Infection Prevention: The HAI That Never Happened

Hospitals need to raise the level of awareness regarding environmental hygiene and its importance throughout society.

By J. Darrel Hicks, Contributing Writer

Believe it or not, I still occasionally meet people who tell me that contaminated surfaces do not contribute to pathogen transmission. That rather dated viewpoint is becoming increasingly untenable as the volume and quality of data evaluating the role of the environment in transmission continues to grow. 

For me, the question has moved on to how much contaminated surfaces contribute to transmission and how best to address contamination of the hospital environment. 

Consumers of healthcare are much more aware of the essential role that cleaning plays in safeguarding patient health and safety. Cleaning for appearance is no longer sufficient. The public now understands that a surface can look and smell clean but still harbor life-threatening pathogens. 

Environmental services professionals should be educated about the prevention and transmission of disease. They are not maids, housekeepers, custodians or janitors. They are members of the infection prevention task force because their primary role is saving lives through better, more thorough cleaning and disinfection. 

Looking at the infection prevention and control (IPC) landscape, the one area that has been consistently undervalued and understudied is the role of the hospital environment in patient care. Environmental Services associates are often relatively untrained, unmotivated, underpaid, and under appreciated by other professional staff in hospitals. 

Once-a-day cleaning is the bare minimum because nature abhors a vacuum. Pathogens return very quickly. The bottom line is that killing and physically removing pathogens are critical in the fight against hospital associated infections (HAIs). One study found that a single cleaning of a patient’s room can reduce contamination by about 90 percent. 

It has become apparent that the surfaces closer to the patient are more likely to transfer contamination than those hand-touch surfaces further away. The role of near-patient hand-touch sites in the transmission of Methicillin-resistant Staphylococcus aureus (MRSA) and other hospital pathogens has not been given the priority it deserves. 

There is a difference between the quantity, quality and methods of routine cleaning compared with what is needed in the event of an outbreak. As a result, there is a shotgun approach to cleaning in an outbreak and a reluctance by leaders to protect or prioritize routine standards of cleaning beyond the outbreak situation. 

Is it sufficient to proclaim the benefits of cleaning with disinfectants without establishing what can be achieved using soap and water alone to remove 96-99 percent of soil from a surface? 

No one has yet modeled different cleaning methods against the infection risk for patients, their degree of vulnerability and the clinical area in which they are exposed. 

Simple cleaning of environmental surfaces could be our only defense when Darwinian evolution finally terminates the antibiotic era. We need to raise the level of awareness regarding environmental hygiene and its importance throughout society. Hospitals should lead the way. 

Since hospital acquisition invariably leads to patients taking infections home, to school, shopping and to the office, hospitals might limit the number of patients with so-called super bugs in the community. Think of it as the HAI that never happened. 

J. Darrel Hicks, BA, MESRE, CHESP, Certificate of Mastery in Infection Prevention, is the past president of the Healthcare Surfaces Institute. Hicks is a nationally recognized subject matter expert in infection prevention and control as it relates to cleaning. He is the owner and principal of Safe, Clean and Disinfected. His enterprise specializes in B2B consulting, webinar presentations, seminars and facility consulting services related to cleaning and disinfection. He can be reached at Learn more at 

March 13, 2023

Topic Area: Infection Control

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