By J. Darrel Hicks, Contributing Writer

A quick daily wipe with a hospital-approved disinfectant — especially if contact time, coverage and mechanical action are suboptimal — often does little more than skim the surface and might leave a biofilm community largely intact. Most environmental services (EVS) workers are still cleaning as if they were wiping dust off a countertop, not disrupting a living, structured community. 

Why daily cleaning often fails 

Insufficient mechanical disruption. Most protocols underemphasize physical removal. Biofilms are glued into micro-crevices, so a light wipe does not break that structure. 

Inadequate contact time and wetness. Disinfectants often are wiped off before the required dwell time, and biofilm exopolymeric substances (EPS) slows penetration even when contact time is met. 

Organic load and residues. Detergent and disinfectant residues and organic soil actually can provide nutrients, supporting regrowth once the active agent dissipates. 

No biofilm-specific validation. Many products are tested against planktonic organisms on smooth carriers, not mature dry surface biofilms on real-world materials. 

If we do not acknowledge the biofilm reality, we are essentially feeding and watering a protected community while feeling reassured by the appearance of the surface and the smell of the disinfectant. 

A biofilm-aware strategy 

Think of developing a biofilm-aware strategy as moving from wipe and hope to disrupt, remove and prevent. 

First, prioritize mechanical removal: 

• Friction should be a core parameter — elbow grease and light scrubbing. 
• Use microfiber or other high-friction textiles with deliberate, overlapping strokes, especially on high-touch points, including bed rails, call buttons, overbed tables, door handles and monitor controls. 
• Use better tools, including flat mops and cloths that maximize surface contact. Avoid worn, low-friction textiles. Consider color-coding and single-use wipes in high-risk zones to avoid the cross-transfer of biofilm fragments. 

Second, use chemistries that target biofilm structure: 

• Biofilm-disrupting agents. EPS-focused chemistry, including surfactants, enzymes, oxidizing agents and certain novel formulations that are being developed and tested specifically against biofilms on medical devices and surfaces. 
• Two-step cleaning-disinfection. The first step here is to break up and lift soil and EPS. The second step is to inactivate exposed organisms. But be aware that combining into a single, rushed wipe often underperforms in biofilm contexts. 
• Validation against biofilms. Select products with data against dry-surface biofilms or at least against biofilm models, not just planktonic log reductions. 

Third, rethink frequency and intensity by risk: 

• Risk-based schedules. High-touch, high-risk focus. Increase the frequency and intensity — mechanical plus chemistry — for bed spaces, near-patient equipment and frequently handled controls rather than treating all surfaces equally. 
• Periodic biofilm reset. Perform deep decontamination at defined intervals or at discharge/terminal clean, and use more intensive methods — including enhanced friction, longer contact times and possibly adjunct technologies — to reduce mature biofilm burden. 

Making surfaces less biofilm-friendly 

Design and materials considerations: 

• Surface topography — i.e., smooth, intact surfaces. Micro-cracks, seams and rough finishes provide niches for biofilm anchoring. Choosing smoother, non-porous, easily cleanable materials for high-touch items reduces biofilm footholds. 
• Equipment design — i.e., cleanability by design. Look for fewer seams, hidden ledges, and complex geometries and detachable parts that can be periodically soaked or reprocessed. Provide clear instructions for cleaning around controls and joints. 

We have treated the environment as inanimate when it is actually teeming with life, often with more cells than the patient we are trying to protect. 

For practice change, that means reframing education from dirt to ecology. Teach staff that they are not just removing visible soil. They are disrupting a microscopic ecosystem that can create infections. Use images, analogies — including microbial cities and villages under a shield — to make it vivid. 

Linking to outcomes means stories and data on healthcare-associated infections. Connect environmental biofilms to real patient harm and multidrug-resistant organism transmission so cleaning is seen as clinical work, not housekeeping. 

Finally, measure what matters beyond just adenosine triphosphate (ATP) testing to indicate whether a surface has been properly cleaned. Explore methods that assess biofilm presence or regrowth over time, not just momentary surface cleanliness. Even if imperfect, the mindset shift — How fast does this surface repopulate? — is crucial. 

J. Darrel Hicks, BA, MESRE, CHESP, Certificate of Mastery in Infection Prevention, is the past president of the Healthcare Surfaces Institute. Hicks is nationally recognized as a 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 darrel@darrelhicks.com, or learn more at www.darrelhicks.com.