The benefits of surface disinfection

Abstract

The effective use of disinfectants constitutes an important factor in preventing hospital-associated infections (HAIs). In 1968, E.H. Spaulding proposed 3 categories of germicidal action to prevent a risk of infection associated with the use of equipment or surfaces: noncritical, semicritical, and critical. Environmental surfaces are considered noncritical items because they come in contact with intact skin, and intact skin is an important barrier to disease acquisition. Use of noncritical items or contact with noncritical surfaces carries a low risk of transmitting a pathogen to patients. Thus, the routine use of disinfectants to disinfect hospital floors and other surfaces (eg, bedside tables or bed rails) is controversial (Table 1). While noncritical surfaces have not been implicated directly in disease transmission, these surfaces potentially may contribute to cross-transmission by allowing acquisition of transient hand carriage by health care personnel due to contact with a contaminated surface or by patient contact with contaminated surfaces or medical equipment. Medical equipment surfaces may become contaminated with infectious agents and may serve as the vehicle in outbreaks for person-to-person transmission. The purpose of this commentary is to review briefly the epidemiologic, clinical, and experimental data and why evidence-based guidelines recommend the use of hospital disinfectants on noncritical patient care surfaces (eg, bed rails), equipment surfaces (eg, blood-pressure cuffs and hemodialysis machines), and housekeeping surfaces (eg, floors) in patient care areas. First, surfaces may contribute to transmission of epidemiologically important microbes such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), Clostridium difficile, and viruses (ie, norovirus, rotavirus, and