Infection prevention
property is related mainly to the biofilm structure itself. Bacteria in biofilm form can develop a “protective” layer, which is hard to penetrate with commonly-used chemical agents, including disinfectants and antibiotics. An endoscope-associated outbreak of
OXA 181 carbapenemase-producing Klebsiella Pneumonia showed that a significantly higher concentration of disinfectant (compared to standard concentration) was needed to achieve efficacy against this pathogen in biofilm form.5
Why environmental disinfection matters Environmental surfaces serve as a major reservoir for MDROs. Pathogens spread by colonised or infected patients accumulate on high-touch surfaces (i.e. bed rails, monitors, doorknobs and infusion pumps), where they can persist for days or even months. When healthcare workers touch these surfaces and subsequently touch patients, they unwittingly facilitate transmission, posing a risk of infection. Multiple reviews and guidelines emphasise
the role of environmental disinfection as a key pillar in preventing MDRO spread: l The CDC identifies enhanced environmental disinfection as one of the core interventions (alongside hand hygiene, equipment disinfection, and contact precautions), which has successfully reduced MDRO rates across healthcare facilities, internationally.1
l A 2025 systematic review and network meta- analysis of 97 studies found that bundles incorporating environmental cleaning (ENV) were among the most effective interventions for reducing MDRO acquisition, infection, and colonisation. For example, standard precautions + contact precautions + environmental cleaning (SP + CP + ENV) achieved an exceptionally low transmission rate ratio (RR) of 0.04–0.09, demonstrating its high efficacy across settings.6
l The British Medical Journal (BMJ) Making Healthcare Safer IV review also found evidence – though of varying certainty – that environmental decontamination can reduce infection risk and is beneficial when combined with other measures such as decolonisation and cohorting.7
a 2025 commentary in the American Journal of Infection Control, disinfectants registered by the EPA continue to be effective against MDROs, and there is no evidence that antibiotic resistance mechanisms confer protection against typical healthcare disinfectants.2
This distinction is
crucial: while antibiotics must navigate complex intracellular mechanisms, disinfectants in the majority of cases act broadly, hitting multiple targets like proteins, cell membranes, and nucleic acids and mitochondria. Such a mode of action makes disinfection a reliable defence, even as antimicrobial resistance worsens.
Disinfection is
not merely an adjunct; it is one of the most consistently effective measures in MDRO infection prevention and resistance spread.
Disinfection works even in the case of drug resistance A common misconception is that MDRO resistance to antibiotics implies resistance to disinfectants. However, drug resistance does not equate to disinfectant resistance. According to
26
www.clinicalservicesjournal.com I April 2026
Routine environmental disinfection Standard routine surface and equipment disinfection using disinfectants, with confirmed efficacy according latest EN standards for healthcare applications – described in EN 14885, remains the backbone of environmental control programmes. Daily disinfection of high-touch surfaces, patient rooms, bathrooms, and shared medical equipment dramatically reduces bioburden. Terminal disinfection of rooms previously occupied by MDRO-positive patients is essential. Terminal disinfection – combined with contact precautions, equipment decontamination and hand hygiene – make MDRO transmission significantly less likely, as validated in multiple systematic reviews and outbreak studies.6 Devices such as blood pressure cuffs,
stethoscopes, glucometers, and mobility aids often carry MDROs between patients. Invasive devices, such as flexible endoscopes, can cause the same risk. Studies consistently show that improved disinfection protocols for medical
devices contribute significantly to reducing cross-transmission risk.8
High-risk settings where disinfection is especially critical Transplantation units, burn treatment wards, isolation rooms and operating rooms also require the highest level of diligence in the implementation of hygiene protocols, as each infection can be extremely dangerous for sensitive patients. ICUs host patients with invasive devices (ventilators, catheters, central lines) and compromised immunity. MDRO infections in ICUs carry mortality rates exceeding 50%, especially in Carbapenem- resistant Klebsiella pneumoniae (CRKP) bloodstream infections. Effective environmental disinfection in ICUs is therefore a life-saving intervention.9
Variability in disinfection quality Suboptimal practices – such as inadequate contact time, missed surfaces, or incorrect dilution – significantly reduce efficacy. Many hospitals lack standardised auditing or adequate training.
Pathogen adaptation to active substances – Karpinski Index The potential for adaptation to chemical compounds has so far been proven for: chlorhexidine gluconate,10 chloride,11
cetylpiridinum triclosan,12 hydrogen peroxide and
povidone-iodine.13 Those findings have been confirmed by
numerous studies, showing that Candida albicans can develop adaptation to typically used concentration of sodium hypochlorite
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