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Effective Health Care Program

Environmental Cleaning for the Prevention of Healthcare-Associated Infections (HAI)

Technical Brief

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Structured Abstract

Background

The cleaning of hard surfaces in hospital rooms is essential for reducing the risk of healthcare-associated infections. Many methods are available for cleaning and monitoring cleanliness, but their comparative effectiveness is not well understood.

Purpose

This Technical Brief summarizes the evidence base addressing environmental cleaning of high-touch surfaces in hospital rooms and highlights future research directions.

Methods

A systematic search for published and gray literature since 1990 was performed using PubMed, EMBASE, CINAHL, the Cochrane Library, and other resources. Clinical studies examining the cleaning and disinfection of high-touch surfaces in adult inpatient hospital rooms were included. Primary outcomes of interest were patient infection, colonization, or surface contamination with Clostridium difficile, methicillin-resistant Staphylococcus aureus, or vancomycin-resistant enterococci. Additionally, 12 Key Informants were interviewed, representing environmental services management, hospital infection control, and clinical infectious diseases.

Findings

Eighty studies were included. Forty-nine studies examined cleaning modalities, including chemical agents, self-disinfecting surfaces, and no-touch technologies. Fourteen studies evaluated monitoring strategies, including visual inspection, microbiological cultures, assays, and ultraviolet light. Seventeen studies addressed challenges or facilitators to implementation. Sixty-five studies used nonrandomized concurrent or historical controls. The outcome of surface contamination was reported in 57 studies; infection rates were reported in 25.

Conclusions

Comparative-effectiveness studies directly comparing disinfection modalities and monitoring strategies are limited. Future research should examine and compare newly emerging strategies, such as peracetic acid, hydrogen peroxide wipes, enhanced coatings, and microfiber cloths as cleaning strategies, and adenosine triphosphate and ultraviolet light technologies as monitoring strategies. Patient colonization and infection rates should be included as outcomes when possible. Other challenges to be addressed include identification of surfaces posing the greatest risk of pathogen transmission, developing standard thresholds for defining cleanliness, and using methods to adjust for confounders such as hand-hygiene practices when examining the impact of disinfection modalities.

Journal Publications

Han JH, Sullivan N, Leas BF, Pegues DA, et. al. Cleaning Hospital Room Surfaces to Prevent Health Care–Associated Infections: A Technical Brief. Ann Intern Med. [Epub ahead of print 11 August 2015] doi:10.7326/M15-1192.