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What we don't know about surface disinfection as
it relates to healthcare-associated infections may
exceed what we do know. After reviewing 80 stud-
ies published between 1998 and 2014
(osmag.net/j8cNTR), that's the somewhat discon-
certing conclusion my colleagues and I reached.
Most studies have focused on before-and-after research. For example, how much
bacteria remains on a surface before and after cleaning with bleach or ammonium
compounds? But measuring surface bacteria isn't a patient-centered outcome. The
reality is that when it comes to HAIs, we know much more about the significance of
hand hygiene and the wise use of antibiotics than we do about surface disinfection.
We can say with some certainty that visual observation is a comparatively poor
way to assess surface cleaning. Studies consistently show that the absence of visi-
ble contamination, even to trained personnel, doesn't mean a surface is free of
bacteria or pathogens. Fluorescent markers or ATP bioluminescence methods are
much more reliable.
We can also say that some newer cleaning modalities look very promising as
adjuncts — automated devices that use UV light or hydrogen peroxide vapor, for
example. But there, too, stakeholders need more evidence, because the devices are
very expensive.
The importance of environmental services is also clear. EVS people need to under-
stand where they fit into the healthcare hierarchy. They're not just "housekeepers" or
"cleaners" — they need to know that they play a vital role in keeping patients safe
from infection. — Jennifer Han, MD, MSCE
Dr. Han (jennifer.han@uphs.upenn.edu) is an assistant professor of medicine and epidemi-
ology in infectious diseases and an associate healthcare epidemiologist of the Hospital at the
University of Pennsylvania in Philadelphia.
SCRAPING
THE SURFACE
The Thin Science of Surface Disinfection
