The Infection Control Society has concentrated its interest on how inanimate objects in the immediate proximity of a patient plays an important role in the transmission of nosocomial pathogens. High-touch surfaces are constantly in contact with a patient, which may be a potential repository for nosocomial pathogens and these pathogens are directly or indirectly transmitted through the hands of healthcare workers (1-3).
The latest recommendation from the Healthcare Infection Control Practices Advisory Committee and the Centers for Disease Control and Prevention concerning environmental control in healthcare facilities states a category II recommendation to disinfect and clean high-touch surfaces on a more frequent basis than minimal-touch surfaces (4).
In light of various studies establishing the importance of high-touch surfaces, a research which was published in the journal, Infection Control and Hospital Epidemiology, quantifiably defined high-touch surfaces depending on the observations assessing the frequency of healthcare workers contact with surfaces in the patient’s immediate environment. Fifty interactions between patients and healthcare workers were observed as quantifiable high-touch surfaces. Out of these five were designated as high-touch surfaces: bed rails, bed surface, supply cart, over-bed table and the intravenous pump (5).
The Rudolf Schuelke Foundation is a pioneer committee addressing issues related to hygiene, infection prevention, and public health. Scientists at the Foundations symposium “The Role of Surface Disinfection in Infection Prevention” concluded that targeted surface disinfection is seen as an indispensable constituent for a multi-barrier approach of universal infection control precautions (6).
In a study, researchers from China and USA constructed a mathematical model to evaluate MRSA concentration dynamics on high-touch and low-touch surfaces. Whole room cleaning and wipe cleaning of touch surfaces were the two cleaning interventions considered. The results demonstrated that frequent wipe cleaning of touched surfaces was more efficient than whole room cleaning because the surface was rapidly re-contaminated with methicillin-resistant Staphylococcus aureus colonization (MRSA) after cleaning. With same-frequency of cleaning, wipe cleaning of high-touch surfaces was more effective than wipe cleaning of low-touch surfaces (7).
Researchers in Ohio, USA, conducted a randomized non-blinded trial where they were able to exhibit that daily disinfection of high-touch surfaces in rooms of individuals with methicillin-resistant Staphylococcus aureus colonization and Clostridium difficile infection reduced the procurement of pathogens on hands of patients and healthcare workers caring for patients (8).
Many disinfectants label claim to wipe high-touch environmental surfaces but they rarely reflect its field use where the contact times are in seconds and the disinfectant deposited on a unit surface area is only in microliters. Hence such products should be properly valued for its combined mechanical and chemical action (9). Careful disinfection and cleaning of environmental surfaces are the fundamental elements of infection prevention programs. However, traditional disinfection and cleaning practices are inadequate in hospitals which are often due to a variety of personnel issues in the organization.
Generally, failure to follow manufacturer’s recommended protocol and lack of antimicrobial activity of some disinfectant are some of the major concerns associated with healthcare pathogenicity. This setback may be uplifted with use of advanced products now available in the market. Electrolyzed water and cold atmospheric pressure plasma have shown its potential use in hospitals. Improved hydrogen peroxide-based liquid disinfectants along with a blended product which contains peracetic acid and hydrogen peroxide are powerful substitutes to disinfectants that are currently in widespread use.
Today few “self-disinfecting” surfaces are produced which are known for its antimicrobial activity. They have a metal coating such as copper or silver as an additional strategy. Newer no-touch technologies are manufactured which include aerosol and vaporized hydrogen peroxide, UV-C emitting devices, pulsed-xenon UV light system and high-intensity narrow spectrum. These systems have shown to reduce bacterial contamination of hospital surfaces (10).
In a study published in the journal Open Forum Infectious Diseases, researchers demonstrated the efficacy of targeted UV-C in reducing aerobic colony counts (ACC) with and without disinfection. 55 random high-touch points were evaluated for ACC after discharge. 26 of the surfaces were disinfected by environmental services (EVS). All surfaces were then subjected to UVC treatment for 5 minutes. The results showed that surfaces disinfected by EVS had 55% decrease in ACC while surfaces treated with targeted UVC resulted in 95% reduction in ACC. Moreover, there was a 98% reduction in ACC with EVS disinfection followed by targeted treatment. This signifies the use of targeted UVC treatment in the reduction of ACC on high-touch surfaces (11).
Researchers in California, USA, developed an economic model to study the latent cost-effectiveness of a disinfection program targeting high-risk food preparation activities in the kitchen. Their primitive analysis demonstrated that approximately 80,000 infections could be prevented within direct medical cost savings of 138 million dollars, a gain of 15,845 quality-adjusted life years and 788 million dollars in program costs (12). These studies, further help in establishing the fact that targeted disinfection effectively enhances the decontamination score.
In conclusion, manual disinfection and cleaning are the backbones of effective infection prevention programs. But several factors make it difficult to achieve higher rates of effective disinfection on a routine basis and therefore continued efforts should be made to achieve the desired results. Moreover, environmental services department should consider the use of newer technologies emerging in the disinfectant industry with particular emphasis on targeted disinfection.