INFECTION PREVENTION
antimicrobial resistance (AMR) on the rise, and a proven link between antibiotic resistance and disinfectant resistance,6 it is now more imperative than ever that we test surfaces in hospitals regularly, to determine levels of contamination. There is still no internationally agreed definition as to what constitutes resistance to disinfectants and sanitisers. In addition, there are no international standards or even national standards, recommending which surfaces in hospitals should be sampled for bioburden, how often, and what test methodologies should be used.7 In fact, as we don’t routinely test
surfaces, there has never been an agreement to produce acceptable standards for what would be deemed to be ‘safe’ levels of contamination on surfaces in hospitals. Whilst there have been atempts to engage the UK Government to approve standards for environmental cleaning in healthcare, poor leadership from ‘NHS Improvement’ in its most recent standard-seting document, left the UK with a significantly watered down practice requirement, and with no requirement for microbial surface or air particle testing.8,9 The NHS Improvement document does recommend cleaning audits; however, this is provided for by visual inspection only. The recommended practice in the document is at best of no clinical value; and is not based on any data or evidence. This was a missed opportunity to produce something of real value to environmental cleaners and a new tool for infection prevention and control (IPC) staff. Disappointingly, it provides litle for either group. For each of the currently available
test methods, whilst there are published standards for air filtration in the UK,10 there are no standards to determine acceptable levels of bioburden for surfaces in diverse areas such as the operating theatre, general ward, or hospital offices. Clearly, the common- sense approach, is to assume that the lower the bioburden in both air and on surfaces, the better it is for patients and staff. The questions that require answers are: 1 Which surfaces should be tested? 2 Which test methods should be used? 3 How often should surfaces be tested?
There is still no internationally agreed definition as to what constitutes resistance to disinfectants and sanitisers.
4 What results are acceptable? 5 When should the test results be a cause for concern/ intervention?
As previously stated, with antimicrobial resistance to both disinfectants and antibiotics being on the rise6
and
inextricably linked; a fast, accurate, simple, and inexpensive surface test, that measures both CFUs per cm2
and that
can identify species, needs to be made available to healthcare staff. Of the currently available tests for
surface contamination, only one has been peer reviewed, and accepted as specifically designed to test surfaces.11 Total adenosine triphosphate (ATP) tests have been shown to be of no value at all.8,11
The rest were designed for
internal medicine and adapted for use on surfaces. As with any products adapted for use in ways other than originally intended, there will understandably be compromises causing limitations on their accuracy, with time delays in results, and therefore usefulness for assessing
efficacy of surface cleaning. If we look again at the ideal criteria
for a useful surface test for hospitals, none of the available tests fulfil all the requirements set out below: 1 Fast: must be in real time, so that dangerous CFU levels and species can be identified quickly and dealt with before they become a problem
2 Accurate: must have a level of confidence that the results are correct within an acceptable margin of error
3 Simple: ideally staff can test their own areas of work responsibility. Whilst specialist equipment is required, it should be simple to learn to use
4 Inexpensive: if tests are expensive, they will not be used regularly. From a global perspective, in countries where they are cost prohibitive, it unlikely they will be done at all.
There is still no internationally agreed definition as to what constitutes resistance to disinfectants and sanitisers
30
WWW.PATHOLOGYINPRACTICE.COM April 2026
If you can measure it, you can improve it One of the main reasons why there are no current standards for surface contamination levels is that there is still no test available that satisfies all the criteria above. This study was intended to find a way to satisfy as many of the above criteria as we can until a test can be developed that does it all. A test that satisfies all requirements would allow infection control teams to adopt a proactive approach to testing, as opposed to the current reactive approach.
AdobeStock /
Rawpixel.com
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56
