Cleaning Hospital Room Surfaces to Prevent Health Care–Associated Infections

Abstract

The cleaning of hard surfaces in hospital rooms is critical for reducing health care–associated infections. This review describes the evidence examining current methods of cleaning, disinfecting, and monitoring cleanliness of patient rooms, as well as contextual factors that may affect implementation and effectiveness. Key informants were interviewed, and a systematic search for publications since 1990 was done with the use of several bibliographic and gray literature resources. Studies examining surface contamination, colonization, or infection with Clostridium difficile, methicillin-resistant Staphylococcus aureus, or vancomycinresistant enterococci were included. Eighty studies were identified—76 primary studies and 4 systematic reviews. Forty-nine studies examined cleaning methods, 14 evaluated monitoring strategies, and 17 addressed challenges or facilitators to implementation. Only 5 studies were randomized, controlled trials, and surface contamination was the most commonly assessed outcome. Comparative effectiveness studies of disinfecting methods and monitoring strategies were uncommon. Future research should evaluate and compare newly emerging strategies, such as self-disinfecting coatings for disinfecting and adenosine triphosphate and ultraviolet/fluorescent surface markers for monitoring. Studies should also assess patient-centered outcomes, such as infection, when possible. Other challenges include identifying high-touch surfaces that confer the greatest risk for pathogen transmission; developing standard thresholds for defining cleanliness; and using methods to adjust for confounders, such as hand hygiene, when examining the effect of disinfecting methods.

Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study

“…However, to our knowledge, no multicentre randomised assessment of enhanced terminal room disinfection strategies has been done. 9 We designed the Benefits of Enhanced Terminal Room Disinfection study to assess the effects of four different strategies for terminal room disinfection on acquisition of multidrug-resistant organisms and C difficile .…”

Colonization of patients, healthcare workers, and the environment with healthcare-associated Staphylococcus epidermidis genotypes in an intensive care unit: a prospective observational cohort study

“…Studies have shown that Staphylococcus spp. constitute an important part of the microbiota colonizing the hospital environment [38]. This is apparent even after routine daily cleaning or after adding copper to surfaces that are frequently touched in hospital settings [39, 40].…”

Exploring surface cleaning strategies in hospital to prevent contact transmission of methicillin-resistant Staphylococcus aureus

“…The variable used to measure the impact of cleaning is the concentration of MRSA in the nares of the susceptible patient and the HCW, which better reflects potential health outcomes than environmental levels [11]. Risk of colonization and risk of infection were not calculated because the dose-response function for infection arising from dermal exposure to S. aureus assumes occlusion of the inoculation site for a week, which is not reasonable [36, 37]; and the risk of colonization has only been associated with airborne concentrations of S. aureus [22].…”

“…In addition, each HCW provides high-intensity care to a small number of patients [10]. Two surface cleaning interventions were studied: whole room surface cleaning and disinfection and wipe cleaning of touched surfaces [11]. Whole room cleaning is typically performed by environmental service workers, and while the frequency is not standardized, this activity was assumed to occur daily.…”