Abstract
Experts agree that careful cleaning and disinfection of environmental surfaces are essential elements of effective infection prevention programs. However, traditional manual cleaning and disinfection practices in hospitals are often suboptimal. This is often due in part to a variety of personnel issues that many Environmental Services departments encounter. Failure to follow manufacturer’s recommendations for disinfectant use and lack of antimicrobial activity of some disinfectants against healthcare-associated pathogens may also affect the efficacy of disinfection practices.Improved hydrogen peroxide-based liquid surface disinfectants and a combination product containing peracetic acid and hydrogen peroxide are effective alternatives to disinfectants currently in widespread use, and electrolyzed water (hypochlorous acid) and cold atmospheric pressure plasma show potential for use in hospitals. Creating “self-disinfecting” surfaces by coating medical equipment with metals such as copper or silver, or applying liquid compounds that have persistent antimicrobial activity surfaces are additional strategies that require further investigation.Newer “no-touch” (automated) decontamination technologies include aerosol and vaporized hydrogen peroxide, mobile devices that emit continuous ultraviolet (UV-C) light, a pulsed-xenon UV light system, and use of high-intensity narrow-spectrum (405 nm) light. These “no-touch” technologies have been shown to reduce bacterial contamination of surfaces. A micro-condensation hydrogen peroxide system has been associated in multiple studies with reductions in healthcare-associated colonization or infection, while there is more limited evidence of infection reduction by the pulsed-xenon system. A recently completed prospective, randomized controlled trial of continuous UV-C light should help determine the extent to which this technology can reduce healthcare-associated colonization and infections.In conclusion, continued efforts to improve traditional manual disinfection of surfaces are needed. In addition, Environmental Services departments should consider the use of newer disinfectants and no-touch decontamination technologies to improve disinfection of surfaces in healthcare.
Highlights
In recent years, there is an increasing consensus that improved cleaning and disinfection of environmental surfaces is needed in healthcare facilities [1,2,3,4]
Experts generally agree on a number of areas, including the fact that careful cleaning and/or disinfection of environmental surfaces, daily and at time of patient discharge, are essential elements of effective infection prevention programs
There are a number of areas of disagreement and controversy regarding best practices for cleaning and disinfection of environmental surfaces
Summary
There is an increasing consensus that improved cleaning and disinfection of environmental surfaces is needed in healthcare facilities [1,2,3,4]. Several of the improved hydrogen peroxide disinfectants have activity against norovirus surrogate viruses, they are not as potent as sodium hypochlorite (bleach) solutions [40] These newer disinfectants have Environmental Protection Agency (EPA) safety rating of category IV (housekeepers do not need to wear any personal protective equipment while using these products). A new sporicidal disinfectant that contains both peracetic acid and hydrogen peroxide has been shown to reduce bacterial levels on surfaces to a greater degree than a quaternary ammonium disinfectant in one study, and reduced contamination by C.difficile, MRSA, and VRE as effectively as sodium hypochlorite in another study [41, 42]. The product has a smell similar to vinegar that may be of concern when it is initially
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