Surface Selection in Health Care - Part 1

Healthcare acquired infections (HAIs) are the third leading cause of death in the US, behind heart disease and cancer. One in every 25 inpatients will acquire an infection while being treated. These infections lead to the loss of tens of thousands of lives and cost billions of dollars every year. Since these infections are largely preventable, the federal government has added significant penalties to facilities with high infection rates. The pressure is on to address this issue now.

Foundational Issue:

The science of surfaces as a fomite (object or material that is likely to carry infection) is just now maturing. Research has shown that microbes can live on “clean and disinfected” surfaces for days, weeks and even months. How is this possible when surfaces are being regularly cleaned and disinfected? The goal of this article is to present seven aspects of surface selection and to gain an understanding of why facilities must set surface criteria to not only minimize financial risk, but also to prevent harm to patients, healthcare workers and the general public.

Surfaces are a complicated subject. Most people think of surfaces as part of the design and construction process and not as part of an infection prevention and control program. When selecting materials, a lot of focus tends to be given to colours and textures that create “a healing environment.” Although these aspects of a surface material are certainly important, there are many other surface properties that are of critical importance, yet are not thought about or given proper evaluation. In order for an environment to be “healing” it need to also not introduce the potential for detrimental effects, like infections. After all, the most soothing colour and texture is of little value to a surface that cannot be cleaned or disinfected properly.

People interact with surfaces throughout the day without a second thought. If hands are washed regularly, a person with a healthy immune system has a good chance of reducing his risk of infection. This is not necessarily true for someone with a compromised immune system.

Ironically, surfaces are often cleaned and disinfected based on visual inspection, even though it is commonly understood that microbes cannot be seen. Research has shown that at the microscopic level, microbe counts can quickly rebound, often times to levels seen prior to cleaning and disinfection. This leaves patients, healthcare workers and the general public at constant risk of acquiring and spreading infection. In fact, studies show that patients are at risk of contracting an infection, such as MRSA or C. Difficilie from the patient who previously occupied the same room at a rate of 35% to 50%, depending on the infection, despite routine and terminal cleaning and disinfection.

Selection of Surfaces:

Currently, the surface evaluation and selection process is predominately based on specific design criteria established before any construction or renovation project. The look, feel and where the surface is located are all based on creating a homelike, healing environment. While this is important, the selection of surfaces is complicated and the evaluation process must go far beyond the way it looks and feels. As I see it, the goal is to evaluate ALL surfaces, taking into consideration seven different aspects that contribute to the spread of infection. Ultimately, it is important that surfaces are capable of being effectively cleaned and disinfected. Unfortunately, the majority of surfaces being used in healthcare today are difficult – if not impossible –  to clean effectively.

There is a science around the spread of infection via surfaces. It is not enough to learn every physical characteristic of a given surface and surface material, nor to become an expert in the latest disinfection agents and protocols. This data must be combined with an understanding of microbiology, the physical environment and insight into human behaviour. Taking into consideration all seven of the following aspects and entrenching surface selection criteria within healthcare facility construction and renovation specifications will begin to address the critical role surfaces play in reducing HAIs.

1) Materials and

Healthcare facilities are full of many different surface materials, textiles and products. Necessary products, such as chairs, beds, sheets, privacy curtains, and bedside tables are selected by looking at sample books or swatches of material, in addition to special features any of these products may offer. While these properties are important, they are only the tip of the iceberg, providing only a small glimpse of what is truly needed in any healthcare setting.

Project managers, architects and designers must be aware of textured surface materials, such as brushed stainless steel, pebble texture acrylic wall surfaces, fabrics with tight or open weave, and vinyl and plastic materials. These types of finishes may create additional challenges during the cleaning and disinfection process.

There are many critical questions to be asked and answered regarding each surface material being considered. A few important ones are:

• What will it take to clean this surface?
• Can it be cleaned with the products the facility is currently using?
• Has it been tested to verify hospital grade disinfectants can be used without causing damage?
• How often will it need to be cleaned and disinfected to reduce bio-burden and prevent cross-contamination?
• Will the use of UV light damage cause cracking and damage?