The role of the surface environment in healthcare-associated infections:

Contamination of surfaces in the hospital environment:

• Pathogens like methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), Pseudomonas spp., Acinetobacter spp., and norovirus can survive for days to weeks on dry inanimate surfaces. Spores of Clostridium difficile (C. difficile) can survive for months on such surfaces.
• A varying proportion of surfaces and furniture in rooms and wards that house infected patients have shown positive for contamination. The level of contamination, however, is very low. Also the difference in level of contamination in high-, medium-, and low-touch surfaces was not statistically significant.

Role of the contaminated environment in transient hand/glove contamination of healthcare personnel:

• Contamination of hands with MRSA occurs irrespective of whether the healthcare worker was in direct contact with an infected patient or touched contaminated surfaces in the patient’s room.
• The frequency of finding cultures of C. difficile on the hands or gloves of healthcare workers was found to be correlated with environmental contamination by C. difficile.

Surface contamination following disinfection:

• Surfaces in hospital rooms are not cleaned thoroughly. Studies have indicated that fewer than 50% of the rooms examined were not clean.
• Portable medical equipment between patients was not always cleaned and disinfected effectively.
• Common disinfectants used for hospital surfaces like phenols and quaternary ammonium compounds are not effective against C.difficile and norovirus.
• The use of non-sporicidal wipes or incorrect use of sporicidal wipes on surfaces contaminated with C. difficile actually transfers the spores of the pathogen to clean surfaces.

Risks of pathogen acquisition due to inadequate terminal disinfection:

•  A patient admitted to a room that previously housed a patient infected with MRSA, VRE, C. difficile, multidrug-resistant Acinetobacter spp., or multidrug-resistant Pseudomonas, faces a risk of getting infected or colonized with the same pathogen.

Preventing transmission of nosocomial pathogens due to contaminated surfaces:

• Improving surface cleaning and disinfection:
  • Education of:
    • Environmental service workers (who clean surfaces)
    • Nursing staff (who clean instruments and equipment)
  • Assessment of cleaning:
    • Fluorescent dye: When applied to a disinfected surface, a fluorescent dot will appear if the surface is not clean.
    • ATP bioluminescence: This measures the presence of ATP which is a marker for microbial contamination. This is not as effective as fluorescent dye.
  • Daily disinfection:
    • Multiple cleaning strategies that included daily disinfection, use of ultraviolet light devices, and use of fluorescent dye were effective in a substantial decrease in C. difficile.
    • Daily disinfection of high-touch surfaces in patient rooms with MRSA and C. difficile reduced contamination of hands and gloves.
• 'No-touch' methods of surface disinfection: Room disinfection units have been created that decontaminate environmental surfaces and contents in a room. These are used only as supplementary to regular cleaning and disinfection processes.
  • Ultraviolet (UV) light devices: Although these devices are being used to decontaminate rooms, surfaces, and equipment, there are no studies in connection with reduction of HAI. A drawback of this device is that it cannot disinfect spaces that are not in its line of sight.
  • Devices using hydrogen peroxide: The use of hydrogen peroxide devices has been effective in almost eliminating pathogens like MRSA, VRE, Mycobacterium tuberculosis, spores, viruses, and multidrug-resistant Gram-negative bacilli, and reduction of C. difficile. A disadvantage of this system is that it needs a lot of time to effectively decontaminate.
• 'Self-disinfecting' surfaces:
  • The use of copper on surfaces: Copper alloys have been used for controlling Legionella species in water supplies and Aspergillus on building materials. One study conducted in a hospital environment found that copper reduces HAIs by over 50%.
  • The authors indicate that the use of germicides such as triclosan, altered topography (e.g., Sharklet AF pattern), and light-activated antimicrobicides are potential methods of disinfection as well.