​What is the process by which an environmental contaminant is transferred to another surface or patient/resident to cause infection?

• The surface must become contaminated by contact or airborne spread

• The organism must survive on the surface

• The surface must be touched by another person who picks up sufficient inoculum on their hands

• The person must omit or poorly perform hand hygiene

• The person must transmit the organism from their hands to another person or object in sufficient quantity to cause disease

The Inanimate Environment. Bennett & Brachman’s Hospital Infections 6th Ed. 2014

Chou. APIC Text of Infection Control & Epidemiology. 2013 (read article via APIC Text Online)

HICPAC /CDC Isolation Guidelines. 2007 (read Isolation Guidelines via CDC)

​Is there evidence that the environment plays a role in disease transmission?

• Yes, the environment has been implicated as a reservoir for healthcare-associated pathogens

• Admission to a room previously occupied by a CDI patient is a significant risk factor for C. difficile

• One study found that 11% of ICU patients admitted to a room previously occupied by a CDI patient developed CDI, versus 4.6% of ICU patients admitted to a room without a prior CDI positive occupant

Shaughnessy et al. Infect Contr Hosp Epidemiol. 2011 (read article via PubMed)

Currie B, Revisiting Environmental Hygiene and Hospital-Acquired Infections, Infectious Diseases Special Edition 2013 (read article via Infectious Disease Special Edition)

Weber DJ, Role of hospital surfaces in the transmission of emerging health care-associated pathogens: Norovirus, Clostridium difficile, and Acinetobacter Species, AJIC  2010 (read article via American Journal of Infection Control)

​Can the floor/carpet play a role in the spread of infection?

• Carpets

• Carpets have shown to become contaminated

• Vacuuming and steam cleaning temporarily reduces the number of organisms

• Evidence linking carpets to HAI rates is limited; no recommendation against use

• Non-carpeted floors

• Disinfection of floors offers no advantage over regular detergent/water cleaning

The Inanimate Environment, Bennett & Brachman’s Hospital Infections 6th Ed. 2014

​Summary of Key Points

• A properly cleaned care environment is essential to prevent or contain HAIs
• A surface must be physically cleaned before it can be disinfected
• Consistent use of best practices and clarity of roles should be emphasized
• Use of technologies such as microfiber, monitoring systems, and whole-room disinfection after cleaning are increasingly becoming the community standard of care
• EVS staff should be valued and supported so they can maximize their unique contributions to preventing HAI