Evidence Map and Systematic Review of Disinfection Efficacy on Environmental Surfaces in Healthcare Facilities

Abstract

Healthcare-associated infections (HAIs) contribute to patient morbidity and mortality with an estimated 1.7 million infections and 99,000 deaths costing USD $28–34 billion annually in the United States alone. There is little understanding as to if current environmental surface disinfection practices reduce pathogen load, and subsequently HAIs, in critical care settings. This evidence map includes a systematic review on the efficacy of disinfecting environmental surfaces in healthcare facilities. We screened 17,064 abstracts, 635 full texts, and included 181 articles for data extraction and study quality assessment. We reviewed ten disinfectant types and compared disinfectants with respect to study design, outcome organism, and fourteen indictors of study quality. We found important areas for improvement and gaps in the research related to study design, implementation, and analysis. Implementation of disinfection, a determinant of disinfection outcomes, was not measured in most studies and few studies assessed fungi or viruses. Assessing and comparing disinfection efficacy was impeded by study heterogeneity; however, we catalogued the outcomes and results for each disinfection type. We concluded that guidelines for disinfectant use are primarily based on laboratory data rather than a systematic review of in situ disinfection efficacy. It is critically important for practitioners and researchers to consider system-level efficacy and not just the efficacy of the disinfectant.

Direct and indirect healthcare and carbon savings with ACTIVE Particle ControlTM air-purification

“…Recently an exhaustive review of studies on anti-infection procedures revealed they were based more on laboratory data rather than in situ efficacy ( 14 ). The authors advised practitioners and researchers to consider system-level efficacy and not just the efficacy of a focal setting.…”

“…They report little to no benefit of either technology in reducing particle counts or inactivating microorganisms and in-fact demonstrated significant ozone generation with photocatalytic technology. This underscores the need for more practical investigation of accepted and novel technical solutions such as APC ( 14 ).…”

Isolation and Identification of Pathogenic Bacteria from Hospital Door Handles/knobs

“…Healthcare Acquired Infections (HCAIs) continue to threaten the quality of patient care, and it is considered a major cause of morbidity and mortality worldwide [1]. In the United States, it is estimated that about 1.7 million people develop nosocomial-related illnesses yearly, and approximately 99,000 of them die [2]. Nosocomial pathogens are organisms causing diseases that are acquired from the hospital and healthcare environment within a few days of admission and are responsible for nosocomial infections [3], an endogenous bacterial flora is considered the main source of nosocomial infections, however, 20 to 40 % of nosocomial infections are caused by cross-contamination [4].…”

Phenotypic Variation in Clinical S. aureus Isolates Did Not Affect Disinfection Efficacy Using Short-Term UV-C Radiation

“…The high effectiveness of UV-C radiation in reducing a wide range of microorganisms, including MRSA, has been demonstrated, although predominantly in experimental studies [ 14 , 15 ]. As known for conventional chemical disinfectants, in vitro efficacy can vary greatly from real-world disinfection in a complex hospital setting depending on factors such as surface area, disinfectant concentration, contact time and type of microorganism [ 16 ]. Until now, mainly representative laboratory and test strains have been used for testing disinfection procedures.…”