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Environmental Cleaning for the Prevention of Healthcare-Associated Infections
Technical Briefs, No. 22
Investigators: Brian F Leas, MS, MA, Nancy Sullivan, BA, Jennifer H Han, MD, MSCE, David A Pegues, MD, Janice L Kaczmarek, MS, and Craig A Umscheid, MD, MSCE.
Author Information and AffiliationsStructured Abstract
Background:
The cleaning of hard surfaces in hospital rooms is essential for reducing the risk of healthcare-associated infections. Many methods are available for cleaning and monitoring cleanliness, but their comparative effectiveness is not well understood.
Purpose:
This Technical Brief summarizes the evidence base addressing environmental cleaning of high-touch surfaces in hospital rooms and highlights future research directions.
Methods:
A systematic search for published and gray literature since 1990 was performed using PubMed, EMBASE, CINAHL, the Cochrane Library, and other resources. Clinical studies examining the cleaning and disinfection of high-touch surfaces in adult inpatient hospital rooms were included. Primary outcomes of interest were patient infection, colonization, or surface contamination with Clostridium difficile, methicillin-resistant Staphylococcus aureus, or vancomycin-resistant enterococci. Additionally, 12 Key Informants were interviewed, representing environmental services management, hospital infection control, and clinical infectious diseases.
Findings:
Eighty studies were included. Forty-nine studies examined cleaning modalities, including chemical agents, self-disinfecting surfaces, and no-touch technologies. Fourteen studies evaluated monitoring strategies, including visual inspection, microbiological cultures, assays, and ultraviolet light. Seventeen studies addressed challenges or facilitators to implementation. Sixty-five studies used nonrandomized concurrent or historical controls. The outcome of surface contamination was reported in 57 studies; infection rates were reported in 25.
Conclusions:
Comparative-effectiveness studies directly comparing disinfection modalities and monitoring strategies are limited. Future research should examine and compare newly emerging strategies, such as peracetic acid, hydrogen peroxide wipes, enhanced coatings, and microfiber cloths as cleaning strategies, and adenosine triphosphate and ultraviolet light technologies as monitoring strategies. Patient colonization and infection rates should be included as outcomes when possible. Other challenges to be addressed include identification of surfaces posing the greatest risk of pathogen transmission, developing standard thresholds for defining cleanliness, and using methods to adjust for confounders such as hand-hygiene practices when examining the impact of disinfection modalities.
Contents
- Preface
- Acknowledgments
- Key Informants
- Peer Reviewers
- Background
- Methods
- Findings
- Overview of Cleaning and Disinfection Modalities (Guiding Question 1)
- Overview of Monitoring Modalities (Guiding Question 1)
- Interaction of Cleaning, Disinfecting, and Monitoring Strategies (Guiding Question 1)
- Defining “Clean” Surfaces (Guiding Question 1)
- Overview of the Context in Which Cleaning, Disinfection, and Monitoring Modalities Are Implemented (Guiding Question 2)
- Evidence of the Effectiveness of Strategies for Implementing Cleaning, Disinfection, and Monitoring Modalities (Guiding Question 2)
- Evidence of the Effectiveness of Strategies for Environmental Cleaning and Disinfection (Guiding Question 3)
- Evidence of the Effectiveness of Strategies for Monitoring of Cleanliness (Guiding Question 3)
- Evidence Map (Guiding Questions 3 and 4)
- Summary and Implications
- References
- Appendix A Literature Search Methods
- Appendix B Excluded Studies Based on Review of Full-Length Articles
- Appendix C Clinical Evidence
- Appendix D Clinical Practice Guidelines and Ongoing Clinical Trials
- Appendix E Appendix References
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services2, Contract No. 290-2012-00011-I, Prepared by: ECRI Institute – Penn Medicine Evidence-Based Practice Center, Plymouth Meeting, PA
Suggested citation:
Leas BF, Sullivan N, Han JH, Pegues DA, Kaczmarek JL, Umscheid CA. Environmental Cleaning for the Prevention of Healthcare-Associated Infections. Technical Brief No. 22 (Prepared by the ECRI Institute – Penn Medicine Evidence-based Practice Center under Contract No. 290-2012-00011-I.) AHRQ Publication No. 15-EHC020-EF. Rockville, MD: Agency for Healthcare Research and Quality; August 2015. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the ECRI Institute-Penn Medicine Evidence-Based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2012-00011-I).
The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients).
AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies may not be stated or implied.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
- *
Mr. Leas and Ms. Sullivan contributed equally to this report.
- 2
540 Gaither Road, Rockville, MD 20850; www
.ahrq.gov
- NLM CatalogRelated NLM Catalog Entries
- Environmental Cleaning for the Prevention of Healthcare-Associated InfectionsEnvironmental Cleaning for the Prevention of Healthcare-Associated Infections
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