Environmental hygiene: From clean surfaces to safer patients

In preparation for this week's journal club (which you can join here) we've taken a look at this paper, which Dr Alexandra Peters will run through.

There is a growing body of evidence that the hospital environment plays a role in the transmission of infections. Clean environments are vital to reduce the risk of transmission and to maintain patient safety. In the paper Dr Peters and colleagues, looked at the impact of healthcare environmental hygiene (HEH) interventions on healthcare-associated infections (HCAIs) and patient colonization. The review analysed 26 studies covering a wide range of interventions from automated disinfection to staff training and cleaning bundles, concluding that improvements in environmental hygiene reduced infection risk.

Across all studies, 88% reported a reduction in multidrug-resistant organism (MDRO) infections or colonization, and over half (58%) showed statistically significant reductions across all organisms studied, including Staphylococcus aureus, Clostridioides difficile, and vancomycin-resistant enterococci (VRE). The most effective approaches were
those that combined multiple elements — for example, pairing enhanced cleaning technologies with staff education and structured monitoring.

Interventions ranged from automated systems (such as ultraviolet-C light disinfection and HEPA filtration) to manual
methods (such as pre-impregnated wipes), and human factors like training, feedback, and organisational support. Importantly, the review noted that most of these interventions also reduced environmental bioburden, reinforcing the link between cleaner surfaces and reduced infection risk.

While some studies were small or lacked robust controls, the overall trend is clear: investing in environmental hygiene delivers real infection prevention gains. It’s a reminder that maintaining a clean and safe environment is not just a support function, but a critical part of patient safety.

At a time when healthcare systems are under increasing pressure to reduce HAIs and combat antimicrobial resistance, HEH interventions represent an evidence-based opportunity to strengthen IPC performance and improve patient safety.