HAIs & Surfaces

HAIs and Surfaces

People enter a healthcare facility for a variety of reasons, but ultimately to improve their health and well-being. Unfortunately, 1 out of every 25 patients who enter the healthcare facility will contract an illness completely unrelated to what they are being treated for.

As a public health issue, healthcare-associated infections (HAIs) have been deemed preventable by a number of regulatory and clinical experts for many years. Despite the best effort by healthcare professionals, HAIs continue to be a challenge.

Surfaces are a virtually overlooked issue due to the complexity of the problem. The focus has been on cleaning and disinfection of surfaces, which is only one aspect of the problem. In reality, the problem begins in the design phase of the build environment and the design of products that are used for patient care.

The critical question that must be asked when surface materials are being tested is:

Can this surface material and product be effectively cleaned and disinfected using EPA-registered hospital-grade disinfectants without causing damage?

It is shocking to know that there are currently no minimum standards or requirements for testing to validate that a surface can be cleaned and disinfected. Moreover, the information that does exist to support surface selection is confusing and fragmented.

The Healthcare Surfaces Institute is focused on addressing these problems.

Finding Solutions Begins with Understanding the Problem

Sustainable solutions can’t be found without identifying and understanding all aspects of the problem. Microbes are transmitted via the air, water, and surfaces. Within each of these three categories there are factors that support transmission. Air and water transmission of pathogens have been the subject of extensive research. However, surfaces research has focused primarily on effective cleaning and disinfection without understanding what the problems actually are and their full scope. Sustainable solutions can’t be found until all aspects of the problem are understood and addressed.

Surface Disinfection Compatibility

What happens when disinfectants and other cleaning products used to disinfect the healthcare environment are not compatible with the surfaces being cleaned?

Damaged surfaces are often called “microbial reservoirs” for a good reason – they provide pathogens safe harbor from the disinfectants meant to destroy them.

The evaluation of surface disinfection compatibility and damage to surface materials and products has become a topic of discussion. Does this issue support microbial proliferation and transmission? We know it does create patient risk and must be addressed.

Read our case study on surface disinfection compatibility to learn more >

No Standard Definition of Disinfection

Adding to the complexity and confusion are different definitions of common terms such as “clean” or “disinfected.” HSI reviewed 31 different organizations for their definition of clean and disinfected. While there were similarities, there were clear differences.

Based on areas of expertise there are many different meanings for the same words. Surgical staff compared to infection prevention or environmental services are different.

Product and material manufacturers also have different understandings of these words therefore cleaning and disinfection guidelines and recommendations for the use of disinfectants are very different. Regulatory agencies also offer conflicting guidelines and recommendations. These issues must be addressed.

Social and Financial Impact of Addressing Surfaces in the Spread of HAIs

Failure to appropriately address surfaces as fomites has led to:


Increased threat of healthcare-associated infections.


Dangerous disparities in infection prevention practices and protocols.


Major financial and capital loss for healthcare facilities when repair and replacement of products must be done long before an expected life cycle has been met.

By successfully addressing the foundational problem of surfaces in the healthcare environment, we can:


Reduce risks for patients and healthcare workers.


Save lives by reducing the spread of pathogens via surfaces.


Select surfaces and products that support the needs of specific environments.


Reduce room turnover times by selecting surfaces that support efficient and effective cleaning and disinfection.


Reduce high costs for repair and replacement of damaged equipment and surfaces due to surface disinfectant incompatibility.

Healthcare Surfaces Institute

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