A Comprehensive Approach to Surface Disinfection

By Kimberly E. LaFreniere, PhD

May 23, 2014 | Formats: Article | Content Areas: Environmental Sanitation Operations | Tags: Chemicals , Emerging Pathogens, Environmental hygiene and sanitation, Evidence-Based Practice Solutions, Infection Prevention and Epidemiology

Today few would argue that the environment plays a role in the transmission of many health care pathogens including C. difficile, MRSA, VRE and others. Manual cleaning and disinfection with EPA-registered hospital products has long been the front-line defense for the reduction of pathogenic organisms on environmental surfaces in health care facilities. Environmental Services (EVS) personnel are tasked with the incredibly important process of cleaning and disinfecting the patient environment and are the unsung heroes of infection prevention.

Yet, hospital staff face a myriad of challenges when performing manual environmental cleaning and disinfection processes, often leading to suboptimal results. Gaps in the cleaning and disinfection processes have given rise to the development of novel technologies, such as ultraviolet (UV) light, that supplement manual environmental hygiene practices. (1)

Consider the following evidence-based facts about the health care environment:

  • Validation that environment plays a role: Environmental contamination has been demonstrated to play a role in acquisition of infection with MRSA, VRE, C. difficile, Pseudomonas aeruginosa, Acinetobacter species and Norovirus. (2,3)
  • Disinfection practice is sub-optimal: Studies have shown that staff is only cleaning and disinfecting about 30 percent to 50 percent of the surfaces that should be cleaned, which include toilet hand holds, light switches, door knobs, bedside rails, nurse call buttons and patient telephones. (4,5)
  • Pathogens survive up to months: Studies have found that both Gram (+) and Gram (-) bacteria can survive for months on dry surfaces; respiratory viruses can survive for days, and gastrointestinal viruses for more than a week. (6)
  • In hospitals, previous occupancy increases risk: It has been shown that patients are at higher risk of acquiring an HAI when their room was previously occupied by an infected patient. (7) 

Given that an HAI can cost a facility up to $45,000, (8) a more comprehensive approach to surface disinfection may be necessary. The adoption of UV surface treatment technology may be a cost-effective intervention.

Best practices

UV devices should be used to supplement - not to replace - standard hospital cleaning and disinfection protocols. Many health care facilities tend to supplement with a UV device in high-risk areas such as patient rooms, patient bathrooms, operating rooms, intensive care units, oncology units, burn units and radiology. As a general guideline, UV devices can be deployed in any room where the door can be closed and the room can be vacated.

All health care facilities strive to obtain the best patient outcomes. By taking a more comprehensive approach to surface disinfection and deploying UV devices or other novel technologies after thorough manual cleaning and disinfection, facilities can be more confident that they are doing everything possible to provide a better environment for their patients.

References

  1. Weinstein, R.A. “Nosocomial Infection Update” Emerging Infectious Diseases, Vol. 4, No. 3, July–September 1998.
  2. David J. Weber, William A. Rutala, Melissa B. Miller, Kirk Huslage, and Emily Sickbert-Bennett “Role of hospital surfaces in the transmission of emerging healthcare associated pathogens: Norovirus, Clostridium difficile, and Acinetobacter Species” Am J Infect Control 2010;38:S25-33. 
  3. C. J. Donskey ”Does improving surface cleaning and disinfection reduce health care-associated infections?” Am J Infect Control 41 (2013) S12-S19.
  4. P. C. Carling , M. F. Parry, S. M. Von Beheren , “Identifying Opportunities to Enhance Environmental Cleaning in 23 Acute Care Hospitals Infect Control Hosp Epidemiol, Vol. 29, No. 1 (January 2008), pp. 1-7.
  5. P. C. Carling, Michael M. Parry, Mark E. Rupp, John L. Po, Brian Dick, Sandra Von Beheren , “Improving Cleaning of the Environment Surrounding Patients in 36 Acute Care Hospitals” Infect Control Hosp Epidemiol, Vol. 29, No. 11 (November 2008), pp. 1035-1041.
  6. Axel Kramer, Ingeborg Schwebke, Günter Kampf, “How long do nosocomial pathogens persist on inanimate surfaces? A systematic review” BMC Infectious Diseases 2006, 6:130.
  7. Datta R, Platt R, Yokoe DS, Huang SS. “Environmental Cleaning intervention and Risk of Acquiring Multidrug-Resistant Organisms from Prior Room Occupants.“ Arch Int Med 2011;171:491-4.
  8. Zimlichman, E. et. al. “Health Care-Associated Infections A Meta-analysis of Costs and Financial Impact of the US Health Care System” JAMA Internal Medicine, published online September 2, 2013.

Key Resources