Innovative Methods of Hospital Disinfection in Prevention of Healthcare-Associated Infections

  • Clare Rock
  • Bryce A. Small
  • Kerri A. Thom
  • For the CDC Prevention Epicenters Program
New Technologies and Advances in Infections Prevention (A Marra, Section Editor)
Part of the following topical collections:
  1. Topical Collection on New Technologies and Advances in Infection Prevention


Purpose of Review

The purpose of this review is to give the reader an update on recent studies and developments regarding the hospital environment role in transmission of healthcare-associated infections (HAIs), and novel strategies to obtain a cleaner, safer patient environment. Hospital patient rooms are increasingly recognized as a reservoir of multi-drug-resistant organisms that contribute to HAIs. In simulated environments, surfaces can easily be adequately disinfected of pathogenic bacteria. However, translation into real healthcare settings has been less reliable and efficacious, with barriers to implementation of best practices.

Recent Findings

In this review, we describe and compare new and evolving technologies for enhancing room disinfection, such as UV-C, hydrogen peroxide vapor, ozone, and chlorine. We also review recent studies examining antimicrobial surfaces such as copper and silver and introduce a novel transdisciplinary human factors, systems engineering, and infection prevention approach to improve manual room cleaning. We highlight outstanding questions, including additional benefit of no touch technology in a human factors-optimized manual cleaning setting, and cost-effectiveness of optimized manual cleaning vs additional of no touch technology.


There are evolving technologies and strategies to enhance patient room cleaning and decrease risk of HAI transmission. It is important for the infection prevention community to keep up to date with, and understand the implications of, these developments so as to best inform hospital HAI reduction strategy.


Healthcare-associated infections Human factors engineering No touch disinfection UV-C Hydrogen peroxide vapor Ozone 



Clare Rock receives research funding from Centers for Disease Control and Prevention Epicenter Program, Johns Hopkins University, grant number 1U54CK000447-01.

Compliance with Ethical Standards

Conflict of Interest

Clare Rock leads a research study examining use of daily UV-C disinfection funded to Johns Hopkins University School of Medicine by The Clorox Company.

Bryce A. Small and Kerri A. Thom declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance.

  1. 1.
    de Regt MJ, van der Wagen LE, Top J, Blok HE, et al. High acquisition and environmental contamination rates of CC17 ampicillin-resistant Enterococcus faecium in a Dutch hospital. J Antimicrob Chemother. 2008;62:1401–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Weber DJ, Anderson D, Rutala WA. The role of the surface environment in healthcare-associated infections. Curr Opin Infect Dis. 2013;26:338–44.CrossRefPubMedGoogle Scholar
  3. 3.
    Weber DJ, Rutala WA, Miller MB, Huslage K, Sickbert-Bennett E. Role of hospital surfaces in the transmission of emerging health care-associated pathogens: Norovirus, Clostridium difficile, and Acinetobacter species. Am J Infect Control. 2010;38:S25–33.CrossRefPubMedGoogle Scholar
  4. 4.
    Smith SJ, Young V, Robertson C, Dancer SJ. Where do hands go? An audit of sequential hand-touch events on a hospital ward. J Hosp Infect. 2012;80:206–11.CrossRefPubMedGoogle Scholar
  5. 5.
    Carling P. Methods for assessing the adequacy of practice and improving room disinfection. Am J Infect Control. 2013;41:S20–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Cheng VCC, Chau PH, Lee WM, Ho SKY, Lee DWY, So SYC, et al. Hand-touch contact assessment of high-touch and mutual-touch surfaces among healthcare workers, patients, and visitors. J Hosp Infect. 2015;90:220–5.CrossRefPubMedGoogle Scholar
  7. 7.
    Grabsch EA, Burrell LJ, Padiglione A, O’Keeffe JM, Ballard S, Grayson ML. Risk of environmental and healthcare worker contamination with vancomycin-resistant enterococci during outpatient procedures and hemodialysis. Infect Control Hosp Epidemiol. 2006;27:287–93.CrossRefPubMedGoogle Scholar
  8. 8.
    Weinstein RA, Hota B. Contamination, disinfection, and cross-colonization: are hospital surfaces reservoirs for nosocomial infection? Clin Infect Dis. 2004;39:1182–9.CrossRefGoogle Scholar
  9. 9.
    Lerner A, Adler A, Abu-Hanna J, Meitus I, Navon-Venezia S, Carmeli Y. Environmental contamination by Carbapenem-resistant Enterobacteriaceae. J Clin Microbiol. 2013;51:177–81.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Manian FA, Griesenauer S, Senkel D, Setzer JM, Doll SA, Perry AM, et al. Isolation of Acinetobacter baumannii complex and methicillin-resistant Staphylococcus aureus from hospital rooms following terminal cleaning and disinfection: can we do better? Infect Control Hosp Epidemiol. 2011;32:667–72.CrossRefPubMedGoogle Scholar
  11. 11.
    Mutters R, Nonnenmacher C, Susin C, Albrecht U, Kropatsch R, Schumacher S. Quantitative detection of Clostridium difficile in hospital environmental samples by real-time polymerase chain reaction. J Hosp Infect. 2009;71:43–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Pankhurst L, Cloutman-Green E, Canales M, D’Arcy N, Hartley JC. Routine monitoring of adenovirus and norovirus within the health care environment. Am J Infect Control. 2014;42:1229–32.CrossRefPubMedGoogle Scholar
  13. 13.
    Sexton T, Clarke P, O’Neill E, Dillane T, Humphreys H. Environmental reservoirs of methicillin-resistant Staphylococcus aureus in isolation rooms: correlation with patient isolates and implications for hospital hygiene. J Hosp Infect. 2006;62:187–94.CrossRefPubMedGoogle Scholar
  14. 14.
    Strassle P, Thom KA, Johnson JK, Leekha S, Lissauer M, Zhu J, et al. The effect of terminal cleaning on environmental contamination rates of multidrug-resistant Acinetobacter baumannii. Am J Infect Control. 2012 [cited 2018 Jan 9]; 40. Available from:
  15. 15.
    Verity P, Wilcox MH, Fawley W, Parnell P. Prospective evaluation of environmental contamination by Clostridium difficile in isolation side rooms. J Hosp Infect. 2001;49:204–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Datta R, Platt R, Yokoe DS, Huang SS. Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants. Arch Intern Med. 2011;171:491–4.CrossRefPubMedGoogle Scholar
  17. 17.
    Huang SS, Datta R, Platt R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med. 2006;166:1945–51.CrossRefPubMedGoogle Scholar
  18. 18.
    Nseir S, Blazejewski C, Lubret R, Wallet F, Courcol R, Durocher A. Risk of acquiring multidrug-resistant Gram-negative bacilli from prior room occupants in the intensive care unit. Clin Microbiol Infect. 2011;17:1201–8.CrossRefPubMedGoogle Scholar
  19. 19.
    •• Ray AJ, Deshpande A, Fertelli D, Sitzlar BM, Thota P, Sankar CT, et al. A multicenter randomized trial to determine the effect of an environmental disinfection intervention on the incidence of healthcare-associated Clostridium difficile infection. Infect Control Amp Hosp Epidemiol. 2017;38:777–83. Fifteen hospital, 12 month, randomized trial comparing standard cleaning to enhanced cleaning with monitoring of environmental services staff found improved removal of fluorescent marker post cleaning and decreased recovery of Clostridium difficile in the patient environment but did not show reduction in incidence of healthcare associated CDI. Demonstrates the complexity of C. difficile acquisition and infection in the in-patient setting; environmental cleaning is one aspect of a bundled approach required to impact this measure.CrossRefGoogle Scholar
  20. 20.
    Medicare C for, Baltimore MS 7500 SB, Usa M. HAC-Reduction-Program [Internet]. 2017 [cited 2018 Jan 9]. Available from:
  21. 21.
    Find and compare information about Hospitals | Hospital Compare [Internet]. [cited 2018 Jan 9]. Available from:
  22. 22.
    Carling PC, Briggs J, Hylander D, Perkins J. An evaluation of patient area cleaning in 3 hospitals using a novel targeting methodology. Am J Infect Control. 2006;34:513–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Carling PC, Von Beheren S, Kim P, Woods C. Intensive care unit environmental cleaning: an evaluation in sixteen hospitals using a novel assessment tool. J Hosp Infect. 2008;68:39–44.CrossRefPubMedGoogle Scholar
  24. 24.
    Gavaldà L, Pequeño S, Soriano A, Dominguez MA. Environmental contamination by multidrug-resistant microorganisms after daily cleaning. Am J Infect Control. 2015;43:776–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Sigler V, Hensley S. Persistence of mixed staphylococci assemblages following disinfection of hospital room surfaces. J Hosp Infect. 2013;83:253–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Gordon L, Bruce N, Suh KN, Roth V. Evaluating and operationalizing an environmental auditing program: a pilot study. Am J Infect Control. 2014;42:702–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Boyce J, Havill N, Lipka A, Havill H, Rizvani R. Variations in hospital daily cleaning practices. Infect Control Hosp Epidemiol Off J Soc Hosp Epidemiol Am. 2010;31:99–101.CrossRefGoogle Scholar
  28. 28.
    Rupp ME, Adler A, Schellen M, Cassling K, Fitzgerald T, Sholtz L, et al. The Time Spent Cleaning a Hospital Room Does Not Correlate with the Thoroughness of Cleaning. Infect Control Amp Hosp Epidemiol. 2013;34:100–2.CrossRefGoogle Scholar
  29. 29.
    Eckstein BC, Adams DA, Eckstein EC, Rao A, Sethi AK, Yadavalli GK, et al. Reduction of Clostridium Difficile and vancomycin-resistant Enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods. BMC Infect Dis. 2007;7:61.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Aldeyab MA, McElnay JC, Elshibly SM, Hughes CM, McDowell DA, McMahon MAS, et al. Evaluation of the efficacy of a conventional cleaning regimen in removing Methicillin-resistant Staphylococcus aureus from contaminated surfaces in an intensive care unit. Infect Control Amp Hosp Epidemiol. 2009;30:304–6.CrossRefGoogle Scholar
  31. 31.
    Carling PC, Parry MM, Rupp ME, Po JL, Dick B, Beheren SV, et al. Improving cleaning of the environment surrounding patients in 36 acute care hospitals. Infect Control Amp Hosp Epidemiol. 2008;29:1035–41.CrossRefGoogle Scholar
  32. 32.
    Blue J, O’Neill C, Speziale P, Revill J, Ramage L, Ballantyne L. Use of a fluorescent chemical as a quality indicator for a hospital cleaning program. Can J Infect Control Off J Community Hosp Infect Control Assoc Can Rev Can Prev Infect. 2008;23:216–9.Google Scholar
  33. 33.
    Boyce JM, Havill NL, Dumigan DG, Golebiewski M, Balogun O, Rizvani R. Monitoring the effectiveness of hospital cleaning practices by use of an adenosine triphosphate bioluminescence assay. Infect Control Amp Hosp Epidemiol. 2009;30:678–84.CrossRefGoogle Scholar
  34. 34.
    Boyce JM, Havill NL, Havill HL, Mangione E, Dumigan DG, Moore BA. Comparison of fluorescent marker systems with 2 quantitative methods of assessing terminal cleaning practices. Infect Control Amp Hosp Epidemiol. 2011;32:1187–93.CrossRefGoogle Scholar
  35. 35.
    Branch-Elliman W, Robillard E, McCarthy G, Gupta K. Direct feedback with the ATP luminometer as a process improvement tool for terminal cleaning of patient rooms. Am J Infect Control. 2014;42:195–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Carling PC, Briggs JL, Perkins J, Highlander D. Improved cleaning of patient rooms using a new targeting method. Clin Infect Dis. 2006;42:385–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Carling PC, Parry MF, Bruno-Murtha LA, Dick B. Improving environmental hygiene in 27 intensive care units to decrease multidrug-resistant bacterial transmission*. Crit Care Med. 2010;38:1054–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Carling PC, Huang SS. Improving healthcare environmental cleaning and disinfection current and evolving issues. Infect Control Amp Hosp Epidemiol. 2013;34:507–13.CrossRefGoogle Scholar
  39. 39.
    Goodman ER, Platt R, Bass R, Onderdonk AB, Yokoe DS, Huang SS. Impact of an environmental cleaning intervention on the presence of Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Enterococci on surfaces in intensive care unit rooms. Infect Control Hosp Epidemiol Off J Soc Hosp Epidemiol Am. 2008;29:593–9.CrossRefGoogle Scholar
  40. 40.
    Munoz-Price LS, Ariza-Heredia E, Adams S, Olivier M, Francois L, Socarras M, et al. Use of UV powder for surveillance to improve environmental cleaning. Infect Control Hosp Epidemiol. 2011;32:283–5.CrossRefPubMedGoogle Scholar
  41. 41.
    Ragan K, Khan A, Zeynalova N, McKernan P, Baser K, Muller MP. Use of audit and feedback with fluorescent targeting to achieve rapid improvements in room cleaning in the intensive care unit and ward settings. Am J Infect Control. 2012;40:284–6.CrossRefPubMedGoogle Scholar
  42. 42.
    Sitzlar B, Deshpande A, Fertelli D, Kundrapu S, Sethi AK, Donskey CJ. An environmental disinfection odyssey: evaluation of sequential interventions to improve disinfection of Clostridium difficile isolation rooms. Infect Control Amp Hosp Epidemiol. 2013;34:459–65.CrossRefGoogle Scholar
  43. 43.
    Han JH, Sullivan N, Leas BF, Pegues DA, Kaczmarek JL, Umscheid CA. Cleaning hospital room surfaces to prevent health care–associated infections. Ann Intern Med. 2015;163:598–607.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Mitchell G. Selecting the best theory to implement planned change. Nurs Manag Harrow Lond Engl 1994. 2013;20:32–7.Google Scholar
  45. 45.
    Rock C, Cosgrove SE, Keller SC, Enos-Graves H, Andonian J, Maragakis LL, et al. Using a human factors engineering approach to improve patient room cleaning and disinfection. Infect Control Amp Hosp Epidemiol. 2016;37:1502–6.CrossRefGoogle Scholar
  46. 46.
    Holden RJ, Carayon P, Gurses AP, Hoonakker P, Hundt AS, Ozok AA, et al. SEIPS 2.0: A human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics. 2013 [cited 2018 Jan 9]; 56. Available from:
  47. 47.
    Xie A, Carayon P. A systematic review of Human Factors and Ergonomics (HFE)-based healthcare system redesign for quality of care and patient safety. Ergonomics. 2015;58:33–49.CrossRefPubMedGoogle Scholar
  48. 48.
    Rutala WA, Gergen MF, Weber DJ. Room decontamination with UV radiation. Infect Control Amp Hosp Epidemiol. 2010;31:1025–9.CrossRefGoogle Scholar
  49. 49.
    Boyce JM, Havill NL, Moore BA. Terminal decontamination of patient rooms using an automated mobile UV light unit. Infect Control Amp Hosp Epidemiol. 2011;32:737–42.CrossRefGoogle Scholar
  50. 50.
    Boyce J, Havill N, Otter J, Mcdonald L, Adams NM, Cooper T, et al. Impact of hydrogen peroxide vapor room decontamination on Clostridium difficile environmental contamination and transmission in a healthcare setting. Infect Control Hosp Epidemiol Off J Soc Hosp Epidemiol Am. 2008;29:723–9.CrossRefGoogle Scholar
  51. 51.
    Umezawa K, Asai S, Inokuchi S, Miyachi H. A comparative study of the bactericidal activity and daily disinfection housekeeping surfaces by a new portable pulsed UV radiation device. Curr Microbiol. 2012;64:581–7.CrossRefPubMedGoogle Scholar
  52. 52.
    Anderson DJ, Gergen MF, Smathers E, Sexton DJ, Chen LF, Weber DJ, et al. Decontamination of targeted pathogens from patient rooms using an automated ultraviolet-C-emitting device. Infect Control Hosp Epidemiol. 2013;34:466–71.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Wong T, Woznow T, Petrie M, Murzello E, Muniak A, Kadora A, et al. Postdischarge decontamination of MRSA, VRE, and Clostridium difficile isolation rooms using 2 commercially available automated ultraviolet-C–emitting devices. Am J Infect Control. 2016;44:416–20.CrossRefPubMedGoogle Scholar
  54. 54.
    •• Anderson DJ, Chen LF, Weber DJ, Moehring RW, Lewis SS, Triplett PF, et al. Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study. Lancet. 2017;389:805–14. Larger cluster randomized controlled trial using UV in conjunction with usual use (quaternary ammonia and bleach for c. diff) and enhanced use (bleach for all discharge) disinfection. This paper reinforced the knowledge that the hospital environment does play a role in transmission of Clostridium difficile and multidrug resistant organisms, however, UV plus bleach or bleach alone, on discharge showed similar reduction in risk of acquisition for the next patient occupant.CrossRefPubMedGoogle Scholar
  55. 55.
    Ultra violet-C light evaluation as an adjunct to removing multi-drug resistant organisms (UVCLEAR-MDRO) - Full Text View - [Internet]. [cited 2018 Jan 9]. Available from:
  56. 56.
    Kokubo M, Inoue T, Akers J. Resistance of common environmental spores of the genus Bacillus to vapor hydrogen peroxide. PDA J Pharm Sci Technol. 1998;52:228–31.PubMedGoogle Scholar
  57. 57.
    Ali S, Muzslay M, Bruce M, Jeanes A, Moore G, Wilson APR. Efficacy of two hydrogen peroxide vapour aerial decontamination systems for enhanced disinfection of Methicillin-resistant Staphylococcus aureus, Klebsiella pneumoniae and Clostridium difficile in single isolation rooms. J Hosp Infect. 2016;93:70–7.CrossRefPubMedGoogle Scholar
  58. 58.
    Bioquell Hydrogen Technology | Bioquell Advanced technologies Science [Internet]. Bioquell. [cited 2018 Jan 9]. Available from:
  59. 59.
    French GL, Otter JA, Shannon KP, Adams NMT, Watling D, Parks MJ. Tackling contamination of the hospital environment by methicillin-resistant Staphylococcus aureus (MRSA): a comparison between conventional terminal cleaning and hydrogen peroxide vapour decontamination. J Hosp Infect. 2004;57:31–7.CrossRefPubMedGoogle Scholar
  60. 60.
    Passaretti CL, Otter JA, Reich NG, Myers J, Shepard J, Ross T, et al. An evaluation of environmental decontamination with hydrogen peroxide vapor for reducing the risk of patient acquisition of multidrug-resistant organisms. Clin Infect Dis. 2013;56:27–35.CrossRefPubMedGoogle Scholar
  61. 61.
    McCord J, Prewitt M, Dyakova E, Mookerjee S, Otter JA. Reduction in Clostridium difficile infection associated with the introduction of hydrogen peroxide vapour automated room disinfection. J Hosp Infect. 2016;94:185–7.CrossRefPubMedGoogle Scholar
  62. 62.
    Horn K, Otter JA. Hydrogen peroxide vapor room disinfection and hand hygiene improvements reduce Clostridium difficile infection, Methicillin-resistant Staphylococcus aureus, Vancomycin-resistant enterococci, and extended-spectrum β-lactamase. Am J Infect Control. 2015;43:1354–6.CrossRefPubMedGoogle Scholar
  63. 63.
    Manian FA, Griesnauer S, Bryant A. Implementation of hospital-wide enhanced terminal cleaning of targeted patient rooms and its impact on endemic Clostridium difficile infection rates. Am J Infect Control. 2013;41:537–41.CrossRefPubMedGoogle Scholar
  64. 64.
    Murdoch LE, Bailey L, Banham E, Watson F, Adams NMT, Chewins J. Evaluating different concentrations of hydrogen peroxide in an automated room disinfection system. Lett Appl Microbiol. 2016;63:178–82.CrossRefPubMedGoogle Scholar
  65. 65.
    de Boer HEL, van Elzelingen-Dekker CM, van Rheenen-Verberg CMF, Spanjaard L. Use of gaseous ozone for eradication of Methicillin-resistant Staphylococcus aureus From the Home Environment of a Colonized Hospital Employee. Infect Control Amp Hosp Epidemiol. 2006;27:1120–2.Google Scholar
  66. 66.
    Foegeding PM. Ozone inactivation of Bacillus and Clostridium spore populations and the importance of the spore coat to resistance. Food Microbiol. 1985;2:123–34.CrossRefGoogle Scholar
  67. 67.
    Sharma M, Hudson JB. Ozone gas is an effective and practical antibacterial agent. Am J Infect Control. 2008;36:559–63.CrossRefPubMedGoogle Scholar
  68. 68.
    Doan L, Forrest H, Fakis A, Craig J, Claxton L, Khare M. Clinical and cost effectiveness of eight disinfection methods for terminal disinfection of hospital isolation rooms contaminated with Clostridium difficile 027. J Hosp Infect. 2012;82:114–21.CrossRefPubMedGoogle Scholar
  69. 69.
    Sharma VK, Johnson N, Cizmas L, McDonald TJ, Kim H. A review of the influence of treatment strategies on antibiotic resistant bacteria and antibiotic resistance genes. Chemosphere. 2016;150:702–14.CrossRefPubMedGoogle Scholar
  70. 70.
    Martinelli M, Giovannangeli F, Rotunno S, Trombetta CM, Montomoli E. Water and air ozone treatment as an alternative sanitizing technology. J Prev Med Hyg. 2017;58:E48–52.PubMedPubMedCentralGoogle Scholar
  71. 71.
    Guo D, Li Z, Jia B, Che X, Song T, Huang W. Comparison of the effects of formaldehyde and gaseous ozone on HBV-contaminated hospital quilts. Int J Clin Exp Med. 2015;8:19,454–9.Google Scholar
  72. 72.
    Lopes MS, JRF F, da Silva KB, de Oliveira Bacelar Simplício I, de Lima CJ, Fernandes AB. Disinfection of corrugated tubing by ozone and ultrasound in mechanically ventilated tracheostomized patients. J Hosp Infect. 2015;90:304–9.CrossRefPubMedGoogle Scholar
  73. 73.
    Lee Y, Kovalova L, McArdell CS, von Gunten U. Prediction of micropollutant elimination during ozonation of a hospital wastewater effluent. Water Res. 2014;64:134–48.CrossRefPubMedGoogle Scholar
  74. 74.
    Wallace CA. New developments in disinfection and sterilization. Am J Infect Control. 2016;44:e23–7.CrossRefPubMedGoogle Scholar
  75. 75.
    Song L, Wu J, Xi C. Biofilms on environmental surfaces: evaluation of the disinfection efficacy of a novel steam vapor system. Am J Infect Control. 2012;40:926–30.CrossRefPubMedGoogle Scholar
  76. 76.
    Abernethy M, Gillespie E, Snook K, Stuart RL. Microfiber and steam for environmental cleaning during an outbreak. Am J Infect Control. 2013;41:1134–5.CrossRefPubMedGoogle Scholar
  77. 77.
    • Gillespie E, Williams N, Sloane T, Wright L, Kotsanas D, Stuart RL. Using microfiber and steam technology to improve cleaning outcomes in an intensive care unit. Am J Infect Control. 2015;43:177–9. The new cleaning involved using microfiber dampened with water for daily cleaning and a combination of microfiber with steam for discharge cleaning. The steam is used to dislodge organic matter, and no scrubbing is required. The microfiber collects the loosened organic matter, leaving surfaces visibly clean and removing bacterial burden. Microfiber cloths are being increasingly used, this novel pairing with steam may impact transmission of bacteria in the in-patient setting and deserves further evaluation.CrossRefPubMedGoogle Scholar
  78. 78.
    Tanner BD. Reduction in infection risk through treatment of microbially contaminated surfaces with a novel, portable, saturated steam vapour disinfection system. Am J Infect Control. 2009;37:20–7.Google Scholar
  79. 79.
    Bagattini M, Buonocore R, Giannouli M, Mattiacci D, Bellopede R, Grimaldi N, et al. Effect of treatment with an overheated dry-saturated steam vapour disinfection system on multidrug and extensively drug-resistant nosocomial pathogens and comparison with sodium hypochlorite activity. BMC Res. Notes [Internet]. 2015 [cited 2017 Dec 19];8. Available from:
  80. 80.
    McGain F, Moore G, Black J. Hospital steam sterilizer usage: could we switch off to save electricity and water? J Health Serv Res Policy. 2016;21:166–71.CrossRefPubMedGoogle Scholar
  81. 81.
    Hohenwarter K, Prammer W, Aichinger W, Reychler G. An evaluation of different steam disinfection protocols for cystic fibrosis nebulizers. J Cyst Fibros. 2016;15:78–84.CrossRefPubMedGoogle Scholar
  82. 82.
    Weaver L, Michels HT, Keevil CW. Survival of Clostridium difficile on copper and steel: futuristic options for hospital hygiene. J Hosp Infect. 2008;68:145–51.CrossRefPubMedGoogle Scholar
  83. 83.
    Różańska A, Chmielarczyk A, Romaniszyn D, Bulanda M, Walkowicz M, Osuch P, et al. Antibiotic resistance, ability to form biofilm and susceptibility to copper alloys of selected staphylococcal strains isolated from touch surfaces in Polish hospital wards. Antimicrob Resist Infect Control. 2017;6:80.CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    Souli M, Antoniadou A, Katsarolis I, Mavrou I, Paramythiotou E, Papadomichelakis E, et al. Reduction of environmental contamination with multidrug-resistant bacteria by copper-alloy coating of surfaces in a highly endemic setting. Infect Control Amp Hosp Epidemiol. 2017;38:765–71.CrossRefGoogle Scholar
  85. 85.
    Salgado CD, Sepkowitz KA, John JF, Cantey JR, Attaway HH, Freeman KD, et al. Copper surfaces reduce the rate of healthcare-acquired infections in the intensive care unit. Infect Control Hosp Epidemiol. 2013;34:479–86.CrossRefPubMedGoogle Scholar
  86. 86.
    Sifri CD, Burke GH, Enfield KB. Reduced health care-associated infections in an acute care community hospital using a combination of self-disinfecting copper-impregnated composite hard surfaces and linens. Am J Infect Control. 2016;44:1565–71.CrossRefPubMedGoogle Scholar
  87. 87.
    • von Dessauer B, Navarrete MS, Benadof D, Benavente C, Schmidt MG. Potential effectiveness of copper surfaces in reducing health care-associated infection rates in a pediatric intensive and intermediate care unit: a nonrandomized controlled trial. Am J Infect Control. 2016;44:e133–9. Individual patient (pediatric) level assignment to room furnished with or without limited number of copper alloyed surfaces. Found 10.6 vs 13.0 per 1,000 patient days for copper and non-copper exposed patients. This contributes to the understanding of how to estimate the effect size that copper may have on HAI acquisition. This important study could inform study design and power calculations for larger studies needed to answer the true effect of copper alloyed surfaces.CrossRefGoogle Scholar
  88. 88.
    Schmidt MG, von Dessauer B, Benavente C, Benadof D, Cifuentes P, Elgueta A, et al. Copper surfaces are associated with significantly lower concentrations of bacteria on selected surfaces within a pediatric intensive care unit. Am J Infect Control. 2016;44:203–9.CrossRefPubMedGoogle Scholar
  89. 89.
    Harbarth S, Maiwald M, Dancer S. The environment and healthcare-acquired infections: why accurate reporting and evaluation of biological plausibility are important. Infect Control Hosp Epidemiol Off J Soc Hosp Epidemiol Am. 2013;34:996–7.CrossRefGoogle Scholar
  90. 90.
    Salgado CD, Sepkowitz KA, John JF, Cantey JR, Attaway HH, Freeman KD, et al. Reply to Harbarth et al. Infect Control Hosp Epidemiol. 2013;34:997–9.CrossRefPubMedGoogle Scholar
  91. 91.
    Dancer SJ. Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination. Clin Microbiol Rev. 2014;27:665–90.CrossRefPubMedPubMedCentralGoogle Scholar
  92. 92.
    Lansdown ABG. Silver in health care: antimicrobial effects and safety in use. Curr Probl Dermatol. 2006;33:17–34.CrossRefPubMedGoogle Scholar
  93. 93.
    Taylor L, Phillips P, Hastings R. Reduction of bacterial contamination in a healthcare environment by silver antimicrobial technology. J Infect Prev. 2009;10:6–12.CrossRefGoogle Scholar
  94. 94.
    Ortí-Lucas RM, Muñoz-Miguel J. Effectiveness of surface coatings containing silver ions in bacterial decontamination in a recovery unit. Antimicrob Resist Infect Control. 2017 [cited 2018 Jan 9];6. Available from:

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Clare Rock
    • 1
    • 2
    • 3
  • Bryce A. Small
    • 1
    • 2
  • Kerri A. Thom
    • 4
  • For the CDC Prevention Epicenters Program
  1. 1.Department of Medicine, Division of Infectious DiseasesJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of Hospital Epidemiology and Infection ControlJohns Hopkins HospitalBaltimoreUSA
  3. 3.Armstrong Institute for Patient Safety and QualityJohns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Department of Epidemiology and Public HealthUniversity of Maryland School of MedicineBaltimoreUSA

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