Role of Environmental Surfaces in Disease Transmission

In-patient/Resident room

Transmission FAQs

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

Hospital environment as a reservoir for cross transmission: cleaning and disinfection procedures

HICPAC /CDC Isolation Guidelines. 2007 (PDF)

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 (How long do nosocomial pathogens persist on inanimate surfaces? A systematic review 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 (Evaluation of hospital room assignment and acquisition of Clostridium difficile infection article via PubMed)

Currie B, Revisiting Environmental Hygiene and Hospital-Acquired Infections, Infectious Diseases Special Edition 2013 (PDF) (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 (PDF) (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 et.al. Am J Infect Control. 2012 (Hospital privacy curtains are frequently and rapidly contaminated with potentially pathogenic bacteria article via PubMed)

Koca et.al. Eurasian J Med. 2012 (Persistence of nosocomial pathogens on various fabrics 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 Environmental Infection Control Guidelines

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

Examples of High Touch Objects

Bed Controls	Phone and Call Button	Chair
Light Switch	Sink Top	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 (updated July 2019)
CDC/HICPAC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 (PDF) updated May 2019)
CDC Options for Evaluating Environmental Cleaning Toolkit (PDF)
CDC Environmental Checklist for Monitoring Terminal Cleaning (PDF)
CDC Environmental Checklist (Word) (scroll to bottom of page and download word doc)
CDC Environmental Cleaning Eval Worksheet (Excel) (scroll to bottom of page and download excel doc)
CDC/HICPAC Guidelines for Hand Hygiene in Healthcare Settings Published 2002 (PDF)
WHO Guidelines on Hand Hygiene in Healthcare (2009)
WHO Guidelines Hand Hygiene for All Initiative: Improving access & behaviour in healhcare facilities (2020)

EnvironCleanRoleOfEnvironSurfaces

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?

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

How long can pathogens survive in the environment?

How long can pathogens survive in the environment?

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

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

Can bedside curtains contribute to transmission of infection?

Can bedside curtains contribute to transmission of infection?

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

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

Examples of High Touch Objects

Examples of High Touch Objects

Summary of Key Points

Summary of Key Points

Environmental Cleaning Resources

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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?

​How long can pathogens survive in the environment?

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

Can bedside curtains contribute to transmission of infection?

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

E​xamples of High Touch Objects​

Summary of Key Points​

​​​​Environmental Cleaning Resources

How long can pathogens survive in the environment?

Examples of High Touch Objects

Summary of Key Points

Environmental Cleaning Resources