Jennifer H. Han, MD, MSCE *; Nancy Sullivan, BA *; Brian F. Leas, MS, MA *; David A. Pegues, MD; Janice L. Kaczmarek, MS; Craig A. Umscheid, MD, MSCE
Disclaimer: This article is based on research conducted by the ECRI Institute–Penn Medicine Evidence-based Practice Center under contract to AHRQ, U.S. Department of Health and Human Services. The findings and conclusions in this document are those of the authors, who are responsible for its contents and should not be construed as endorsement by AHRQ or the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank the following persons at the ECRI Institute for their assistance with the preparation of the technical brief: Michele Datko, MS; James Davis, MSN, RN; David Snyder, PhD; Gina Giradi, MS; Luke A. Petosa, MSc; Joann Fontanarosa, PhD; Michael Phillips; Jennifer Dell'Aquila Maslin; Helen Dunn; Lydia Dharia; and Evidence-based Practice Center Director, Karen Schoelles, MD, SM. They also thank the following persons, who served as key informants on the associated technical brief: Michelle Alfa, PhD; Philip Carling, MD; Patti Costello; Mia Gonzales Dean, MBA, MS; Curtis Donskey, MD; Rich Feczko; Elaine Larson, PhD, RN; Luis Ostrosky-Zeichner, MD; William A. Rutala, PhD, MS, MPH; Daniel Schwartz, MD, MBA; and James P. Steinberg, MD. The authors also thank the following persons, who served as peer reviewers on the associated technical brief: Dottie Borton, RN, BSN, CIC; Mary K. Hayden, MD; L. Clifford McDonald, MD; Gina
Pugliese, RN, MS; Gary A. Roselle, MD; and Robert A. Weinstein, MD. They also acknowledge Kim Marie Wittenberg, MA, who served as the AHRQ Task Order Officer, and Timothy J. Wilt, MD, MPH, at the Minnesota Evidence-based Practice Center, who served as the Associate Editor for the associated technical brief.
Grant Support: This project was funded under AHRQ (contract HHSA 290-2012-00011-I). This topic was nominated by a member of the 3M Hospital Hygiene Global Advisory Board on behalf of the Board. This work was also supported in part by the National Institutes of Health (K01-AI103028; Dr. Han).
Disclosures: Dr. Han, Ms. Sullivan, Mr. Leas, Dr. Pegues, Ms. Kaczmarek, and Dr. Umscheid report grants from AHRQ during the conduct of the study. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?ms Num=M15-1192.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Requests for Single Reprints: Jennifer Han, MD, MSCE, Division of Infectious Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 811 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Han: Division of Infectious Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 811 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104.
Ms. Sullivan and Ms. Kaczmarek: ECRI Institute Evidence-based Practice Center and Health Technology Assessment Group, ECRI Institute Headquarters, 5200 Butler Pike, Plymouth Meeting, PA 19462-1298.
Mr. Leas and Dr. Umscheid: Center for Evidence-based Practice, University of Pennsylvania Health System, 3535 Market Street, Suite 50, Philadelphia, PA 19104.
Dr. Pegues: Department of Healthcare Epidemiology, Infection Prevention, and Control, Hospital of the University of Pennsylvania, 3400 Spruce Street, Ground Founders, Philadelphia, PA 19104.
Author Contributions: Conception and design: J.H. Han, B.F. Leas, D.A. Pegues, C.A. Umscheid.
Analysis and interpretation of the data: J.H. Han, N. Sullivan, B.F. Leas, D.A. Pegues, C.A. Umscheid.
Drafting of the article: J.H. Han, N. Sullivan, D.A. Pegues.
Critical revision of the article for important intellectual content: J.H. Han, B.F. Leas, D.A. Pegues, C.A. Umscheid.
Final approval of the article: J.H. Han, N. Sullivan, B.F. Leas, D.A. Pegues, J.L. Kaczmarek, C.A. Umscheid.
Provision of study materials or patients: B.F. Leas, C.A. Umscheid.
Obtaining of funding: B.F. Leas, C.A. Umscheid.
Administrative, technical, or logistic support: N. Sullivan, B.F. Leas, J.L. Kaczmarek, C.A. Umscheid.
Collection and assembly of data: J.H. Han, N. Sullivan, B.F. Leas, D.A. Pegues.
The cleaning of hard surfaces in hospital rooms is critical for reducing health care–associated infections. This review describes the evidence examining current methods of cleaning, disinfecting, and monitoring cleanliness of patient rooms, as well as contextual factors that may affect implementation and effectiveness. Key informants were interviewed, and a systematic search for publications since 1990 was done with the use of several bibliographic and gray literature resources. Studies examining surface contamination, colonization, or infection with Clostridium difficile, methicillin-resistant Staphylococcus aureus, or vancomycin-resistant enterococci were included.
Eighty studies were identified—76 primary studies and 4 systematic reviews. Forty-nine studies examined cleaning methods, 14 evaluated monitoring strategies, and 17 addressed challenges or facilitators to implementation. Only 5 studies were randomized, controlled trials, and surface contamination was the most commonly assessed outcome. Comparative effectiveness studies of disinfecting methods and monitoring strategies were uncommon. Future research should evaluate and compare newly emerging strategies, such as self-disinfecting coatings for disinfecting and adenosine triphosphate and ultraviolet/fluorescent surface markers for monitoring. Studies should also assess patient-centered outcomes, such as infection, when possible. Other challenges include identifying high-touch surfaces that confer the greatest risk for pathogen transmission; developing standard thresholds for defining cleanliness; and using methods to adjust for confounders, such as hand
hygiene, when examining the effect of disinfecting methods.
Appendix Table 1. Electronic Database Searches
Appendix Table 2. Search Strategies*
Appendix Table 3. Cleaning and Disinfecting Methods Used in Acute Care Settings
Appendix Table 4. Monitoring Methods Used in Acute Care Settings
Summary of evidence search and selection.
* Gray literature included 6 clinical practice guidelines and 2 background articles. These were used for background information and were not included in the systematic overview.
Appendix Table 5. Clinical Practice Guidelines
Appendix Table 5. Continued
Appendix Table 6. Ongoing Clinical Trials
Evidence map showing the number and study designs of published studies that address major categories of cleaning and disinfection strategies and monitoring methods.
ATP = adenosine triphosphate; HP = hydrogen peroxide; HPV = hydrogen peroxide vapor; RCT = randomized, controlled trial; UV = ultraviolet.
* 2 systematic reviews and 47 primary studies. Some studies evaluated >1 method.
† 2 systematic reviews and 12 primary studies. Some studies evaluated >1 method.
Evidence needs for future research in environmental cleaning.
Adapted from reference 10. HP = hydrogen peroxide; HPV = hydrogen peroxide vapor; PCR = polymerase chain reaction; QAC = quaternary ammonium compound; RCT = randomized, controlled trial; UV = ultraviolet.
Appendix Table 7. Characteristics of Systematic Reviews
Appendix Table 8. Characteristics of Cleaning and Disinfecting Studies
Appendix Table 8. Continued
Appendix Table 9. Characteristics of Monitoring Studies
Appendix Table 10. Characteristics of Implementation Studies
In this video, Jennifer H. Han, MD, MSCE, and Craig A. Umscheid, MD, MSCE, offer additional insight into their article, "Cleaning Hospital Room Surfaces to Prevent Health Care-Associated Infections. A Technical Brief."
Han JH, Sullivan N, Leas BF, et al. Cleaning Hospital Room Surfaces to Prevent Health Care–Associated Infections: A Technical Brief. Ann Intern Med. 2015;163:598–607. [Epub ahead of print 11 August 2015]. doi: https://doi.org/10.7326/M15-1192
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Published: Ann Intern Med. 2015;163(8):598-607.
Published at www.annals.org on 11 August 2015
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