In today’s world of cleaning, we run the risk of answering questions nobody is asking. Instead, we need to hone in on what really matters; saving lives through better, more thorough cleaning.

At the end of the day, does the fact that your organization is “green cleaning” really matter if building occupants are getting sick due to inadequately addressing high touch surfaces? Does the fact that you have great patient satisfaction scores really matter when your hospital contributes to a national travesty (over 100,000 patients die of healthcare associated infections every year)?

As long as environmental surfaces are inadequately processed (cleaning is a process of specific, prescribed steps that lead to a clean, safe disinfected environment), the best hand hygiene program will fail.

Adding to the problem of inadequately processed high touch surfaces is the fact that deadly pathogens such as MRSA, VRE, Acinetobacter, C. diff and others can remain on surfaces for extended periods of time (greater than 150 days). Patients, visitors and staff don’t realize the potential danger that remains on surfaces after the Housekeeper finishes her daily chores and parts with a cheerful, “Have a nice day!”

Research clearly links the hospital environment to HAI’s so there’s no excuse for not adequately addressing environmental hygiene. Here are some points to consider:

• Hospital rooms are not cleaned well (AJIC 2006; ICHE 2008)

• Previously contaminated rooms increase transmission risks (Sturdis 2008)

• Cleaning can be improved in hospitals (ICHE 2008; Hayden 2006)

• Decreased environmental contamination with improved cleaning (Hayden 2006; Huang 2008)

• Decreasing pathogens with improved cleaning outcomes (Hayden 2006; Datta 2009)

In an effort to draw attention to the importance of a clean, safe and disinfected environment, requirements, recommendations by standards bodies and health agencies are recommending that data be used to measure progress:

• CDC — Guidelines for Environmental Infection Control in Health Care

• CMS — Infection Control program must include appropriate monitoring of housekeeping

• Institute for Healthcare Improvement—Hospitals should use immediate feedback mechanisms to assess cleaning

• Joint Commission—Use data analysis to identify and resolve environmental issues

• State of California — Constant evaluation and monitoring of a sanitary environment

My advice to you is to involve Infection Preventionists (IP’s) in an ongoing program of monitoring the effectiveness of your environmental hygiene program. Ask the right questions and seek to understand the benefits of saving lives through better cleaning.


J. Darrel Hicks, REH, CHESP, is the author of "Infection Control For Dummies" and has over 30 years of experience in the jan/san industry. Hicks has served as past president of IEHA and remains an active member of ASHES. He can be reached at through his website at or by email at