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. 2021 Oct 22;18(21):11100.
doi: 10.3390/ijerph182111100.

Evidence Map and Systematic Review of Disinfection Efficacy on Environmental Surfaces in Healthcare Facilities

Elizabeth C Christenson  1 , Ryan Cronk  1   2 , Helen Atkinson  1 , Aayush Bhatt  1 , Emilio Berdiel  1 , Michelle Cawley  3 , Grace Cho  1 , Collin Knox Coleman  1 , Cailee Harrington  1 , Kylie Heilferty  1 , Don Fejfar  1 , Emily J Grant  1 , Karen Grigg  3 , Tanmay Joshi  1 , Suniti Mohan  1 , Grace Pelak  3 , Yuhong Shu  1 , Jamie Bartram  1   4
Affiliations

Evidence Map and Systematic Review of Disinfection Efficacy on Environmental Surfaces in Healthcare Facilities

Elizabeth C Christenson et al. Int J Environ Res Public Health. .

Abstract

Healthcare-associated infections (HAIs) contribute to patient morbidity and mortality with an estimated 1.7 million infections and 99,000 deaths costing USD $28-34 billion annually in the United States alone. There is little understanding as to if current environmental surface disinfection practices reduce pathogen load, and subsequently HAIs, in critical care settings. This evidence map includes a systematic review on the efficacy of disinfecting environmental surfaces in healthcare facilities. We screened 17,064 abstracts, 635 full texts, and included 181 articles for data extraction and study quality assessment. We reviewed ten disinfectant types and compared disinfectants with respect to study design, outcome organism, and fourteen indictors of study quality. We found important areas for improvement and gaps in the research related to study design, implementation, and analysis. Implementation of disinfection, a determinant of disinfection outcomes, was not measured in most studies and few studies assessed fungi or viruses. Assessing and comparing disinfection efficacy was impeded by study heterogeneity; however, we catalogued the outcomes and results for each disinfection type. We concluded that guidelines for disinfectant use are primarily based on laboratory data rather than a systematic review of in situ disinfection efficacy. It is critically important for practitioners and researchers to consider system-level efficacy and not just the efficacy of the disinfectant.

Keywords: disinfection; environmental surfaces; healthcare facilities; healthcare-associated infections; infection prevention and control.

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Conflict of interest statement

The authors declare no conflict of interest. Kersia Group contributed to the scope of the research project and study design but had no role in study implementation, data collection, analyses, interpretation of the data, preparation of the manuscript, or decision to publish.

Figures

Figure 1
Figure 1
Results of ensemble supervised clustering using 32 seed studies. Studies with an ensemble score of 1 or more were screened manually for relevance.
Figure 2
Figure 2
PRISMA flowchart of systematic review.
Figure 3
Figure 3
Number of studies with the indicated outcome organism or healthcare-associated infection and the indicated intervention type. A darker shade indicates more studies with the indicated outcome and intervention type.
Figure 4
Figure 4
Average score for fourteen study quality indicators individually and in sum for each disinfection intervention type.
See this image and copyright information in PMC

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