Cleaning Up in Health Care

High-touch hospital surface disinfection methods may lack evidence on effectiveness

You touch, I touch, we all touch. In hospitals, that means a lot of germs on surfaces that need cleaning.

A new overview from the University of Pennsylvania (UPenn) found that high-touch surface cleaning methods varied between hospitals. And that may be a problem, as there’s no good evidence to indicate which methods are the most effective at reducing healthcare-associated infections (HAIs).

"The cleaning of hard surfaces in hospital rooms is critical for reducing healthcare-associated infections," said lead study author Jennifer Han, MD, an assistant professor of medicine and epidemiology at UPenn, in a press release. "We found that the research to date does provide a good overall picture of the before and after results of particular cleaning agents and approaches to monitoring cleanliness."

HAIs can have a serious impact on hospital patients.

According to the US Centers for Disease Control and Prevention (CDC), more than 721,000 HAIs occurred in 2011, and approximately 75,000 people die from HAIs each year in the US.

Dr. Han and team looked at 80 studies published between 1998 and 2014 that looked at hospital surface contamination (the number of germs on a surface before and after cleaning).

These researchers found that studies comparing the effectiveness of different hospital surface cleaning methods were uncommon. There were also relatively few studies that focused on the effects these methods had on patients, such as HAI prevention.

More than 65 percent of the studies only looked at surface contamination, while less than 35 percent looked at the effects on patients.

Dr. Han and team noted some specific areas of concern.

Several studies found that C. difficile germ — a germ responsible for most hospital-related gastrointestinal infections — saw reduced numbers with bleach-based disinfectant use, but not with chlorine dioxide-based disinfection use.

However, wipes moistened with hydrogen peroxide helped reduce HAIs.

Surfaces made of solid copper-based metals, ultra-light disinfecting devices and hydrogen peroxide vapor were also effective in killing bacteria.

In a related editorial, Tara N. Palmore, MD, and David K. Henderson, MD, of the National Institutes of Health, wrote that the problem is extremely complex.

"A major challenge [is] the inextricable interrelationships among environmental contamination, hands of health care personnel and patients, and patient care equipment,” Drs. Palmore and Henderson wrote.

This study and editorial were published in the August issue of the journal Annals of Internal Medicine.

The Agency for Healthcare Research and Quality (AHRQ) funded this research. All study authors disclosed grants from AHRQ.