Fostering Collaboration Between Infection Prevention and Environmental Services

“I think there are several unresolved issues raised in the guideline,” says Roye-Horn. “The question can be asked, what is the role of the environment in transmission of infection, and then there is the part that asks, do we need to use different products than what we’ve been using? In terms of the environment, I think we all believe that it does contribute to patient infection. Previously, when the infection control community was of the firm mind there was very little contribution, it was a time when there were fewer resistant organisms and less of a problem with the spore-forming Clostridium difficile in hospitals than we see now. I think both have contributed to changing our thoughts on this. Years ago we were concerned about how long viruses persisted in the environment and their threat to healthcare workers (HCWs) and patients, whether it was hepatitis or HIV. These days, we are concerned about resistant organisms like methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). I think we agree now that it’s easy enough for these organisms to be transmitted to a patient’s skin, where, while they may not cause an infection, they may colonize the patient. That colonization may lead to an infection later, even if it’s during another admission or at another time entirely. I think there’s still a question as to how much of a role the environment plays but we’re more concerned about it these days.

Roye-Horn continues, “As far as what products we should use, that’s where the bigger question may still lie because is it the product that’s important or is it that you do enough physical cleaning to remove the organisms from the surface? Listening to and speaking with Dr. Bill Rutala, he has a lot of data indicating that our old products work. But are we cleaning adequately? Are we using the elbow grease and getting to all of those surfaces? That’s the new question, I think.”