Environmental Hygiene Resources

A recent study evaluated surfaces at 36 acute care hospitals and found that, on average, only 48% of all environmental surfaces were effectively cleaned.*

*Carling, PC, Parry MM, Rupp ME, et al. Improving cleaning of the environment surrounding patients in 36 acute care hospitals. Infect Control Hosp Epidemiol. Nov 2008:29(11):1035-1041.

Sporicidal Disinfectants

Optimizing Environmental Hygiene: The Impact of Combined Daily-Use Sporicide, Objective Environmental Monitoring
and Best Practices Training on Environmental Hygiene and Infection Control Outcomes
Vicki G. Allen MSN, RN, CIC; Mary G. Scott BSN, RN CIC; Beverly A. Yoder BS, RN; Lavane Barnes; Willie Mae Powell;
Jessica Shafi, MLT (ASCP)

Clostridium difficile (CD) Hospital Acquired Infection (HAI) Rates Unaffected by Switch from Bleach (B) to Hydrogen Peroxide (H2O2) and Peracetic Acid (PA) Based Disinfectants – The New Smell of Clean
Authors: Carlene Muto, MD, MS; Amy Metzger, BS, MT (ASCP), CIC; Ashley Querry, BS, CIC; Dan Gasparovic; Brian Depalma; and Laurie Rack, DNP, RN, NEA-BC

Impact of Novel Sporicidal Disinfectant Use on Environmental Contamination and Infection Rates Compared to Standard Cleaning Practice
Authors: Samran Haider, MD, Judy Moshos, MT (ASCP), CIC, Tim Burger, Philip Carling, MD, Paul Lephart, PhD, Paul Kilgore, MD, MPH, Debbie Decamillo, RN and Keith S. Kaye,

Effect on patient room environmental bioburden from use of a novel daily-use sporicidal hard surface disinfectant
Authors: Perkins J., Ferguson J., Thomasser A., Ventrucci C., Brown E.
Publication: Presented at IDWeek 2012

Comparing the Clinical Effectiveness of Surface Disinfectants
Authors: Perkins J., Ferguson J., Thomasser A., Carling P.
Presented at IDWeek 2013

Effectiveness of a sporicidal peracetic acid/hydrogen peroxide-based daily disinfectant cleaner for disinfection of floors in rooms of patients with Clostridium difficile infection
Authors: Deshpande A., Mana T., Jencson AC., Cadnum JL., Sitzlar B., Fertelli D., Hurless K., Kundrapu S., Sunkesula VCK, Donskey CJ
Publication: Presented at IDWeek 2013

Clostridium Difficile Cross-Contamination in the Textile Laundering Process: The Importance of Selecting and Appropriate Hard Surface Disinfectant
Authors: Henry L. Carbone II, BS, MS; Lisa A Helickson, BA; Anita Thomasser, BS; Loan K Vu, BA; Ecolab Research and Development, Eagan, MN
Publication: Presented at Fifth Decennial International Conference on Healthcare Associated Infections (2010) 

Environmental Monitoring

Evaluation of a Programmatic Approach to Improving Patient Room Cleaning Outcomes

Authors: Emily McCracken, MPH; Karen martin, RN, BS, HPN, CIC; Linda Homan, MSN, CIC
Presented at: APIC 2010

An evaluation of patient area cleaning in 3 hospitals using a novel targeting methodology

Authors: Carling PC, Briggs J, Hylander D, Perkins J
Publication: Am J Infection Control 2006 Oct; 34(8):513-9

Intensive care unit environmental cleaning: an evaluation in sixteen hospitals using a novel assessment tool
Authors: Carling PC, Von Beheren S, Kim P, Woods C
Publication: Healthcare Environmental Hygiene Study Group. J Hosp Infect 2008 Jan; 28(1):39-44. Epub 2007 Dec 11.

Impact of an environmental cleaning intervention on the presence of  methicillin-resistant Staphylococcus aureus and vancomycin-resistant entercocci on surfaces in intensive care unit rooms
Authors: Goodman ER, Platt R, Bass R, Onderdonk AB, Yokoe DS, Huang SS
Publication: Infect Control Hosp Epidemiol 2008 Jul;29(7):593-9.

Improving cleaning of the environment surrounding patients in 36 acute care hospitals
Authors: Carling PC, Parry MM, Rupp ME, Po JL, Dick B, Von Beheren S; Healthcare Environmental Hygiene Study Group
Publication: Infect Control Hosp Epidemiol. 2008 Nov; 29(11):1035-41.

Dangerous cows: An analysis of disinfection cleaning of computer keyboards on wheels
Authors: Po JL, Burke R, Sulis C, Carling PC
Publication: Am J Infect Control 2009 Nov; 37(9):778-80. Epub 2009 May 19. 
(Must register for access to this article)

Beyond the "Hawthorne Effect": Reduction of Clostridium difficile environmental contamination through active intervention to improve cleaning practices
Authors: Guerrero D, Carling PC, Jury L, Ponnada S, Nerandzic M, Eckstein EC, Donskey C.
Publication: Society for Healthcare Epidemiology in America Fifth Decennial Meeting; Atlanta GA:March 18-22, 2010.

Environmental cleaning intervention and risk of acquiring multi-drug resistant organisms from prior room occupants
Authors: Datta R, Platt R, Yokoe DS, Huang SS
Publication: Arch Intern Med; 211;17(6):491:494

A novel technique to identify opportunities for improving environmental hygiene in the operating room
Authors: Jefferson J, Whelan R, Dick B, Carling PC
Publication: AORN J 93; March 2011:358-364
(Abstract Only)

Decreasing operating room environmental pathogen contamination through improved cleaning practice
Authors: Munoz-Price SL, Birnbach DJ, Lubarsky DA, Arheart KL, Fajardo-Aquino Y, Rosalsky M, Cleary T, DePascale D, Coro G, Namias N, Carling P
Publication: Infect Control Hosp Epidemiol 2012;33(9):897-904

Variability of adenosine triphosphate-based bioluminescence assay readings among drug resistant pathogens
Authors: Heller M., Thompson PA., Loock MH., Sawchuk A., Guerrero DM
Publication: Infect Control Hosp Epidemiol. 2012 33:12.
(Cost to download complete article)

Diagnostic assessment of different environmental cleaning monitoring methods
Authors: Luick L, Thompson PA, Loock MA et al.
Publication: Am J Infect Control 2013;41(8):751-2.
(Abstract Only)
This study compares visual inspection, DAZO™ fluorescent marker, and ATP to the gold standard of aerobic cultures to test the hypothesis that fluorescent dye and ATP-based monitoring systems are better than visual inspection alone in "diagnosing" the cleanliness of environmental surfaces. They concluded that visual inspection alone is a poor predictor of thoroughness of cleaning.

Best Practices for Environmental Hygiene 

Quat Absorption onto Textiles

Authors: Ecolab White Paper 2010

Evaluation of Quat Absorption and Efficacy of Cleaning Cloths
Authors: Grieme LE., Thompson KM., Carbone HL
Presented at 37th Annual APIC Conference 2009

Improving Healthcare Environmental Cleaning and Disinfection: Current and Evolving Issues
Authors: Carling, PC., Huang SS
Publication: Infection Control Hosp Epidemiology 34:5, Special Topic Issue: The Role of the Environment in Infection Prevention (May 2013), pp 507-513.

This commentary discusses the significant advances in the science and application of innovations in environmental cleaning and provides direction for future research. The authors discuss the need to carefully evaluate the role and return on investment of new technologies in clinical practice by incorporating sound study design. They also discuss the importance of separating the process of cleaning from the agent itself when evaluating specific cleaning agents.

Climbing the Evidentiary Hierarchy for Environmental Infection Control
Authors: McDonald, CL and Arduino M.
Publication: Editorial Commentary. Clin Infect Dis 2013 56:Jan 1

The authors propose a hierarchy of evidence be used when assessing environmental disinfection strategies. At the foundation are laboratory efficacy studies similar to those required for registration by the EPA. At the top of the hierarchy are studies that link environmental hygiene interventions to infection rate reduction.

Infection control: the case for horizontal rather than vertical interventional programs
Authors: Wenzel RP., Edmond MB
Publication: International Journal of Infectious Diseases 14S4 (2010) S3-S5.
(Note: Must register for access to article)

Screening inpatients for MRSA - Case closed
Authors: Edmond MB., Wenzel RP
Publication: N Engl J Med 368:24 NEJM.2314 org June 13, 2013

A programmatic approach to environmental hygiene for healthcare: A literature review
Authors: Various authors, 2012

Guidelines and Recommendations

Guideline for Disinfection and Sterilization in Healthcare Facilities (2008)

Guidelines for Environmental Infection Control in Healthcare Facilities (2003)

Management of Multi-drug Resistant Organisms in Healthcare Settings (2006) 

CDC Toolkit: Options for Environmental Cleaning (2010) 

Practice Guidance for Healthcare Environmental Cleaning (2012) This manual is available for purchase from the Association for the Healthcare Environment and is intended to be recommended practice for professionals who care for the healthcare environmental and are responsible for management of healthcare cleaning and disinfection. The guidance is based on industry research, peer-reviewed clinical evidence and guidelines and best practice from other leaning healthcare organizations.

Note: Some resources may require additional registration and/or subscription.