Emerging Strategies for Effective Cleaning and Disinfection in Healthcare Settings

Author: Clinical Affairs PDI Healthcare

New research, technology, and strategies in cleaning and disinfection have been on the rise throughout the last decade in the constant pursuit of improving infection prevention in healthcare settings. To keep professionals informed, our clinical team has put together some highlights of the pros and cons of several such technologies, including “no-touch” methods, the “bundle” approach, and continuously active disinfection, based on recent industry meetings, research, and discussions.

Cleaning and Disinfecting with No-Touch Technologies

Traditional cleaning and disinfection practices, such as the use of mops, towels, and wipes are valuable and necessary in healthcare, but require a manual application and the risk of potential human error. The existence and persistence of biofilms, which are collectives of microorganisms that are highly resistant to antibiotics and other disinfectants, further complicate the infection control process in healthcare settings. Biofilms can persist on improperly cleaned textiles and surfaces and create a greater need for more advanced cleaning methods, including no-touch technologies.

• Electrostatic spraying, fogging, or misting is a no-touch cleaning method that can be beneficial for quicker and easier use and to cover hard-to-reach areas compared to typical manual cleaning. One recent study evaluating sprayers on wheelchairs noted significant overall efficacy in the reduction of pathogens with the exception of difficile. However, as a drawback, they do not remove organic debris and may present hazardous chemical exposure to users. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) do not recommend routine spraying or fogging as a primary method of surface disinfection.
• Ultraviolet light (UV) technology is a growing no-touch disinfection practice used in hospitals with the backing of several recent studies showing significant efficacy (when used according to manufacturer instructions) as well as high satisfaction and favorable opinions by healthcare staff. UVC energy has been found to be a safe, effective, environmentally friendly, and chemical-free way to inactivate germs and pathogens for total room disinfection. However, factors such as the distance and orientation of the surface from the UV light, shadowing, and the presence of organic material can impact efficacy.
• Another emerging disinfection method is antimicrobial coatings on surfaces including antimicrobial agents incorporated into objects or applied as coatings or films to provide residual protection. Benefits of this approach are its lasting protection against microbes, EPA approval with standardization, and the need for less frequent cleaning. However, products should ideally be used in addition to manual cleaning, and not as a replacement for standard cleaning and disinfection.
• A “bundle” approach has also been found to be a highly effective best practice for environmental cleaning and disinfection. This involves the creation of evidence-based policies and procedures, selection of appropriate cleaning and disinfection products, education of all staff, monitoring of compliance with feedback, and implementing adjuvant “no-touch” room decontamination strategies. Based on risk assessment, the frequency, method, and process for every major area in healthcare settings should be established to help users develop tailored standard operating procedures (SOPs) for all patient care areas.

There is no current substitute for the “tried and true” mechanical cleaning practices, however, no-touch technologies can enhance cleaning and disinfection overall. Future evidence-based research on these new technologies is still needed to further understand benefits and promote widespread use.

Continuously Active Disinfection

A clinical study to evaluate whether a continuously active disinfectant would inactivate virus 229E, a surrogate for SARS-CoV-2, on hard nonporous surfaces was presented at the 2021 APIC conference. Continuous active disinfection (CAD) is the application of a surface chemical that has intermediate-level disinfection on contact and then continuously disinfects potential pathogens that land on the surface thereafter.

In the study, the team of investigators from the University of North Carolina and the University of Arizona analyzed CAD against the human coronavirus 229E, using the “EPA Protocol Residual Self-Sanitizing Activity of Dried Chemical Residuals on Hard, Non-Porous Surfaces.” CAD demonstrated excellent sustained antiviral activity against the test pathogen. Results showed >4.5 log10 (99.99%) reduction within one minute after application on surface treated with CAD.

Continuously active disinfection (CAD) is a revolutionary technology that helps break the chain of surface re-contamination and minimize the risk of HAIs by forming a protective shield on surfaces.

As new virus variants and persistent HAIs continue to cause disease and sickness in healthcare settings, there is a vital need to continue to study and advance cleaning and disinfection practices.  For more information and resources on best practices in infection prevention, review our PDI Education center.