Infection Prevention Advice for Patient Room Turnover

Key Takeaways:
• Terminal cleaning helps prevent healthcare-associated infections.
• Consistent procedures and training are essential.
• Technology helps, but manual cleaning remains key.

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Darrel Hicks has a go-to exercise when explaining the difficulties of cleaning against healthcare-associated infections (HAIs). He will find two identical pictures of a random hospital room then ask, “Can you pick the room that had a C. diff isolated patient three days ago?”

Hicks, who owns Safe, Clean and Disinfected, knows this is a trick question. No one can visually detect C. diff, or any other multidrug resistant organism (MDRO), like Methicillin-resistant Staphylococcus aureus (MRSA) or Vancomycin-resistant Enterococci (VRE), on surfaces. That's why the image he chooses to share doesn't matter, but the answer does.

“If you choose the room that previously housed a patient with C. diff, your risk of developing a C. diff infection doubles. The same association has been demonstrated for MRSA, VRE, Acinetobacter baumannii, and Pseudomonas aeruginosa,” Hicks says.

This is why terminal cleaning—which occurs after a patient is discharged—is vital to keeping patients, and the rest of the hospital community, safe and healthy. The practice of terminal cleaning, according to the National Emerging Special Pathogens Training & Education Center (NETEC), is meant to remove visible contamination, thoroughly disinfect surfaces, and safely prepare the room for the next patient.

Terminal cleaning doesn’t just happen. It’s a clearly defined process designed to systematically control the spread of infection. Getting it right requires training, support, and validation. Getting it wrong opens the door to infection.

Guidelines and Procedures

To be clear, terminal patient room cleaning doesn’t mean creating a sterile environment.

“From an environmental hygiene perspective, a patient room is the environmental services (EVS) worker’s patient,” says Ruth Carrico, an Infection Prevention and Control Consultant. “That room is a living organism full of things that thrive. The EVS worker must remove and reduce those things to an acceptable level.”

Accomplishing this requires strict adherence to standard operating procedures (SOPs). Those SOPs will vary depending on patient room design and furniture placement, so communication between EVS, nursing leadership, and infection preventionists is key.

“To ensure consistent quality of terminal cleaning and adequate staffing resources for infection prevention, a total facility cleaning standard should be agreed upon in advance by EVS, infection preventionists, and administrative management,” says Hicks.

Some important considerations, he adds, include who is responsible for which roles.

“Responsibilities for processing between EVS and nursing should be clearly drawn and communicated,” he says. “EVS leaders should collaborate with infection preventionist and nursing leadership to formulate a shared agreement of responsibilities.”

Even though terminal cleaning procedures and responsibilities vary depending on room setup, the basic protocols remain the same. The process starts with an empty room and a cleaning cart loaded with recommended equipment, chemicals, and consumables. Before starting, the EVS associate performs hand hygiene and dons gloves.

They then enter the space, carefully following a prescribed order defined by the Centers for Disease Control and Prevention (CDC) to clean and disinfect. This order avoids cross-contamination by moving from cleaner to dirtier areas, and proceeding from high to low. Moving systematically through the space, clockwise for example, ensures EVS does not overlook anything.

One of the highest priority areas to clean is the patient's bed.

“We are very detailed when it comes to the patient’s bed. It’s a main focus,” says Scott Hedding, Vice President of Environmental and Linen Services, MedStar Health.

The patient’s bathroom is another important area and one of the dirtiest. EVS staff should clean bathrooms last (before the floors) after changing into a fresh pair of gloves. Again, the protocol asks that workers move from cleanest to dirtiest and high to low, addressing each facet of the space.

“Our EVS associates wipe down walls by the toilet to remove any germs left by the toilet plume,” Hedding adds.

When cleaning is complete, workers should place a tent card saying something like, “This room was cleaned/disinfected by (name)” on the overbed table. They can then mop the floor, starting in the farthest corner and working towards the door, to avoid walking on wet surfaces.

This entire process should take approximately 40 to 60 minutes, depending on the room and the number of surfaces that need processing. The CDC Environmental Checklist for Monitoring Terminal Cleaning identifies the surfaces that must be processed for terminal cleaning.

That said, those guidelines have not been updated since 2008, and there are no indications of updates arriving in the future. In fact, the CDC terminated the Healthcare Infection Control Practices Advisory Committee (HICPAC) in early 2025. This committee provided federal guidance on the prevention and control of HAIs and the spread of antimicrobial resistance.

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How Technology Impacts Terminal Cleaning