Important updates have recently been made to the national recommendations around hospital cleaning and disinfection in England, with the publication of the National Standards of Healthcare Cleanliness and the National Infection Prevention and Control Manual.1, 2 This article looks at the future of surface cleaning and disinfection in hospitals in reference to these documents.
There has never been a better time to focus attention on ensuring the most effective methods to clean and disinfect our hospitals. There is evidence that the healthcare environment becomes contaminated with a range of important pathogens that can cause healthcare-associated infections (HCAIs), including MRSA, CPE, C. difficile, norovirus, and others.3, 4 Perhaps the most compelling evidence that contaminated surfaces play a key role in the transmission of these pathogens is the finding that being admitted to a room where the previous occupant had one of these potentially HCAI-causing microbes increases the risk of acquisition for the incoming occupant.4, 5 Furthermore, improving the standard of cleaning and disinfection at the time of patient discharge mitigates this increased risk.6
The National Standards of Healthcare Cleanliness (2021),2 and the National Infection Prevention and Control Manual (2022)1 will both help to standardise IPC cleaning practices across the country and, in doing so, improve patient safety. The National Standards of Healthcare Cleanliness provide a structured framework to evaluate the design, implementation, and monitoring of cleanliness in healthcare. For the first time, the standards require “star ratings” to be displayed publicly in healthcare settings. This adds a helpful new layer of accountability for high standards of cleanliness in healthcare facilities. The National Infection Prevention and Control Manual follows on from the publication of the comparable document for Scotland some years ago, and provides a concise basis for the development of local policies based on these nationally defined principles
The National Standards of Healthcare Cleanliness are not prescriptive in terms of choice of cleaning and disinfection agents, but rather make general recommendations about local policy decisions, training, personal protective equipment (PPE), and methods (including a direction of activity from ”top to bottom” and from “clean to dirty”). The National Infection Prevention and Control Manual describes standard infection control precautions (SICPs), to be used when patients have no known infection risks, and transmission-based precautions (TBPs) to be used when patients have either confirmed or suspected infectious diseases. Under SICPs, routine disinfection of the environment is not routinely recommended in the manual, aside from routine disinfection of sanitary fittings using chlorine. While detergent-only cleaning may be suitable in some hospital settings, there is a strong evidence base that detergent-only cleaning has important limitations, and that routine use of disinfectants is a safer approach.7 A key risk with using a detergent-only approach is that since detergents have little or no direct biocidal impact, they can simply transfer contamination with key microbes associated with HCAI from surface to surface.8, 9 Also, while historically, a detergent-only cleaning approach has not been thought to damage surfaces in healthcare settings, some emerging evidence demonstrates that detergent-only cleaning is associated with some degree of damage to surfaces.10 Perhaps unsurprisingly, there is evidence that switching away from a detergent-only approach to routine use of surface disinfection is associated with reduced prevalence of HCAI-causing microbes.7
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