby SP. Effect of in-line drinking water chlorination at the point of collection on child diarrhoea in urban Bangladesh: a double-blind, cluster-randomised controlled trial. Lancet Glob Health. 2019 Sep;7(9):e1247-e1256. doi: 10.1016/S2214-109X(19)30315-8.

Reference Type BACKGROUND
PMID: 31402005 (View on PubMed)

Other Identifiers

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R01AI184756

Identifier Type: NIH

Identifier Source: secondary_id

View Link

2024-01-17100

Identifier Type: -

Identifier Source: org_study_id

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