Why this should be a routine aspect of SSI prevention
For a long time, a contaminated environment was considered less important as a contributor to healthcare-associated infections (HAIs). Other factors were in the foreground. But recent evidence has shown that a contaminated healthcare environment plays an important role in the transmission of microorganisms3.
|CDC4||“When visible soiling or contamination with blood or other body fluids of surfaces or equipment occurs during an operation, use an EPA-approved hospital disinfectant to clean the affected areas before the next operation.”||Category IB|
“Wet vacuum the operating room floor after the last operation of the day or night with an EPA-approved hospital disinfectant.”||Category II|
|“No recommendation on disinfecting environmental surfaces or equipment used in operating rooms between operations in the absence of visible soiling.”||Unresolved issue|
|WHO3||“Between cases, hand-touch surfaces and surfaces that may have come in contact with patients’ blood or body fluids, should be wiped clean first by using a detergent solution and then disinfected according to hospital policy and allowed to dry.”|
“If disinfectants are used, they must be prepared and diluted according to the manufacturer’s instructions. Too high and/or too low concentrations reduce the effectiveness of disinfectants. In addition, high concentrations of disinfectant may damage surfaces.”
”Detergent and/or disinfectant solutions must be discarded after each use.”
|KRINKO6||After each operation, the surfaces close to the patient, all visibly contaminated surfaces and the entire floor of the operating room that has been walked on must be disinfected.|
After drying off the disinfectant, the operating room can be walked on again.
In the washing areas, the taps and washbasins used must be disinfected at regular intervals; in the other adjoining rooms, disinfecting intermediate cleaning is carried out in the event of visible soiling.
In general, sporocidal or virucidal preparations should be selected in the event of contamination with bacterial spores or non-enveloped viruses.
At the end of the daily operating program, floor surfaces and potentially contaminated surfaces in all rooms of the operating department must be subjected to disinfecting cleaning.
Documentation aids (e.g., data processing equipment) also require regular disinfection.
"Surface disinfection can make a decisive contribution to preventing the spread of diseases."
Instructions for Surface Disinfection
- Place cold water (20 °C) in a mixing container7
- Follow the manual instructions (material safety data sheet)
- Wear personal protective equipment8
- Carefully add the disinfectant concentrate
CAVE: concentration may vary
Wipe down the surface while applying gentle pressure.
Ensure that the entire surface is wetted.
- As there are aerosols that may develop during spraying, users may be exposed to a health threat.
- Only carry out spray disinfection when the surface cannot be reached by wipe disinfection.8
When to disinfect surfaces
- After each operation, the surfaces close to the patient, all visibly contaminated surfaces and the entire floor of the operating room that has been walked on must be disinfected.6
- At the end of the daily operating program, floor surfaces and potentially contaminated surfaces in all rooms of the operating department must be subjected to disinfecting cleaning.6
- In the washing areas, the taps and washbasins used must be disinfected at regular intervals; in the other adjoining rooms, disinfecting intermediate cleaning is carried out in the event of visible soiling.6
- An exception applies to surgical areas in which only interventions with a low risk of SSI (e.g., small interventions on the skin, on the eyes, in the oral cavity) are carried out. Here, the rooms outside the OR can be combined, and disinfecting intermediate cleaning can be limited to visibly contaminated and near-patient surfaces.6
High touch surfaces: of special interest
High risk of transmission of pathogens
- Surfaces in the immediate patient surrounding
- Surfaces that come into contact with the skin and mucous membrane of patients
- Surfaces that are contaminated by secretion and excrements
No short-term problem: persistence of pathogens
Since pathogens can survive on surfaces for up to several months and can be further spread during this time, e.g. via hands or dust particles, surface disinfection can make a decisive contribution to preventing the spread of diseases.
Get an impression of how long pathogens can survive:
Persistence on surfaces9–11
|Klebsiella spp.||<1 hour-30 months|
|Pseudomonas spp.||1 hour-16 months|
|Escherichia coli||1.5 hours-16 months|
|Staphylococcus aureus(incl. MRSA)||30 minutes-3 years|
|Clostridioides difficile(incl.Sporen)||15 minutes-5 months|
|Enterococcus spp.(incl. VRE)||5 days-4 months|
|Candida albicans||5 minutes-4 months|
|Norovirus||30 minutes-30 days|
|Influenza virus||<2 hours-2 days|
|Adenovirus||1 hour-3 months|
|SARS-CoV-2||30 minutes-28 days|
We highlight the following 2 surface disinfection methods: Routine and targeted disinfection
- Prevention of the spread of pathogens in day-to-day work
- Spectrum of activity: at least bactericidal, yeasticidal and virucidal against enveloped viruses
- Surfaces of routine disinfection:
—surfaces with frequent hand/skin contact
—surfaces close to patients
Targeted disinfection should be performed:
- in case of visible contamination
- in outbreak situation
- for special pathogens
- as terminal disinfection
- Huslage K et al. (2010) A quantitave approach to defining “high-touch” surfaces in hospitals. Infect Control Hosp Epidemiol 31(8): 850–853.
- Cheng VCC et al. (2015) Hand-touch contact assessment of high-touch and mutual-touch surfaces among healthcare workers, patients, and visitors.
J Hosp Infect 90(3): 220–225.
- WHO (2016) Global guidelines for the prevention of surgical site infection. World Health Organization 2016.
- CDC (1999) Guideline for Prevention of Surgical Site Infection. Infect Control Hosp Epidemiol. 20(4): 247–278.
- NICE (2019) Surgical site infections: prevention and treatment. NICE guidelines. Published 11 April 2019. www.nice.org.uk/guidance/ng125.
- KRINKO (2018) PräventionpostoperativerWundinfektionen. Empfehlungen der Kommission für Krankenhaushygiene und Infektionsprävention(KRINKO) beim Robert Koch-Institut. Bundesgesundheitsbl 61: 448–473.
- Committee on Hazardous Substances (2014) TRGS 525 – Hazardous substances in healthcare facilities.
- KRINKO (2022) Anforderungen an die Hygiene bei der Reinigung und Desinfektion von Flächen, Bundesgesundheitsbl 65: 1074–1115.
- Kramer A et al. (2006) How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis 6: 130.
- Riddell S et al. (2020) The effect of temperature on persistence of SARS-CoV-2 on common surfaces. Virol J 17(1): 145.
- Wißmann JE et al. (2021) Persistence of Pathogens on Inanimate Surfaces: A Narrative Review. Microorganisms, 9(2): 343.
- Assadian O et al. (2021) Practical recommendations for routine cleaning and disinfection procedures in healthcare institutions: a narrative review. J Hosp Infect 113: 104–114.
- Framework Hygiene Plan, Emergency and Hospital Transport Services, District Working Group on the Preparation of Hygiene Plans as per Section 36 German Protection against Infection Act, valid: June 2011.
Temperatures in the winter months can pose particular challenges for rescue workers, as low temperatures below 10 °C can reduce the efficacy of disinfectants. Simple measures can be taken to counteract this effect known as “low temperature failure”.
When emergency medical teams tend to patients with multiple severe injuries, there is no room for trial and error. Instead timing, reliability and precision are key – not just for doctors and nurses but also for the tools and supplies they rely on.
Surfaces are often underestimated as sources of contaminations and infections, although many pathogens can persist on them for several days or longer . Thorough and effectivesurface disinfectionis therefore an important cornerstone of infection prevention – especially in healthcare facilities. But which method is suitable and when: wiping, spraying, or even both?
Related & interesting
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