Dos and don’ts for hospital cleaning

Abstract

Purpose of review More evidence is emerging on the role of cleaning and decontamination for reducing hospital-acquired infection. Timely and adequate removal of environmental pathogens leads to measurable clinical benefits for patients. This article considers studies published from 2013 examining hospital decontamination technologies and evidence for cost-effectiveness. Recent findings Novel biocides and cleaning products, antimicrobial coatings, monitoring practices and automated equipment are widely accessible. They do not necessarily remove all environmental pathogens, however, and most have yet to be comprehensively assessed against patient outcome. Some studies are confounded by concurrent infection control and/or antimicrobial stewardship initiatives. Few contain data on costs. Summary As automated dirt removal is assumed to be superior to human effort, there is a danger that traditional cleaning methods are devalued or ignored. Fear of infection encourages use of powerful disinfectants for eliminating real or imagined pathogens in hospitals without appreciating toxicity or cost benefit. Furthermore, efficacy of these agents is compromised without prior removal of organic soil. Microbiocidal activity should be compared and contrasted against physical removal of soil in standardized and controlled studies to understand how best to manage contaminated healthcare environments.

Proactive Approach for Safe Use of Antimicrobial Coatings in Healthcare Settings: Opinion of the COST Action Network AMiCI

“…Dancer [106] clearly suggested that more work is required on the AMCs as futuristic antiseptic surfaces.…”

Healthcare‐acquired infections: prevention strategies

“…44 HPV has also been used in C. difficile and MRSA outbreaks, and may have a role in norovirus infection. 38,46 The addition of UV to standard cleaning reduced VRE rates by 31%. 42 However, both systems are expensive, require trained staff, and are adjuncts to standard physical cleaning.…”

“…23,36 Patients admitted to rooms previously occupied by VRE or MRSA carriers have a two-to three-fold increased risk of acquisition, and similar rates are seen for A. baumannii, Pseudomonas aeruginosa and, as discussed above, C. difficile. 37,38 Molecular typing of MRO outbreaks has linked the environment, hands of HCW, and patient isolates. HCW may have a primary role in spread, but they can acquire MRO from the environment or inadequately cleaned equipment, including monitors, blood pressure cuffs and tourniquets.…”

“…47,48 Initiatives including staff education, implementation of regular feedback and discussion of objective performance data, engender accountability and ownership and can result in improved standards. 38 Investment in cleaning staff as a valuable resource relies on the support of hospital executives. Time pressure, inadequate training and high staff turnover rates will, if unaddressed, undermine performance and MRO control.…”

Infection control: Evidence-based common sense

“…Novel biocides and cleaning products, antimicrobial coatings, auditing practices and automated equipment are widely accessible, but most have not been comprehensively assessed against patient outcome nor subjected to appropriate cost-benefit analyses [37]. It is singularly unhelpful when studies showcasing a new product claim patient benefit but are then found to be confounded by concurrent infection control and/or antimicrobial stewardship initiatives [37].…”