Surfaces in healthcare facilities pose a considerable risk for the spread of nosocomial infections, because several clinically relevant pathogens have the ability to persist for a long time on surfaces. For example, C. difficile spores can persist on inanimate surfaces for up to 5 months. For Klebsiella, persistence times of over 30 months have been described [1]. If such contaminated surfaces are not cleaned and disinfected properly, there is an increased risk of infection for patients and staff. Risk assessment is a basic prerequisite for effective cleaning and disinfection of surfaces in healthcare facilities. This is also necessary for hospitals to comply with the new DIN13063 standard on hospital cleaning [2].
An easy-to-understand overview with practical recommendations for routine cleaning and disinfection of surfaces in healthcare is also provided in the article by Professor Ojan Assadian et al. published in2021 in the Journal of Hospital Infection, which also deals with the topic of risk assessment [3].
The three cornerstones of risk assessment
Three closely interrelated cornerstones play anessential role in the risk assessment of surfaces [3-5] (see figure):
1. risk profile of the patients: Which patients could come into contact with the surfaces? Are they less susceptible patients on the general ward or more susceptible intensive care patients with critical illnesses?
2. surface risk profile: what is the risk of the surface becoming contaminated and infected with clinically relevant pathogens? Is it the walls in the cafeteria (low risk area) or a bedside table in the ICU (high risk area)? Do the surfaces only come into contact with intact skin (e.g. light switches, non-critical surface) or with blood and mucous membranes (e.g.catheters, critical surface)? Are they touched frequently (high-touch surface, e.g. door handle) or rather rarely (low-touch surface, e.g. ceiling lamp)?
3. risk profile of the pathogen: what is known about the possible pathogen? How must the room of a patient be cleaned who is known to be infected with a multidrug-resistant and/or highly contagious pathogen, or is it the routine cleaning of the floor in the entrance hall of the hospital?
Measures regulate routine as well as targeted cleaning and disinfection
The risk assessment should ideally be carried out fo rall areas or surfaces of the clinic. It specifies which surfaces must be cleaned and disinfected in which way and how often, both as part of the regular routine and as a targeted measure, for example after contamination. In this way, the risk of nosocomial infections can be kept as low as possible. This specification can also be used to draw up service specifications for staff, which also facilitate interface management and clarify the question of who is responsible for which areas.
Sources:
1. Kramer A etal. (2006) How long do nosocomial pathogens persist on inanimate surfaces? Asystematic review. BMC Infect Dis 6: 130.
2. DIN13063:2021-09. Krankenhausreinigung - Anforderungen an die Reinigung und desinfizierendeReinigung in Krankenhäusern und anderen medizinischen Einrichtungen.
3. Assadian O et al. (2021) Practical recommendations for routine cleaning and disinfection procedures in healthcare institutions: a narrative review. J Hosp Infect 113: 104–114.
4. Centers for Disease Control and Prevention. Appendix A: Risk assessment. Atlanta, GA:CDC. : https://www.cdc.gov/hai/prevent/resource-limited/risk-assessment.html. [abgerufen am 06.01.2022]
5. KRINKO (2004) Anforderungen an die Hygiene beider Reinigung und Desinfektion von Flächen. Bundesgesundheitsbl 47: 51–61.
