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Evaluating a New Paradigm for Comparing Surface Disinfection in Clinical Practice

  • Philip C. Carling (a1), Jennifer Perkins (a2), JoAnn Ferguson (a2) and Anita Thomasser (a3)



Despite an increasing understanding of the importance of near-patient surfaces in the transmission of healthcare-associated pathogens, there remains a need to define the relative clinical effectiveness of disinfection interventions


A serial 2-phase evaluation of the clinical effectiveness of 2 surface disinfectants.


A general acute care hospital.


A unique system for quantifying bioburden reduction while monitoring the possible impact of differences in cleaning thoroughness was used to compare the clinical effectiveness of a traditional quaternary ammonium compound (QAC) and a novel peracetic acid/hydrogen peroxide disinfectant (ND) as part of terminal room cleaning.


As a result of QAC cleaning, 93 (40%) of 237 cleaned surfaces confirmed by fluorescent marker (DAZO) removal were found to have complete removal of aerobic bioburden. During the ND phase of the study, bioburden was removed from 211 (77%) of 274 cleaned surfaces. Because there was no difference in the thoroughness of cleaning with either disinfectant (65.3% and 66.4%), the significant (P > .0001) difference in bioburden reduction can be attributed to better cleaning efficacy with the ND.


In the context of the study design, the ND was 1.93 times more effective in removing bacterial burden than the QAC (P > .0001). Furthermore, the study design represents a new research paradigm in which 2 interventions can be compared by concomitantly and objectively analyzing both the product and process variables in a manner that can be used to define the relative effectiveness of all disinfection cleaning interventions.

Infect Control Hosp Epidemiol 2014;35(11):1349–1355


Corresponding author

Carney Hospital, 2100 Dorchester Avenue, Dorchester, MA 02124 (


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1. Dancer, SJ. Control of transmission of infection in hospitals requires more than clean hands. Infect Control Hosp Epidemiol 2010;31(9):958960.
2. Otter, JA, Yezli, S, French, GL. The role played by contaminated surfaces in the transmission of nosocomial pathogens. Infect Control Hosp Epidemiol 2011;32:687699.
3. Donskey, CL. Does improved disinfection reduce healthcare-associated infections? Am J Infect Control 2013;41(5 suppl):S12S19.
4. Webber, D, Rutala, W. Understanding and preventing transmission of healthcare associated pathogens due to the contaminated hospital environment. Infect Control Hosp Epidemiol 2013;34:449452.
5. Carling, PC, Huang, SS. Improving healthcare environmental cleaning in disinfection: current and evolving issues. Infect Control Hosp Epidemol 2013;34(5):507513.
6. Rutala, WA, Weber, DJ. Guideline for disinfection and sterilization in healthcare facilities, 2008. Atlanta: Centers for Disease Control and Prevention, 2008. Accessed March 10, 2014.
7. Guh, A, Carling, PC; the Environmental Evaluation Workgroup. Options for evaluating environmental cleaning. Atlanta: Centers for Disease Control and Prevention, 2010. Accessed March 10, 2014.
8. Carling, PC, Parry, MM, Rupp, ME, Po, JL, Dick, B, Von Beheren, S. Improving cleaning of the environment surrounding patients in 36 acute care hospitals. Infect Control Hosp Epidemiol 2008;29(11):10351041.
9. AORN. Recommended practices for environmental cleaning. In: 2013 Perioperative Standards and Recommended Practices. Denver: AORN, 2013.
10. Carling, PC. Methods for assessing the adequacy of practice and improving room disinfection. Am J Infect Control 2013;41(suppl):S20S25.
11. Rupp, ME, Fizgerald, T, Sholtz, L, Lyden, E, Carling, PC. Maintaining the gain: program to sustain improvement in environmental cleaning. Infect Control Hosp Epidemiol 2014;35(7):866868.
12. Wolkewitz, M, Barnett, AG, Palomar Martinez, M, Frank, U, Schumacher, M. Interventions to control nosocomial infections: study designs and statistical issues. J Hosp Infection 2014;86(2):7782.
13. McDonnell, GE. Chemical disinfection. In: Antisepsis, Disinfection and Sterilization . Washington DC: American Society of Microbiology Press, 2007:115130, 140144.
14. Dancer, SJ, White, L, Robertson, C. Monitoring environmental cleaning on two surgical wards. Int J Environ Health Res 2007;18:357364.
15. Hayden, MK, Bonten, MJ, Blom, DW, Lyle, EA, van de Vijver, DA, Weinstein, RA. Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis 2006;42(11):15521560.
16. Goodman, ER, Platt, R, Bass, R, Onderdonk, AB, Yokoe, DS, Huang, SS. Impact of an environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in intensive care unit rooms. Infect Control Hosp Epidemiol 2008;29(7):593599.
17. Sitzlar, B, Deshpande, A, Fertelli, D, Kundrapu, S, Sethi, A, Donskey, C. An environmental disinfection odyssey: evaluation of sequential interventions to improve disinfection of Clostridium difficile in isolation rooms. Infect Control Hosp Epidemiol 2013;34(5):459465.
18. Strassle, P, Thom, K, Johnson, JK, et al. The effect of terminal cleaning on environmental contamination rates of multidrug-resistant Acenitobacter baumanii . Am J Infect Control 2012;40:10051007.
19. Dancer, SJ. How do we assess hospital cleaning? A proposal for microbiological standards for surface hygiene in hospitals. J Hosp Infect 2004;56:1015.
20. Dancer, SJ. Hospital cleaning in the 21st century. Eur J Coin Microbiol Infect Dis 2011;30:14731481.
21. Carling, PC, Bartley, JM. Evaluating hygienic cleaning in healthcare settings: what you do not know can harm your patients. Am J Infect Control 2010;38:S41S50.
22. Humphries, H. Self-disinfecting in microbicide-impregnated surfaces and fabrics: what potential in interrupting the spread of healthcare-associated infection? Clin Infect Dis 2014;58:848853.
23. Moore, G, Smyth, D, Singleton, J, Wilson, P. The use of adenosine triphosphate bioluminescence to assay the efficacy of a modified cleaning program implemented within an intensive care setting. Am J Infect Control 2010;38:617622.
24. Loveday, HP, Wilson, JA, Pratt, RJ, et al. Epic 3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2014:86(supplement 1):S1S70.
25. White, LF, Dancer, SJ, Robertson, C, McDonald, J. Are hygiene standards useful in assessing infection risk? Am J Infect Control 36;5:381384.
26. Dancer, SJ, White, LF, Lamb, J, Girvan, EK, Robertson, C. Measuring the effect of enhanced cleaning in a UK hospital: a prospective cross-over study. BMC Med 2009;7:28:112.
27. Sherlock, O, O’Connell, N, Craemer, E, Humphreys, H. Is it really clean? an evaluation of the efficacy of four methods for determining hospital cleanliness. J Hosp Infect 2009;72:140146.
28. Al-Hamad, A, Maxwell, S. How clean is clean? proposed methods for hospital cleaning assessment. J Hosp Infect 2008;70(40):328334.
29. Boyce, JM, Havill, NL, Havill, HL, Magione, E, Dumigan, TG, Moore, BA. Comparison of fluorescent marker systems with 2 quantitative methods of assessing terminal cleaning practices. Infect Control Hosp Epidemiol 2011;32(12):11871193.
30. Mulvey, D, Redding, P, Robertson, C, et al. Finding a benchmark for monitoring hospital cleanliness. J Hosp Infect 2011;77:2530.
31. Boyce, JM, Havill, NL, Dumigan, TG, Golebiewski, M, Balogun, O, Rizvani, R. Monitoring the effectiveness of hospital cleaning practices using an ATP bioluminescence assay. Infect Control Hosp Epidemiol 2009;30:988999.
32. Kuhn, TS. The Structure of Scientific Revolutions. 2nd ed. Chicago: University of Chicago Press, 1970.
33. McDonald, LC, Arduino, M. Climbing the evidentiary hierarchy for environmental infection control. Clin Infect Dis 2013;56(1):3639.


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