What We Can’t See Can Hurt Us

We evaluate the cleanliness of surfaces in the healthcare environment by how they look. If they look clean they must be clean, right?

Not so fast.

Research has shown that pathogens live on surfaces for days, weeks, even months after they have been cleaned. How can this be?

There is the potential for human error during the cleaning process. But to make a point, let’s pretend the potential for human error doesn’t exist.

  • Can the surface actually be cleaned/disinfected using the standard cleaning and disinfection products in our healthcare facilities?

  • If we look at the surface at a microscopic level after it has been cleaned and disinfected, is the surface clean?

Knowingly and unknowingly, microbial reservoirs are designed and built into healthcare environments via the surface materials that are selected.

The evaluation of how a surface looks and what it costs takes precedence over a thorough evaluation of the surface function, cleaning recommendations, and how a surface might contribute to the spread of healthcare-acquired infections (HAIs).

Rigorous cleaning and disinfection processes are required and a wide variety of products and chemicals are used. Terminal disinfection often requires higher concentrations of chemical. Bleach-based products are effective in eliminating Clostridium difficile (“C-diff”) and are used frequently.

Sadly, the majority of surfaces used in our healthcare environments carry warnings against the use of harsh disinfectants/chemicals, many calling out bleach specifically.

What happens to the surface when these products are used?  We don’t see any damage, so it must not be there, right?

Damage to a surface can begin at a microscopic level. Pits, cracks and fissures create the perfect environment for bacterial colonies to form and proliferate. Bio-burden recovers quickly after cleaning and the perfect storm has been created for pathogens to be transferred to other surfaces and to patients.

In this series of images, we see a new laminate surface and the same surface after a single cleaning. The dark areas are pits and voids that can become microbial reservoirs. The final image shows E. coli attached to a rough surface (scanning electron micrograph by Ronn Friedlander and Michael Bucaro).

To address the issue of HAIs, the surfaces selected for healthcare environments need to be evaluated differently.

What we can’t see can hurt us, even kill us.