Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals

John M Boyce, John M Boyce

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.

Keywords: Cleaning; Disinfectants; Disinfection; Hydrogen peroxide vapor; UV-C; Ultraviolet light.

Figures

Fig. 1
Fig. 1
Contact agar plate cultures showing bacterial colonies recovered from a patient’s overbed table before (left) and after (right) the surface was cleaned by a housekeeper using contaminated quaternary ammonium disinfectant. Colonies on right are Serratia marcescens and Achromobacter xylosoxidans
Fig. 2
Fig. 2
Photographs of a fluorescent marker visible with a “black light” on a high touch surface before cleaning (left), and absence of the fluorescent marker after cleaning was performed (right)
Fig. 3
Fig. 3
Three steps of an ATP bioluminescence assay for monitoring cleanliness of surfaces. Step 1: a special swab is used to sample the surface. Step 2: the swab is placed in a reaction tube and shaken for 10–15 s. Step 3: the reaction tube is placed in a luminometer and a result is reported as relative light units (RLUs). The higher the RLU value, the greater the amount of ATP detected on the surface

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