Seven Aspects of Surface Selection: Choosing the Right Materials to Help Staff Prevent Infections

By Lybert, Linda | Health Facilities Management, July 2016 | Go to article overview

Seven Aspects of Surface Selection: Choosing the Right Materials to Help Staff Prevent Infections


Lybert, Linda, Health Facilities Management


Preventing health care-associated infections (HAIs) is a top concern of all health care organizations. On the front lines of these efforts, environmental services (ES) professionals are availing themselves of the latest science-based training, technology and supplies as they fight multidrug-resistant organisms.

Beyond their traditional role in cleaning and disinfection, however, ES professionals are playing an ever-larger role in determining which surfaces are selected for health care interiors. This not only ensures that these finishes won't degrade under rigorous cleaning regimens, but they also will be easier to disinfect in the first place.

Foundational issue

Most people think of surfaces as part of the design and construction process rather than part of an infection prevention and control program. When selecting materials, a lot of focus tends to be given to colors and textures. Although these aspects of a surface material are certainly important, there are many other surface properties that are critically important, yet are not thought about or given proper evaluation. After all, the most soothing color and texture is of little value to a surface that cannot be cleaned or disinfected properly.

People interact with surfaces throughout the day without a second thought. If hands are washed regularly, someone with a healthy immune system has a good chance of reducing his or her risk of infection. This is not necessarily true for someone with a compromised immune system.

Ironically, surfaces often are cleaned and disinfected based on visual inspection, even though it is commonly understood that microbes cannot be seen. Research has shown that at the microscopic level, microbe counts can rebound quickly--oftentimes to levels seen prior to cleaning and disinfection. This leaves patients, health care workers and the general public at constant risk of acquiring and spreading infection. In fact, studies have shown that patients are at a 35 to 50 percent risk of contracting an infection such as methicillin-resistant Staphylococcus aureus or Clostridium difficile from the patient who previously occupied the same room, depending on the infection and despite routine and terminal cleaning and disinfection.

The science of surfaces as a fomite (object or material that is capable of carrying infectious organisms and serve in their transmission) is just maturing. Research has shown that microbes can live on "clean and disinfected" surfaces for days, weeks and even months. How is this possible when surfaces are being regularly cleaned and disinfected? Below are seven aspects of surface selection that will help ES professionals to gain an understanding of why facilities must set surface criteria to minimize risk and prevent harm to patients, health care workers and the general public.

Selection of surfaces

Currently, the surface evaluation and selection process is predominantly based on specific design criteria established before any construction or renovation project. The look, feel and location of the surface is based on creating a homelike healing environment. While this is important, the selection of surfaces is complicated and the evaluation process must go far beyond the way it looks and feels. Ultimately, it is important that surfaces can be cleaned and disinfected effectively, leaving little room for human error. Unfortunately, the majority of surfaces being used in health care today are difficult, if not impossible, to clean effectively.

There is a science around the spread of infection via surfaces. It is not enough to learn every physical characteristic of a surface or to become an expert in the latest disinfection agents and protocols. These data must be combined with an understanding of microbiology, the physical environment and insight into human behavior.

Taking all seven of the following aspects into consideration and setting surface selection criteria within health care facilities will begin to address the critical surfaces issue. …

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