INFECTION PREVENTION
Proposal to use a new testing protocol to improve the cleaning of surfaces
Following their recent article in Pathology in Practice which proves the relationship between air contamination and surface contamination, Andrew Kemp and Denise Hanson ask how can this knowledge be used to improve cleaning, and reduce potential cross contamination and microbial resistance to disinfectants?
There is a saying throughout industry: ‘If you can measure it, you can improve it.’ In the case of the disinfectant and hand sanitiser industry, it could be: ‘If you don’t measure it, there is no need to spend any time, effort, or money improving it.’
Background For as long as I have been studying surface contamination, no one has yet routinely tested the effectiveness of their cleaning regimes or disinfectants to an extent that would be acceptable as evidence in any other industry. In many hospitals around the world, cleaning is still routinely tested by the majority of healthcare institutions using the mark one eyeball.1
How can this
be in 2026? Why is this the case, and why is it considered acceptable, when we know it is of litle value? For other healthcare institutions, and
certainly in the food industry, total ATP (adenosine triphosphate) measurements are considered an acceptable measure. This should seem as perplexing to the reader as it does to the authors, when we know how inaccurate these measurements are.2 There can be no doubt that surfaces
play a significant role in cross infection/ cross contamination,3,4
proven they have a measurable effect on the air passing over them.5,6
In which
case, it would not be beyond expectation that we should regularly check not just how we clean, but test how efficiently we clean, and that includes the efficacy of the disinfectants we use. We know for instance that the efficacy
and now it is also
There can be no doubt that surfaces play a significant role in cross infection/ cross contamination, and now it is also proven they have a measurable effect on the air passing over them.
of hand sanitisers can change when applied to the skin as compared to the results on a laboratory bench,7
yet we
do not test to see if there is an efficacy change when disinfectants are used in different environments; and on different surfaces, we simply accept the bench top results. Why? Is it because the regulators use this as their measure of efficacy? In addition, given that there is a
year-on-year significant increase in antibiotic resistance linked to disinfectant resistance,8
and that this is seen as a
major health issue, why has there been litle or no improvement in testing for the build-up of disinfectant resistance? Is it just that we are too lazy to be
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bothered to test, or is there something else standing in the way of progress?
Current doctrine In order to understand the reasons why, we have to look at what tests have been available, and the reasons they have not been used extensively to test surfaces. The pros and cons of currently
available tests were looked into in a recent paper.2
In order for a test to
be adopted widely for use, there are a number of requirements for what could be considered an ideal test. 1 Fast: must be in real time, so that dangerous CFU levels and species can be identified quickly, and dealt with before
AdobeStock / Andrii Lysenko
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