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healthcare-associated infections (HAI) program

Role of Environmental Surfaces in Disease Transmission


​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)

​How long can pathogens survive in the environment?

  • Multiple factors influence duration of survival including the type of microbe, temperature, humidity, size of inoculum, porosity of surface and disinfectant residual
  • C. difficile spores are shed in high numbers, are resistant to desiccation and some disinfectants, and can live on surfaces for up to 5 months

Kramer et al. BMC Infect Dis. 2006 (read article via BioMed Central)

​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 bedside curtains contribute to transmission of infection?

  • Bacteria and fungi can survive on polyester, cotton, wool, and other fabrics
  • Privacy curtains are considered high-touch surfaces and can become rapidly contaminated especially when used in isolation rooms.
  • Hands can become contaminated after handling curtains. In one study, 50% of hands contaminated after handling curtains

Ohl Am J Infect Control. 2012 (read article via PubMed) 
(read document via Institut National De Sante Publique Du Qubec)
Koca Eurasian J Med. 2012 (read article via PubMed)

​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

CDC. MMWR. June 6, 2003 (read Environamental Infection Control Guidelines via CDC)

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

​Examples of High Touch Objects



Phone and Call Button




Light Switch


Sink Top

Flush Handle

Flush Handle

​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

​Environmental Cleaning Resources

CDC/HICPAC Guidelines for Environmental Infection Control in Health-Care Facilities, 2003

CDC/HICPAC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008

CDC Options for Evaluating Environmental Cleaning Toolkit

CDC Environmental Checklist for Monitoring Terminal Cleaning

CDC Environmental Checklist (scroll to bottom of page and download word doc)

CDC Environmental Cleaning Eval Worksheet (scroll to bottom of page and download excel doc)

CDC/HICPAC Guidelines for Hand Hygiene in Healthcare Settings Published 2002

WHO Guidelines on Hand Hygiene in Healthcare (2009)  

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