John Muir Health

Prior to 1970, hospitals regularly and routinely cultured air and environmental surfaces for microbial contamination. By 1970, both the CDC and the American Hospital Association were discouraging this practice. The 2003 CDC Guidelines for Environmental Control in Healthcare Facilities and the CDC Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007, do not recommend routine, random microbial sampling of the environment in healthcare facilities for several reasons, the foremost being that infection transmission was deemed less from the environment and more from hand contamination.

The CDC Guidelines for Environmental Control in Healthcare Facilities (published in 2003) state that environmental microbial sampling is indicated in 4 situations: 1) during the "...investigation of an outbreak of disease or infections when environmental reservoirs or fomites are implicated epidemiologically in disease transmission...", 2) when warranted in a research study, 3) "...to monitor a potentially hazardous environmental condition to confirm the presence of a hazardous chemical or geological agent and validate the abatement of the hazard...", and, 4) "...to evaluate the effects of a change in infection control practice or to ensure that equipment or systems perform according to specifications and expected outcomes." The Guidelines add that "...sampling on an extended basis in the absence of an adverse outcome, is usually unjustified."

Environmental surfaces can be a source of hand contamination and thus disease transmission. To reduce environmental hand contamination facilities should:

1. Facilitate healthcare staff adherence to Standard Precautions and good Hand Hygiene as these remain the best method of reducing microbial transmission during routine healthcare activities. Routine hand washing should ensure a 20-second cleaning and scrubbing, include all surfaces of the hands and wrists, and utilize water and liquid soap or appropriate alcohol hand sanitizers. Patients should also be instructed in good hand hygiene and encouraged to wash their hands with soap and water or an alcohol hand sanitizer before leaving their rooms.
2. Identify high-touch surfaces in patient rooms and common areas and ensure their cleansing and disinfection at least daily and when visibly soiled. Checklists and direct observation help housekeeping staff to not miss these frequently touched areas or items. Housekeeping staff should change or disinfect mop-heads and cleaning implements immediately after cleaning an isolation room or the room of a patient infected or colonized with difficult to eradicate organisms, such as Clostridium difficile, norovirus, or Acinetobacter baumannii.
3. Ensure regular cleansing and disinfection of personal care and medical equipment, when visibly soiled, and prior to use on another patient. Patients infected or colonized with MDROs (Multiple Drug Resistant Organisms) or with difficult to eradicate organisms should have equipment dedicated to their use.
4. Carefully consider roommate selection, especially when patients are colonized with an MDRO or a potential environmental contaminant. Patients colonized with an MDRO should have the opportunity to bathe or shower frequently and access to a fresh change of clothes at least daily.
5. Ensure that manufacturer's instructions are carefully followed when equipment, such as whirlpools and bathing tubs, hydrotherapy tanks and pools, ice machines, water dispensers, etc. are cleaned and disinfected.