Environmental hygiene


and staff safety should not be underestimated. There is compelling evidence to indicate that effective and appropriate HEH interventions can reduce the incidence of HCAI1,5


and reduce


the transmission of healthcare-associated pathogens.6 Pathogens like MRSA and vancomycin-


resistant enterococci (VRE) are capable of surviving for days to weeks on environmental surfaces in the healthcare environment,6


and


studies have documented that staff may soil their hands or gloves by touching contaminated environmental surfaces.6


This means that


pathogens may be transferred from surfaces to susceptible patients via the hands of healthcare workers. Patients interact with medical equipment and surfaces which are often contaminated with healthcare-associated pathogens. An observational study found that hospitalised patients frequently interacted with medical equipment and other fomites that are shared between patients. These items are often contaminated with healthcare-associated pathogens.5


Therefore, high-touch surfaces,


particularly those in a patient’s immediate surroundings, need regular decontamination to prevent the transfer of pathogens. A 2022 evidence review found a strong


relationship between interventions to improve HEH and a reduction in both environmental bioburden, patient colonisation and HCAI. While HCAIs are usually the result of an infection with the patient’s own flora, this flora can change due to colonisation with hospital pathogens through healthcare workers’ hands or from the hospital environment. The authors conclude that optimal HEH practices are an integral part of patient safety and a key component in improving infection prevention and control.1


Health and Social Care Act The need for good healthcare environmental hygiene is enshrined in law in the 2012 Health and Social Care Act.7


This was updated


in December 2022 to make it clear that environmental cleanliness is an integral part of infection prevention and control. The Act requires NHS organisations to have systems in place to minimise the risk of HCAI, stating that infection prevention, including cleanliness, must be part of everyday practice and be applied consistently by all members of staff.


Decontamination of surfaces and equipment Effective cleaning and disinfection of the environment and equipment associated with patient care is imperative, to minimise cross infection. Disinfectant wipes which combine the


microbiocidal action of the disinfectant with the physical (mechanical) action of wiping are frequently the agent of choice as they are quick, effective and ready to use. Clinical wipes may look similar, but their composition and ability to clean and disinfect surfaces shows considerable variation. The size, thickness, material composition, formulation, and degree of absorbency of the wipe will determine the quantity of disinfectant retained in and released from it. The wipe needs to be capable of both containing and transferring the optimum amount of disinfectant onto the surface to achieve the required antimicrobial effect. The EN16615 test is the highest level of testing for antimicrobial wipes under the recognition of the European Standards committee. The test examines the efficacy of the wipe as a whole i.e. the wipe plus the disinfectant component. It is therefore an excellent starting point for wipe selection. A combination of how the surface has been used, its location in the clinical setting, accessibility and contamination of the surface will determine the efficiency of wiping. The surface must not only permit direct contact between the pathogens and disinfectant but also allow for an optimum contact time to achieve the desired level of decontamination.8 The disinfectant solution released by the wipe on the surface is mainly responsible for the antimicrobial activity. The quantity and concentration of active ingredient and the


38 www.clinicalservicesjournal.com I December 2023


amount of the solution remaining on the surface are important efficacy indicators. This means the wipe needs to be manufactured to ensure the optimum release of disinfectant, while also facilitating the mechanical action of wiping to remove and retain pathogens on the cloth.2


Disinfectant choice Nosocomial pathogens vary widely in their susceptibility to surface disinfectants depending on their biology, environmental conditions, nature of the surface, and type and level of the associated soil. Therefore, for routine wiping to be effective, it must be designed to cover as wide a variety of commonly encountered pathogens as possible while not damaging sensitive surfaces.8


An ideal disinfectant should have a high


inactivating capacity for a wide range of viruses, including HIV and hepatitis, as well as being effective against bacteria. It should be safe to use and suitable for frequent application. There are two main types of disinfection available for wiping hard, non-porous surfaces: those that are alcohol based and those which are non- alcohol based. The non-alcohol ones are usually types of quaternary ammonium compounds known as ‘quats’.9


Alcohol based surface disinfectants possess


some of the widest disinfectant kill ranges available. Alcohol based disinfectants tend to kill more microorganisms than quats and are effective at eliminating vegetative bacteria


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