A guide to surface hygiene in healthcare environments

A guide to surface hygiene in healthcare environments

Surface hygiene is a critical concern in healthcare environments. With so many people touching surfaces and handling equipment, it’s easy for surfaces to become contaminated with dangerous microorganisms. Pathogens then are transferred to the hands of other people, other surfaces (such as medical devices), and even to patients.

Handwashing and masks help reduce the spread of microorganisms via touch and droplet transmission (coughing, sneezing, talking). But surface cleaning and disinfection should form the foundation of a healthcare facility’s hygiene strategy. Understanding the most effective methods and materials for surface cleaning is essential to maintain high levels of overall cleanliness and prevent illnesses caused by dangerous microorganisms.

Understanding healthcare-associated infections (HAIs)

An HAI is an illness caused by a microbial pathogen picked up in healthcare environments such as hospitals, outpatient surgery centers, and long-term care facilities. Microorganisms can infect patients via wounds, contaminated devices (such as a catheter or thermometer), or mucus membranes. Some common microorganisms that cause HAIs include CDiff, staph, coronaviruses, E.coli, and the norovirus.  

Preventing HAIs is a key concern in the healthcare industry because they put patients at risk, complicate and extend treatment, and drive costs higher. Worldwide, HAIs affect five to 10% of all hospital patients1 and their frequency has increased by 36% over the last two decades. In the US, 2 million patients are affected each year, and HAIs are currently the primary cause of death for 136,000 people every year in North America and Europe.2

Microorganisms that cause HAIs are often transmitted via surfaces—making frequent and effective cleaning and disinfection vital to preventing them.

Different surface types and proper treatment

Low-touch surfaces
Under the Spaulding classification of surfaces, devices and areas that are contacted only by intact skin are considered non-critical. While some non-critical surfaces may be very infrequently touched (such as floors and ceilings), evidence shows they can still be a source of pathogen transmission. For example, a person would need to touch their shoes to put them on or tie the laces–and the shoes contact the floor. Other low-touch surfaces include vents and walls.

High-touch healthcare surfaces faucet handle

High-touch surfaces
High-touch surfaces are those that frequently come into contact with hands. Therefore, the following areas should be cleaned and disinfected more often:

  • Doorknobs
  • Light switches
  • Bed rails
  • Wall areas around the toilet
  • Faucet handles
  • Bedside tables
  • Call bells
  • IV poles
  • Patient monitoring equipment, especially keyboards, screens, and touchpads
  • Transport equipment, such as wheelchair handlebars

It’s also important to understand the difference between cleaning and disinfecting:

  • Cleaning involves using detergents and water to remove soil and other organic matter as well as microorganisms. The friction between a cleaning textile (such as a cloth) and the surface also helps remove them.
  • Disinfection refers to the process of using chemicals to kill microorganisms after cleaning. If the surface is not properly cleaned before disinfection, the process may be less effective. Some products may combine cleaning methods and disinfecting chemicals.

Thorough surface hygiene requires both cleaning and disinfection. While a visual check is often enough to confirm sufficient cleaning, verification of successful disinfection requires more intensive methods, such as swab cultures, adenosine triphosphate (ATP), or a UV light tool.

The surface cleaning process in healthcare environments

Successful surface hygiene in healthcare facilities involves detailed procedures, appropriate cleaning products and tools, staff training on product usage and cleaning techniques, and frequent monitoring.

Healthcare facilities should take care to have ample supplies on hand. These include cleaning products and disinfecting chemicals, cloths and wipes, floor tools, and PPE such as gowns, goggles, and face shields. Even respirators should be available for dealing with hazardous circumstances or highly contagious pathogens.

Before beginning to clean non-critical surfaces in an area such as a patient room, evaluate for:

  • any obstacles or clutter that could inhibit a complete cleaning
  • whether the status of the patient presents a challenge
  • a need for special PPE or supplies, such as if there are body fluids to be cleaned or if there is a high risk of disease transmission

A three-step approach to cleaning noncritical surfaces in healthcare environments supports greater efficiency and removal of microorganisms and other contaminants. This approach also reduces the risk of inadvertently missing areas or further spreading dirt and germs.

1. Start with cleaner areas and end with dirtier ones.
Focus on low-touch surfaces before high-touch areas. Objects and areas within the “patient zone” (surfaces and items they directly touch, such as bedrails and television remotes) should be cleaned last. Any areas under transmission-based precautions should also be left for the end of the cleaning process.

2. Clean from high to low, top to bottom.
Doing so ensures that any contaminants that drip or fall from higher areas will be cleaned during the lower sweep. For example, clean the top of a table or desk before wiping down the legs.

3. Use a system.
A consistent method, such as always cleaning around a room in a clockwise direction, can help ensure that no areas are missed.

To ensure surfaces are thoroughly cleaned, soak a fresh cleaning cloth in detergent or solution, then fold it in half twice—which will give you eight sides of the cloth to work with. Following the strategies outlined above, wipe down surfaces, making sure that all areas are completely wetted. Regularly unfold the cloth to expose a fresh surface.

Always use a new cleaning cloth for each cleaning session, such as each patient room or area of the facility. A fresh cloth should also be used for each patient zone in higher-risk areas, such as multi-bed intensive care units.

Ensure your healthcare facility is safe from pathogens

From supplies to strategy, there’s a lot to cover when it comes to safe and effective surface cleaning in hospitals and other healthcare environments. Make sure your cleaning staff has the training and the tools they need. For more information and tools from Tork to prepare your cleaning staff, visit our interactive hospital training.

1 National Conference of State Legislatures: Hospital acquired infections FAQ
2 National Center for Biotechnology Information: Economic burden of healthcare-associated infections: an American perspective