Evidence Spotty for Healthcare Facility Cleaning Practices

Among 80 studies, 49 examined cleaning methods, while 14 evaluated monitoring strategies, and 17 addressed challenges or facilitators to implementation, reported Jennifer Han, MD, of the University of Pennsylvania in Philadelphia, and colleagues.

But only five studies were randomized controlled trials -- most simply compared microbial counts before and after cleaning -- and there was a lack of studies on disinfecting methods and monitoring strategies, they wrote in a technical brief in the Annals of Internal Medicine.

The findings point to a need for more rigorous, comparative effectiveness trials to determine the best hospital cleaning practices for preventing infections transmitted via hard surfaces such as tables, bed rails, light switches, and toilets, the authors stated.

Han said the study "came about because of a recently increased interest in the role of environmental cleaning and reducing HAIs ... because there are a lot of newer technologies for disinfection such as ultraviolet (UV) light and hydrogen peroxide vapor." Recently emerging infections like the Ebola virus also added to the interest in environmental contamination research.

HAIs affect about one in 25 American inpatients daily, according to the CDC. They're a leading cause of illness and death; about 75,000 Americans died from HAIs in 2011. Despite years of research, little is known about the relative role environmental factors play in transmission of the diseases, and the most effective ways to prevent transmission in the environment.

Han's group performed a systematic overview of all scientific literature on cleaning, disinfecting, and monitoring of frequently touched surfaces in inpatient facilities, focusing on studies examining surface contamination, colonization and infections with Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci.

Han said her group focused on "hard surfaces of hospital rooms -- tray tables, intravenous poles, call buttons, hard surfaces -- that are easily contaminated by pathogens that cause HAIs" also known as "high-touch objects."

They evaluated three broad categories of evidence, specifically which agents and methods were being used for cleaning surfaces, how the "effectiveness and appropriateness" of cleaning was monitored, and what systems-level factors were needed to best facilitate cleaning practices.

Studies on chemical disinfectants like bleach, chlorine, and peroxide solutions reported mixed findings. Six studies on disinfecting wipes and 17 studies on no-touch methods (UV light, hydrogen peroxide vapor) had positive outcomes, some of which included decreased infection rates. Seven out of eight studies on antimicrobial coatings, such as copper, also reported positive findings.

"The newer technologies such as UV light and hydrogen peroxide vapor seem to have promising results, but we can't know how well they work compared with or in addition to other cleaning methods until we have randomized control trials," Han explained.

You may read the original article in it’s entirety by Hanneke Weitering on MedPage Today