Environmental Hygiene in Healthcare

CDC proposes research agenda focused on the cleaning and disinfection of surfaces in patient rooms

In the 1970s and 1980s the transmission of pathogens from healthcare surfaces to susceptible patients was thought to be insignificant. More recent studies show surfaces in the patient’s room such as bedrails, bedside tables and call buttons may play a role in the transmission of disease from one patient to another patient. However there is limited evidence guiding facilities on the best practices for preventing or reducing the contamination of these environmental surfaces.

On September 14, 2015, CDC’s Division of Healthcare Quality Promotion (DHQP) hosted the roundtable discussion, “Environmental Hygiene for Ebola and Other Emerging Pathogens in Healthcare.” The meeting brought together more than 30 clinical and academic experts, members of industry, patient advocates, federal agencies and union representatives to discuss the current state of knowledge regarding how patient care surfaces become contaminated, how transmission of infections occur from these surfaces, and importantly, what facilities can do to improve the cleanliness of these surfaces. Many of the experts attending the meeting are actively engaged in research in understanding the role of the environmental surfaces in transmission of infections and are evaluating solutions in order to reduce healthcare-associated infections (HAIs). CDC proposed a framework for research that can give context to these current projects and guide future projects in order to answer key questions in this field.

Key areas of interest that were highlighted throughout the discussion included:

• Understanding transmission events related to patient room surfaces
  • An estimated 722,000 healthcare-associated infections occurred in 2011 and about 75,000 hospital patients with HAIs died during their hospitalizations. A continued focus on traditional infection control efforts such as hand hygiene is still paramount, however it is unknown how many of these infections may be prevented by improving the cleanliness of a patient’s hospital room. By understanding how surfaces in a patient’s room contribute to transmission events, facilities can understand which surfaces are the most likely to become contaminated and optimize the cleaning and disinfection of these surfaces as one more tool for preventing infections.
• Measuring cleanliness
  • Many methods for sampling a surface and measuring its cleanliness exist. In order to evaluate the impact that environmental surface contamination has on the risk for healthcare-associated infections, a standardized approach to measuring cleanliness is needed. By standardizing these methods, future studies can evaluate whether certain levels of cleanliness are associated with improved patient safety.
• Improving cleanliness by focusing on process
  • The importance of the environmental service (EVS) worker was discussed throughout the meeting. There are a multitude of factors that may impede the ability of environmental services to adequately clean and disinfect hospital rooms. The roundtable discussed subject areas that need further study and guidance, which included methods of education and training of EVS workers, methods for monitoring cleaning and disinfection, and structural challenges to the work of EVS.
• Improving cleanliness by evaluating emerging interventions
  • Industry has developed a number of tools for preventing and reducing the contamination of patient room surfaces as well as tools for monitoring cleaning and disinfection. However, the body of evidence regarding these technologies is still limited, therefore facilities struggle with how to compare these emerging methods and optimize their use. Much of the roundtable discussion highlighted the challenges of comparing these methods and recognize that understanding the comparative effectiveness of these methods is of considerable interest.

CDC is currently actively engaged in a number of projects regarding infection control related to patient rooms. One of the purposes of this roundtable was to establish shared goals and highlight the issues that are most pressing. CDC plans to continue to work with its partners to identify priority areas and build a body of evidence that can help guide healthcare facilities on how to reduce the contamination of these surfaces in order to improve patient safety.

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