Hospitals' environmental hygiene leaves room for improvement 'regardless of geography or income level': report

Infection control and environmental hygiene practices appear to have room for improvement across healthcare facilities around the world, according to the results of a new global pilot survey.

Among 51 responding healthcare facilities from 35 nations of varying income levels, nearly all reported some deficit in their practices related to cleaning all surfaces of a hospital room, according to a paper published Thursday in the American Journal of Infection Control.

“We were surprised to find that 98% of the facilities participating in our survey were majorly lacking in one or more of the World Health Organization’s multimodal improvement strategies for infection prevention and control practices,” Alexandra Peters, of the University of Geneva and the University of Geneva Hospitals’ infection control program as well as the study’s first author, said in a statement.

According to the published results, 71% of responding facilities said they believed their facility appropriately valued healthcare environmental hygiene (HEH). A little over half said their HEH protocols were based on best practice and updated regularly, while 14% said their practices either were not based on best practice or were not available at all.

Forty-seven percent said their budget for cleaning and disinfection was adequate. Sixty-seven percent said necessary HEH products and supplies were always available, 27% said they were sometimes available and 6% said they were rarely or never available.

Eighty-six percent of facilities said they monitored staff performance and the effectiveness of their environmental cleaning practices. Three in 5 said they gave immediate feedback at the individual level, with just over a quarter providing team-level feedback.

Comprehensive, formal HEH training was only provided or required for staff at 22% of the facilities, while 28% did not provide or require any formal HEH training whatsoever. Eighteen percent said they did not employ workplace reminders, and more than half said they did not host any events for staff around HEH.

“This survey suggests that challenges with key components of HEH, including staff education and training, workplace culture, and access to adequate products and equipment, remain ubiquitous regardless of geography or income level,” Peters said. “These results reinforce the need for a self-assessment tool to help [healthcare facilities] worldwide identify HEH challenges and necessary resources.”

Researchers distributed the survey from April to June 2021 to 743 healthcare facilities across the world and received 51 completed surveys. Most countries only had one facility respond, with the exception of two in Congo and 16 in Croatia, a disproportionately high response rate for the country that was the result of one respondent sharing the survey with several other facility leaders. Nearly all of those who filled out a survey indicated they made decisions regarding how their facility was cleaned.

Peters and colleagues conducted their survey to help test and inform the development of an HEH self-assessment tool for facilities worldwide. Their results, they said, speak to the need for such tools across facilities of every income level.

“This study highlights environmental hygiene needs that are similar to those we identified more than 25 years ago for hand hygiene promotion at the time we introduced alcohol-based hand gels in hospitals,” Didier Pittet, M.D., director of the University of Geneva Hospitals’ infection control program, a professor of medicine at the university and the study’s senior author, said in a statement.