There are three key components in the infection chain. One is the susceptible subjects, especially those immune compromised patients or patients undergoing through invasive procedures that requires prolonged stay in hospitals. The second is the source of pathogens, such as positive patients, environmental and device surfaces or water & air. The third is the mode of transmission, i.e. the path connecting source of pathogens and the susceptible subjects. It can be further divided into direct contact and indirect contact such as high touch surfaces.

Healthcare associated infections (HAIs) are one of the leading causes of morbidity and mortality in healthcare in the United States and other countries /regions. HAIs are also responsible for substantial healthcare costs. Based on a cost analysis data in 2012, the total annual costs for the 5 major infections were $9.8 billion (95% CI, $8.3-$11.5 billion), with surgical site infections contributing the most to overall costs (33.7% of the total), followed by ventilator-associated pneumonia (31.6%), central line–associated bloodstream infections (18.9%), C. difficile infections (15.4%), and catheter-associated urinary tract infections (<1%)[1]. With the growing concerns of multidrug resistant microorganisms (MDROs), prevention of such infections becomes even more important.

Role of high touch surfaces in HAIs

There are growing numbers of studies showing that the pathogens identified from surrounding areas of positive inpatients are statistically higher than from negative inpatients. The odds of contracting the infections are significantly higher if the negative patients were put into a room previously occupied by positive patients. The pathogens have been reported to be able to survive on inanimate surfaces for hours, weeks and even months. There is direct epidemiological relation between pathogens on the inanimate surfaces (environmental surfaces and medical device surfaces) and increased HAIs including Methicillin-Resistant Staphylococcus aureus (MRSA), Vancomycin-Resistant enterococcal (VRE), Acinetobacter and Clostridium difficile (C. difficile) [2].

Surface disinfection and reduced HAIs

Cleaning and disinfection have become a standard practice for many facilities due to the evidence-based data and guidelines. For example, The Centers for Disease Control and Prevention (CDC) and Healthcare Infection Control Practices Advisory Committee recommend that all health care settings, regardless of the level of care provided, make infection prevention a priority and that standard precautions, including environmental cleaning, be used as a means to reduce infection transmission[3].

Hand hygiene and surface disinfection

The importance of hand hygiene in reducing infection risks have been discovered, developed and disciplined in the past 100 years to date. Without proper environmental cleaning and disinfection, the beneficial effects of hand hygiene is compromised due to the frequency of using hands touching surfaces and the persistence of pathogens on surfaces. The contact with the environmental surfaces, including medical devices, was just as likely to contaminate the hands of healthcare providers as was direct contact with the patients[2].

How to choose a proper surface disinfectant

The most commonly used disinfectants are EPA registered wipes, ready-to-use spray and concentrated liquids. There are four key features in choosing a proper surface disinfectant. (1) Contact time or dwell time. It is the time needed to effectively disinfect pathogens. The mainstream products on the markets have a contact time less than or equal to 3 minutes to meet the practical needs in clinical settings. (2) Broad-spectrum pathogen claims. Bactericidal, Virucidal, and Mycobactericidal are most common. However, fungicidal claim should not be overlooked. According to the National Healthcare Safety Network (NHSN) report, fungi accounted for 13% HAIs[4]. In another multicenter cohort study, fungal infections accounted for about 30% HAIs [5]. (3) Cleaning properties. Organic debris such as blood, salvia and body fluids can function as a shield for pathogens. Choosing a disinfectant with good cleaning property is helpful. Studies show that substantial amount blood contamination is occult due to the size visually detected. (4) Material compatibility. Medical device providers and disinfectant manufacturers need to work more closely especially at the early stage to choose materials more durable for common disinfectants and to develop disinfectants with less residue and better chemical compatibility.

1Zimlichman E, Henderson D, Tamir O, et al. Health Care-Associated Infections A Meta-analysis of Costs and Financial Impact on the US Health Care System. JAMA Intern Med 2013;173:2039-46.

2 Rutala WA, Weber DJ. Monitoring and improving the effectiveness of surface cleaning and disinfection. American Journal of Infection Control 2016;44:E69-E76.

3 Quinn MM, Henneberger PK, Natl Inst Occupational S, Hl, Natl Occupational Res Agenda N. Cleaning and disinfecting environmental surfaces in health care: Toward an integrated framework for infection and occupational illness prevention. American Journal of Infection Control 2015;43:424-34.

4 Hidron AI, Edwards JR, Patel J, et al. Antimicrobial-Resistant Pathogens Associated With Healthcare-Associated Infections: Annual Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol 2008;29:996-1011.

5 Dabar G, Harmouche C, Salameh P, et al. Community- and healthcare-associated infections in critically ill patients: a multicenter cohort study. Int J Infect Dis 2015;37:80-5.

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