Tray tables, light switches, toilets, call buttons – these high-touch surfaces are common mediums for spreading germs among patients and staff in hospitals nationwide. And while research has shown that certain cleaning techniques lead to a reduction in bacterial cells on hospital surfaces, there is no definitive proof of which cleaning procedures, if any, actually reduce the risk of patient infection.
According to an analysis recently published in the Annals of Internal Medicine, few studies evaluate cleaning methods and their effectiveness in regards to patient safety. This new insight is not only concerning, but surprising, given that hospitals are evaluated on their ability to reduce the occurrence of healthcare-associated infections (HAIs) in patients.
Major Gaps in Pertinent Evidence
The University of Pennsylvania and ECRI Institute researchers who conducted the analysis reviewed 80 studies published internationally between 1998 and 2014. They found that most studies were before and after comparisons that examined the amount of surface contamination after cleaning with a particular agent.
A better (or more relevant) study would directly compare different methods of cleaning and disinfecting, and take it a step further by examining patient outcomes to determine which were most effective in reducing infection rates. One challenge in determining if a reduction in infection rates can be attributed to a particular cleaning substance or process is the element of other hygiene factors, such as frequency of handwashing. If other hygiene practices change—wittingly or unwittingly—it may affect the results.
The researchers found very few studies on emerging sanitizing technologies, such as the use of alternative surface materials that are toxic to micro-organisms (copper-based metals and alloys) and no-touch disinfecting methods (UV devices and hydrogen peroxide vapor).
Putting Patients at Risk
Though progress has been made with certain safety procedures, such as encouraging frequent hand-washing and following protocols to prevent catheter-associated bloodstream infections, hospital infection rates remain problematic, evident in the staggering statistics. It is estimated that:
- Approximately 722,000 patients a year contract an infection while being treated in acute care hospitals
- 75,000 of those cases results in death
Washing Hands, Not Surfaces
One factor aggravating the issue is the lack of focus on the hygiene of inanimate objects in healthcare settings. For instance, hand-cleanliness is universally accepted as necessary to a safe and clean hospital environment. However, when it comes to surfaces, such as bed rails and other static items, the same thought pattern is often not applied, leading to inconsistent hygienic practices. In fact, many experts believe that only 50 percent of hospital surfaces are typically disinfected during the cleaning of patient rooms.
Ultimately more research is needed to guide the best methods of cleaning to prevent HAIs. For now, healthcare facilities can focus on being diligent in carrying out the policies and procedures they currently have in place, and take action to improve the cleaning of hard surfaces based on current best practices.
After all, a nurse may have just washed her hands, but if she touches an unsanitized bed rail and then touches a patient, the risk of spreading infection has just increased.