The Changing Role of the Healthcare Environment

INTRODUCTION The role of the healthcare environment and its contribution to acquisition and transfer of microorganisms that cause infection and illness in both patients and healthcare workers is not by any means straightforward. Considerations include potential contamination of hard surfaces like desks, sinks, beds, light switches, carts, walls, and floors, as well as porous surfaces like wheelchairs, bedding, linen, curtains, and upholstery. Historically the focus on managing the role of environmental variables was considered less critical because we knew less about the impact those surfaces had in infection prevention.

Several factors are now monitored within healthcare settings that are considered environmental controls. One of the primary areas includes environmental surfaces. These have been categorized by the Spaulding Classification as “noncritical items” or those that do not come into contact with a patient's vascular system or body cavities, but rather simply by a brief or momentary touch from a patient or healthcare worker.¹

Critical or semi-critical items, in contrast to environmental or touch surfaces, are medical devices that are either implanted into a patient like joints, stints or other devices used during medical or surgical procedures like scalpels, endoscopes or probes that are in contact with a patient for minutes, hours, weeks, or years. These items pose a higher risk than noncritical items because they come into direct contact with a patient's blood or body fluids. This year, the U.S. witnessed how improper cleaning and disinfection or sterilization or medical devices like endoscopes can result in serious patient illness and infection,…

ABBREVIATIONS: ACHA – American College of Healthcare Architects, AHE - Association for the Healthcare Environment, CRE - carbapenem-resistant Enterobacteriaceae, CDC – Centers for Disease Control and Prevention, CDI – Clostridium difficile Infection, CFU – Colony Forming Units, EVS – Environmental Services, FDA - Food and Drug Administration, HCW – Healthcare Worker, HICPAC – Healthcare Infection Control Practices Advisory Committee, MDRO – Multiple Drug Resistant Organisms, MRSA – Methicillin Resistant Staphylococcus aureus, OR – Operating Room, OSHA - Occupational Safety and Health Administration, PPE – Personal Protective Equipment, VRE - Vancomycin-resistant Enterococci