What's the best method for cleaning hospital rooms?

August 10, 2015 by Dennis Thompson, Healthday Reporter

What's the best method for cleaning hospital rooms?
Surprisingly little research exists to guide infection-prevention efforts, study finds.
(HealthDay)—Concerns about hospital "superbugs" have spotlighted the need to prevent the spread of germs in health-care settings. But a new report reveals a disturbing lack of knowledge on something as basic as proper cleaning of a patient's room.

Very little research addresses the best ways to disinfect and sanitize the hard surfaces in a hospital room, investigators report in the Aug. 11 issue of Annals of Internal Medicine.

"We basically found that there are studies available to guide actions, but there are much fewer than you might expect for such an important issue," said lead author Dr. Craig Umscheid, an assistant professor of medicine and epidemiology at the University of Pennsylvania's Perelman School of Medicine in Philadelphia.

At any given time, about one in every 25 hospital patients has an infection they got from being at a hospital, according to the U.S. Department of Health and Human Services. An estimated 721,000 health care-related infections occurred in 2011, which led to about 75,000 deaths, the authors noted in background information.

Hand-washing receives much attention for preventing the spread of germs, but disinfecting the hard surfaces in an examination room or hospital suite can be just as important, Umscheid said. Many dangerous germs are spread by touching counters, floors, tray tables, bed rails, IV pulls, light switches, toilets, and even call buttons.

Many experts believe that only 50 percent of surfaces are typically disinfected during cleaning of a patient's room, according to background notes.

For this report, researchers reviewed 80 studies published between 1998 and 2014.

The investigators found only five randomized, controlled trials that explored the best ways to disinfect surfaces. Most were before/after studies, in which germs were measured on a surface before and after a cleaning product had been used.

Fewer than 35 percent of the studies focused on or spread of disease due to unclean surfaces, the researchers said.

They also found that most studies only examined the effectiveness of a single cleaning product or method, rather than comparing it against others.

"There are all these approaches that are available, and there just are no head-to-head trials that compare one versus another and look at outcomes that matter to patients," said Umscheid.

The team identified several studies showing that rates of C. difficile, the most common cause of hospital-acquired gastrointestinal infections, fell with the use of bleach-based disinfectants but that a chlorine dioxide-based product was ineffective in reducing contamination and infection rates.

Seventeen studies on newer cleaning technologies—such as devices that emit ultraviolet rays or hydrogen peroxide vapor—reported positive findings, with three demonstrating reductions in infection rates.

The researchers also found some evidence supporting use of contamination-resistant surfaces such as copper-coated bed rails.

Studies attempting to assess the best hospital cleaning strategies are difficult to perform, said Victoria Richards, an associate professor of medical sciences with the Frank H. Netter MD School of Medicine at Quinnipiac University in North Haven, Conn.

"A hospital is a busy and chaotic place," Richards said. "There are a lot of different individuals who go into a lot of different rooms, touching different surfaces. Just by virtue of the environment, it's a very difficult type of research to conduct."

Hospital officials rely heavily on manufacturers' recommendations when it comes to choosing , said Donna Armellino, vice president of infection prevention for the North Shore-LIJ Health System in New York.

These recommendations often focus more on how a cleaner would affect a surface, and just assume it's an effective germ-killer, Armellino said.

"From a medical equipment standpoint, basically they're looking to see what chemicals are compatible with the surface of that specific medical equipment," she said. "Will it discolor the plastic or will it harm the surface of the metal?"

At the same time, Armellino said the threat posed by contaminated surfaces is not as dire as that posed by unwashed hands or unclean medical instruments.

"I would be more concerned with those items that penetrate or come into contact with the mucous membrane, rather than items that come into contact with intact skin," she said.

Patti Costello, executive director of the Association for the Healthcare Environment, objected to the study's methodology.

"This study seems to be more of a compendium of past studies and doesn't provide any new information," she said. Her organization, a personal membership group of the American Hospital Association, stresses on-going education, training and certification that demonstrates a commitment to correct and consistent disinfection, Costello said.

"Hospitals take cleaning and surface disinfection very seriously," she added.

Explore further: More evidence needed to identify best methods to clean hospital rooms, prevent infections

More information: For more on hospital-acquired infections, visit the U.S. Centers for Disease Control and Prevention.

Related Stories

More evidence needed to identify best methods to clean hospital rooms, prevent infections

August 10, 2015
Tray tables, bed rails, light switches, and toilets: All are common vectors for swapping germs between patients and health care workers. While a new systematic overview in this week's Annals of Internal Medicine points to ...

Hand washing vital in multi-bed hospital wards

May 5, 2015
Hospital room designs make a significant difference to the likelihood of bugs being spread through person-to-person contact between medics and patients, according to University of Leeds research.

UV light robot to clean hospital rooms could help stop spread of 'superbugs'

April 14, 2015
Can a robot clean a hospital room just as well as a person? According to new research out of the Texas A&M Health Science Center College of Medicine, that is indeed the case. Chetan Jinadatha, M.D., M.P.H., assistant professor ...

Daily disinfection of isolation rooms reduces contamination of healthcare workers' hands

September 13, 2012
New research demonstrates that daily cleaning of high-touch surfaces in isolation rooms of patients with Clostridium difficile (C. difficile) or methicillin-resistant Staphylococcus aureus (MRSA) significantly reduces the ...

Ultraviolet cleaning reduces hospital superbugs by 20 percent

May 28, 2014
Healthcare-associated vancomycin-resistant enterococcus (VRE), methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile (CD), and other multidrug-resistant organisms (MDRO) were decreased among patients after ...

Hospital cleaning protocol ineffective against A. baumannii

November 30, 2012
Current hospital cleaning protocol may be inadequate to rid patient rooms of multidrug-resistant (MDR) Acinetobacter baumannii, according to a study in the December issue of the American Journal of Infection Control, the ...

Recommended for you

Antibiotic prescribing influenced by team dynamics within hospitals

November 15, 2018
Antibiotic prescribing by doctors is influenced by team dynamics and cultures within hospitals.

Zika may hijack mother-fetus immunity route

November 14, 2018
To cross the placenta, Zika virus may hijack the route by which acquired immunity is transferred from mother to fetus, new research suggests.

Maternally acquired Zika immunity can increase dengue disease severity in mouse pups

November 14, 2018
To say that the immune system is complex is an understatement: an immune response protective in one context can turn deadly over time, as evidenced by numerous epidemiological studies on dengue infection, spanning multiple ...

New research aims to help improve uptake of hepatitis C testing

November 14, 2018
New research published in Scientific Reports shows persisting fears about HIV infection may impact testing uptake for the hepatitis C Virus (HCV).

Synthetic DNA-delivered antibodies protect against Ebola in preclinical studies

November 13, 2018
Scientists at The Wistar Institute and collaborators have successfully engineered novel DNA-encoded monoclonal antibodies (DMAbs) targeting Zaire Ebolavirus that were effective in preclinical models. Study results, published ...

Scientists illuminate causes of hepatitis B virus-associated acute liver failure

November 13, 2018
National Institutes of Health scientists and their collaborators found that hepatitis B virus (HBV)-associated acute liver failure (ALF)—a rare condition that can turn fatal within days without liver transplantation—results ...

2 comments

Adjust slider to filter visible comments by rank

Display comments: newest first

Moebius
not rated yet Aug 11, 2015
The best method is to make them cleanable first and comfortable second. Make everything out of stainless steel and cleaning and disinfecting becomes easy. Make it out of cloth and paint and it looks cool but becomes impossible to disinfect.
Squirrel
not rated yet Aug 11, 2015
This is a scandal. Tax dollars are diverted to "sexy" career advancing blue sky basic research from humdrum low status but big lives-saved-per-dollar research that gets as a result left on the unfunded or poorly funded shelf. The NIH should earmark a percentage of its funds for low status and rarely done research that has a real impact on patient welfare.

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.