Environmental Surface Disinfection in the Healthcare Environment
By J. Hudson Garrett Jr., PhD, MSN, MPH, APRN, CIC
One of the most critical interventions that can be routinely performed to decrease the risk for cross transmission and development of healthcare-associated infections (HAIs) is routine cleaning and disinfection of the healthcare environment. This includes both medical equipment and environmental surfaces. To maximize the efficacy of the chosen disinfectant product, thorough cleaning must be performed prior to disinfectant use.
Cleaning, as defined by the latest CDC Guideline for Disinfection and Sterilization in Healthcare Facilities released in 2008, is “the removal of foreign material (e.g., soil and organic matter) from objects, and is normally accomplished using water with detergents or enzymatic products. Thorough cleaning is essential before high-level disinfection and sterilization because inorganic and organic materials that remain on the surfaces of instruments interfere with the effectiveness of these processes.” Cleaning removes bioburden from the affected surface by reducing the number of microorganisms that must be inactivated. Removing bioburden from the surface prior to application of the disinfectant solution will result in increased disinfectant efficacy. It is also important to also apply friction to the area being cleaning and disinfected in order to remove more resistant forms of microorganisms such as spores (i.e., Clostridium difficile) from the surfaces that may not be readily inactivated by the disinfectant. This will decrease the risk for development of multidrug-resistant organisms (MDROs).
The use of an Environmental Protection Agency (EPA)-accepted product with proven efficacy claims is also crucial to selection of the appropriate product. In addition, the infection preventionist should refer to the facility’s risk assessment and ensure that the disinfectant selected has efficacy claims for microorganisms that are routinely found within the facility. Efficacy claims are readily available through the product’s manufacturer, and should be carefully reviewed prior to introduction of the product into the facility. A thorough cleaning and disinfection program combined with careful selection of the most appropriate hospital-grade disinfectant will dramatically improve the healthcare professional’s daily fight against HAIs.
J. Hudson Garrett Jr., PhD, MSN, MPH, APRN, CIC, is director of clinical affairs at PDI Healthcare.