The 3 Pillars of the Healthcare Surfaces Institute: Validation, Selection, Disinfection

by Jan 25, 2023Cleaning & Disinfection, Surface Selection, Surface Testing Standards

contaminated hospital mattress and bed

Surfaces are a foundational issue in infection prevention. There are many aspects to this complex problem, and it requires a collaborative effort to address them all. The Healthcare Surfaces Institute (HSI) is the only organization focused on the issue of surfaces. HSI focuses its work, research, and education on the following three pillars.

Pillar 1: Testing and Validation

Surface material and product testing validation to ensure healthcare surfaces can be cleaned and disinfected without damage

before and after of a surface after cleaning showing damage caused by disinfectant

Surface disinfection compatibility is a costly and risky issue. There is a gap between understanding infection prevention guidelines on cleaning and disinfection, how often cleaning and disinfection occur during patient care, and manufacturer cleaning instructions. This gap exists because there are no consistent minimum testing requirements to validate that surface materials can be cleaned and disinfected using standard disinfectants in the healthcare setting. The result is damage from cleaning with disinfectants incompatible with the surface materials.

Initially, this damage is not seen. Microscopic tears, cracks, or crazing create reservoirs that harbor pathogens away from the biocides meant to destroy them. Biofilm forms and microbes proliferate. Since visual inspection cannot accurately assess whether a surface is clean and disinfected, patients and healthcare providers are at constant risk of acquiring a deadly infection.

The first pillar of HSI focuses on addressing this issue at the source – we are researching surface disinfection compatibility and developing testing protocols to ensure that surface materials and assembled products can be efficiently and effectively cleaned and disinfected using EPA-registered hospital-grade disinfectants.

Pillar 2: Selection

Surface selection methodology to support infection prevention practices

photo of a hospital room with dozens of arrows pointing at different surfaces

When designing a healthcare facility and selecting surface materials to design medical devices and other equipment for patient care, hundreds of surface materials are evaluated and ultimately used and placed in the healthcare environment. How can the people responsible for selection be sure that their choices support infection prevention?

Evaluating every surface’s characteristics or being an expert in disinfection agents and protocols is insufficient. These data must be combined with an understanding of microbiology, the physical environment, and insight into human behavior.

HSI works to help healthcare facilities set criteria for surface selection based on input from infection preventionists, scientists, value analysts, environmental services professionals, and many other healthcare clinicians who are faced with ongoing infection risks. Guidelines are being developed, and we are working to build a bridge between manufacturers and key decision-makers who face these challenges.

Pillar 3: Cleaning and Disinfection

Inform the cleaning and disinfection instructions of reusable medical devices and other surfaces in the healthcare environment

a sample of an IFU with conflicting instructions circled

Every surface and every product comes with specific cleaning guidelines in the instructions for use (IFUs). An impossible situation is created when environmental services professionals are confronted with hundreds of different IFUs for every product in any given environment. Many don’t even see the IFUs. Chaos, confusion, and damage occur.

IFUs are created at the manufacturer’s discretion and frequently are not compatible with the infection prevention guidelines of a healthcare facility. As a result, hospitals may use a non-approved disinfectant or cleaning method that can damage these surfaces and products. This damage provides a safe harbor for pathogens to proliferate and can result in product recalls and significant costs to healthcare organizations.

After researching and developing a case study evaluating the root causes for these problems,  HSI is working to ensure that IFUs provide guidance and recommendations pertinent to active healthcare environments and that support infection prevention guidelines and protocols.

Collaboration is Key

Responsibility and accountability for infection prevention are spread over many areas of expertise. The 3 Pillars of HSI are rooted in the collaboration we have created, comprised of experts in healthcare, manufacturing, academia, professional organizations, standards-setting organizations, and regulatory agencies. This approach allows HSI to address the foundational issue of surfaces, which are virtually overlooked but provide an opportunity to realize sustainable reductions in HAIs.

Please help support our mission to stop healthcare-associated infections: become a member, donate, or consider a corporate sponsorship.

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