Surfaces & HAIs FAQ

Surfaces are fomites. Fomites are “objects or materials which are likely to carry infection, such as clothes, utensils, and furniture

How are HAIs spread?

There are many factors contributing to the spread of HAIs. The use of indwelling medical devices (such as central lines, catheters, and ventilators), insufficient handwashing or PPE, and contaminated surfaces all increase the instance of HAIs.

What types of surfaces spread HAIs?

All surfaces can harbor microbes. This includes environmental surfaces (flooring, countertops, door handles, case work, sinks, etc.), patient care items and medical devices used for patient care (patient beds, gurneys, patient monitors, IV pumps and poles), and don’t forget porous, soft surfaces (pillows, privacy curtains, bedding, scrubs, patient gowns, gait belts, and chairs – just to name a few.)

How do surfaces support HAIs?

Surfaces can harbor microbes for days, weeks, or months even after cleaning and disinfection. There are many contributing factors that come into play when microbes are acquired and transmitted. Most important is the need to effectively clean and disinfect all surfaces. This is a subject that is virtually overlooked. There are many different types of surface materials and textiles within the healthcare setting and not all of them can be cleaned and disinfected the same way. Microbes proliferate on improperly cleaned or damaged environmental surfaces and equipment used for patient care.

If not disinfected properly, these microbes can then spread to healthcare workers, medical devices, and ultimately, patients.

When patients, visitors, or healthcare workers touch contaminated surfaces, they can transmit the microbes to another person or themselves. After handwashing, many assume the environmental surfaces to be clean and/or sterile, yet this is not always the case.

When surfaces become damaged with pitting, cracks, or fissures, they develop microbial reservoirs that protect pathogens from disinfectants. This damage is often unseen. Some surfaces being used in the healthcare environment have features that act as microbial reservoirs built into the design. Some surface materials are simply difficult to disinfect effectively and should not be used in a patient care area.

What is surface disinfection compatibility/incompatibility?

This issue has many facets, but begins with the many different infection prevention protocols, processes, and products used within a healthcare setting. Currently there are no requirements for surface material or product manufacturers to test and validate that its surfaces can be cleaned and disinfected using EPA-registered hospital-grade disinfectants. Manufacturers will provide IFUs and care and maintenance manuals which suggest what disinfectant or cleaning healthcare professionals should use. If those IFUs are in conflict with what a healthcare facility’s cleaning and disinfection guidelines require, however, that is surface disinfection incompatibility. As a result, the disinfectant and disinfection process used by the healthcare facility to protect patient safety can then damage the surfaces and make them more likely to harbor microbes.

Why aren’t people using more antimicrobial or self-cleaning surfaces?

There is no such thing as a self-cleaning surface. ALL surfaces must be cleaned and disinfected regularly.

The question about antimicrobial surfaces is complicated. There are many different types of antimicrobials, and they don’t all work the same way. Some require activations, others require that surface materials not be coated with anything. This presents a unique challenge because there are disinfectants that require a dwell time to be effective, which means there is a coating on the surfaces for a required amount of time.

It is also important to recognize that surfaces accumulate bioburden. It is unknown how much bioburden can accumulate on any given surface before cross-contamination can occur. Moreover, we don’t know how much bioburden can accumulate before the antimicrobial properties no longer work.

Additionally, it is not uncommon for front line workers to misunderstand how antimicrobial surface products work. Therefore, they have a false sense of security resulting in a lack due diligence required for cleaning and disinfection.

Antibiotic/antimicrobial resistance is a serious issue within the healthcare setting. Microbes are building up resistance to antibiotics and antimicrobials and become superbugs. Patients and healthcare workers are in danger of contracting microbes that are resistant to standard treatments.

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