Practical recommendations for routine cleaning and disinfection procedures in healthcare institutions: a narrative review.

Abstract

Healthcare-associated infections (HAIs) are the most frequent adverse outcomes due to delivery of medical care. HAIs increase morbidity and mortality, prolong the hospital stay, and are associated with additional healthcare costs. Contaminated surfaces, particularly those that are frequently touched, act as reservoirs for pathogens and contribute towards pathogen transmission. Therefore, healthcare hygiene requires a comprehensive approach whereby different strategies may be implemented together, next to targeted, risk-based approaches, in order to reduce the risk of HAI for patients. Such approach includes hand hygiene in conjunction with environmental cleaning and disinfection of surfaces and clinical equipment. This review focusses on routine environmental cleaning and disinfection including areas with a moderate risk of contamination, such as general wards. Since scientific evidence has not yet resulted in universally accepted guidelines nor led to universally accepted practical recommendations pertaining to surface cleaning and disinfection, this review provides expert guidance for healthcare workers in their daily practice. It also covers outbreak situations and suggests practical guidance for clinically relevant pathogens. Key elements of environmental cleaning and disinfection, including a fundamental clinical risk assessment, choice of appropriate disinfectants and cleaning equipment, definitions for standardised cleaning processes and relevance of structured training are reviewed in detail with focus on practical topics and implementation.