The Case for Standardizing Cleaning and Disinfection: Why Consistency Is Critical to Patient Safety

Standardizing Cleaning and Disinfection

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Inconsistent cleaning and disinfection practices continue to pose significant risks to patient safety in health care environments. Despite broadly aligned guidelines from agencies like the CDC, the World Health Organization, the Association for Professionals in Infection Control and Epidemiology (APIC), and the Association of periOperative Registered Nurses (AORN), critical operational differences and accessibility barriers persist.

This article examines the need for internal standardization, the role of professional memberships, regulatory frameworks from The Joint Commission, Centers for Medicare & Medicaid Services (CMS), The Occupational Safety and Health Administration (OSHA), and US Environmental Protection Agency (EPA), and the vital importance of viewing cleaning as a clinical service, not a commodity. Grounded in both personal experience and real-world examples, it emphasizes that Cleaning is Patient Care and offers a blueprint for health care facilities to lead with safety, consistency, and trust.

Introduction: Why Standardization Matters

Environmental cleaning and disinfection are foundational pillars of infection prevention. Yet, while the clinical community emphasizes protocols and stewardship, the healthcare environment itself remains vulnerable to inconsistencies. Even among recognized leaders like the CDC,¹ WHO,² APIC,³ and AORN,⁴ guidance varies enough to create confusion on the front lines.
In today's environment of emerging and reemerging pathogens, antimicrobial resistance, biofilms, and heightened regulatory oversight, internal standardization of cleaning and disinfection practices is not optional. It is a foundational investment in patient safety, staff confidence, and organizational resilience. Simply stated, all surfaces matter in the war on pathogen transmission in health care and community settings.

A Landscape of Best Intentions—and Missed Alignment

How Leading Guidelines Align

A Landscape of Best Intentions—and Missed Alignment

How leading guidelines align

Where leading guidelines differ

Key takeaway:
Even minor inconsistencies around cleaning frequency, chemical selection, training expectations, and auditing methods can lead to operational drift, unless a facility sets and enforces its own consistent standard.

Access to Standards Is Always Best Practice, Not a Barrier

While foundational guidelines from agencies like the CDC¹ and WHO² are freely accessible, health care-specific cleaning standards often require membership or purchase:

• AORN’s perioperative cleaning guidelines⁴: membership or purchase required, updated annually.
• AHE certifications¹²: CHEST, CSCT, CHESP.
• ISSA + Healthcare Surfaces Institute (HIS)*¹³: surface safety, materials compatibility, validated cleaning protocols.

(*Disclosure: The author serves on the Healthcare Surfaces Institute Advisory Council under ISSA.)

Key takeaway:
Membership isn’t a hurdle; it’s a strategic investment.
Direct access connects facilities to validated education, best practices, and peer collaboration critical for resilient infection prevention programs.

Real-World Consequences (with HealthPlus Case Study and National CMS Deficiency Data)

Case Study: HealthPlus Surgery Center, Saddle Brook, New Jersey⁹

In 2018, HealthPlus Surgery Center temporarily closed after the NJ Department of Health found critical lapses in sterilization and infection prevention protocols. Over 3,700 patients were notified of potential exposure to HIV, Hepatitis B, and Hepatitis C. While sterilization was a primary issue, inadequate environmental hygiene also surfaced as a major breakdown.

Key Lesson:
Failure to verify and enforce infection control protocols, including cleaning and disinfection, can escalate rapidly into a patient safety crisis.

National Trends: CMS Data on ASC Deficiencies⁸

CMS data from 2023 to 2024 shows infection prevention failures are the most frequently cited deficiencies across ambulatory surgical centers.

Top failures include:

• Failure to follow standardized cleaning protocols
• Inadequate training and competencies
• Lack of documentation for terminal and between-case cleaning
• Improper disinfectant use and dwell time compliance

Key lesson:
Infection prevention lapses, including improper cleaning, are systemic risks, not isolated mistakes.

Agencies Advancing Health Care Cleaning Standards

Recognizing environmental hygiene as a pillar of patient safety, national and global organizations lead initiatives to close gaps:

• AHE¹²: Certifications (CHEST, CSCT, CHESP) advancing healthcare cleaning competence.
• International Sanitary Supply Association (ISSA) + Healthcare Standards Institute (HSI) + International Executive Housekeepers Association (IEHA)^11,13: Interdisciplinary surface safety and facility leadership training.
• Global Biorisk Advisory Council (GBAC)¹¹: STAR Facility Accreditation, outbreak preparedness and response.
• Clean Hospitals Initiative¹⁰: International collaboration for health care hygiene research and advocacy.

Key takeaway:
Active participation with these agencies represents a strategic investment in health care excellence and resilience.

Regulatory Standards Reinforce the Need for Consistency

Regulatory agencies shape health care cleaning requirements:

• The Joint Commission: Mandates cleanliness validation under the Environment of Care standards.
• CMS⁸: Requires safe, sanitary environments under Conditions of Participation.
• OSHA⁵: Bloodborne pathogens, PPE, and chemical handling safety.
• EPA⁶⁷: Disinfectant registration (List N, List K) ensuring efficacy against health care pathogens.

Key takeaway:
Compliance fulfills the fundamental obligation to protect patients, staff, and the community.

Building Your Internal Standard

Facilities must own their environmental hygiene processes:

• Standard chemicals: Use EPA-registered, pathogen-appropriate disinfectants (tuberculocidal, fungicidal, sporicidal as needed).
• Standard procedures: Implement two-step cleaning, validated dwell times, and clear Standard Operating Procedures (SOPs).
• Training validation: Certification, annual competencies, ongoing education.
• Access to standards: Membership and direct access to standards ensure adherence to current best practices.
• Auditing: Regular inspections benchmarked against internal SOPs, not industry averages.
• Microbiology Medical Laboratory: Collaborative relationships with a medical laboratory for microbiological sampling and understanding of the pathogen burdens with the facility.

Key takeaway:
Standardization empowers staff, strengthens infection prevention, and builds operational resilience.

In-House or Outsourced, Cleaning Is Patient Care

Whether environmental services are in-house or contracted, cleaning is a clinical service, not a commodity.

Key questions when vetting contractors:

• Are staff health care-certified (CHEST, CSCT)?
• Are supervisors credentialed?
• Are SOPs aligned with the CDC, AORN, and CMS?
• How is dwell time compliance enforced?
• Are audits regular and transparent?
• Is association engagement (ISSA, AHE, HSI) maintained?
• Are outbreak response protocols established?

Personal perspective:
Having worked as both a customer and a provider, we’ve seen firsthand that too often, facilities contract cleaning services to the lowest bidder, overlooking the real costs: increased health care-associated infections, surgical site infections, readmissions, reputational damage, and patient harm.
Environmental cleaning is not a commodity. It is patient care.

Key takeaway:
Outsourcing does not outsource responsibility for patient safety.
Facilities that treat environmental hygiene as clinical care will achieve stronger outcomes, safer environments, and greater community trust.

Cleaning Is Patient Care

Environmental cleaning must be recognized as a frontline health care service—essential to infection prevention, patient outcomes, and healthcare resilience.

Standardization is not bureaucracy.
Standardization is protection.

Facilities that invest in clear, accessible cleaning protocols, supported by training, membership, and strategic partnerships, will lead in safety, innovation, and patient trust.

Outsourcing does not absolve responsibility.
Internal teams do not guarantee readiness.
Only a culture of continuous education, accountability, and excellence sustains real infection prevention.

We have spent our careers on both sides: as customers and now as service providers.
The lesson remains clear:

Cleaning is not ancillary to patient care.
Cleaning is patient care.¹⁴

References:

1. CDC Environmental Cleaning Guidelines. CDC. Accessed May 12, 2025 https://www.cdc.gov/healthcare-associated-infections/media/pdfs/environmental-cleaning-rls-508.pdf
2. Guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Care Facility Level. World Health Organization. 2016. Accessed May 12, 2025. https://www.who.int/publications/i/item/9789241549929.
3. Infection prevention: a perioperative nurse’s guide to preventing infections in surgical settings. APIC. Accessed May 12, 2025 https://www.aorn.org/article/infection-prevention--a-perioperative-nurses-guide-to-preventing-surgical-site-infections
4. Association of periOperative Registered Nurses. Guidelines for Perioperative Practice: Environmental Cleaning. AORN. Accessed May 12, 2025. https://aornguidelines.org/guidelines/content?sectionid=173715702&view=book 
5. Occupational Safety and Health Administration. Bloodborne Pathogens. 29 CFR §1910.1030. U.S. Department of Labor. Accessed May 12, 2025. https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030 
6. List N: Disinfectants for Emerging Viral Pathogens (COVID-19). EPA. Accessed May 12, 2025. https://www.epa.gov/pesticide-registration/list-n-disinfectants-coronavirus-covid-19.
7. List K: EPA’s Registered Antimicrobial Products Effective Against Clostridium difficile Spores. EPA. Accessed May 12, 2025. https://www.epa.gov/pesticide-registration/list-k-epas-registered-antimicrobial-products-effective-against-clostridium.
8. Centers for Medicare & Medicaid Services. Ambulatory Surgical Center Top Deficiencies Report, 2023–2024. CMS. https://www.cms.gov/medicare/provider-enrollment-and-certification/guidanceforlawsandregulations/surveycertificationgeninfo. Accessed May 12, 2025.
9. NBC News, Time Magazine, New Jersey Department of Health. HealthPlus Surgery Center Investigation. Various media sources. Accessed May 12, 2025. https://www.nbcnews.com/health/health-news/n-j-surgery-center-possibly-exposed-thousands-hiv-had-rusty-n952971
10. University of Geneva. Clean Hospitals Initiative. Clean Hospitals. https://www.cleanhospitals.com. Accessed May 12, 2025.
11. GBAC STAR Facility Accreditation. ISSA. Accessed May 12, 2025. https://gbac.issa.com/gbac-star-facility-accreditation/ 
12. CHEST, CSCT, and CHESP Certifications and Resources. AHE. Accessed May 12, 2025. https://www.ahe.org/ahe-education 
13. HSI Programs under ISSA Partnership Initiatives. Healthcare Surfaces Institute. Accessed May 12, 2025. https://www.healthcaresurfacesinstitute.org.
14. Lybert L. & Rohde RE. Why Surface Materials Matter in Health Care Settings American Society for Microbiology, Bugs and Drugs. January 25, 2024. Accessed May 13, 2025. https://asm.org/Articles/2024/January/Why-Surface-Materials-Matter-in-Health-Care-Settin