Despite the acknowledged importance of environmental cleaning of hard surfaces as part of an overall infection control program, only limited evidence exists regarding which practices are most effective, according to a report from the ECRI Institute-Penn Medicine Evidence-Based Practice Center sponsored by the Agency for Healthcare Research and Quality. The study's authors reviewed 80 clinical studies published in the past 25 years regarding cleaning practices targeting high-profile infections such as Clostridium difficile, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci. They found few comparative effectiveness studies directly comparing either disinfection methods or monitoring and surveillance methods; they note that although "surface cleaning and disinfection products and technologies have been widely studied…the evidence base and current expert opinion have yielded consensus favoring only the value of quaternary ammonium and chlorine-based products." Furthermore, subject matter experts interviewed by the authors consistently emphasized that although certain cleaning or disinfection agents may perform a certain way in studies, their use in practical applications can vary widely, limiting their effectiveness. The experts also emphasized the importance of appropriate hand hygiene in limiting the spread of healthcare-associated infections, a factor that may not be accounted for in reviewing environmental cleaning practices.

HRC Recommends: Healthcare facilities have reservoirs of microorganisms that may pose a threat to patients, visitors, and workers. Several areas require special attention, including laundries, computers, mail rooms, operating rooms, and areas where research animals are present. Preventing exposure to infectious agents associated with environmental reservoirs requires development of appropriate infection control policies and procedures, which should include steps to monitor, identify, and eliminate common and uncommon environmental fungi, bacteria, and viruses. Although past studies have suggested that healthcare workers lack knowledge about environmental infection control practices (see the March 20, 2013, HRC Alerts), the current study suggests there may in fact be little evidence to support establishing best practices for workers to be trained in and to perform.