Hand hygiene or environmental cleaning: Which is more effective?

While both proper hand hygiene and environmental cleaning are essential to infection prevention strategies in healthcare settings, assessing the effect of each is important as hospitals, surgery centers and other facilities allocate resources.

"Significant efforts and resources are required to improve compliance in either of these areas," a study in Infection Control and Hospital Epidemiology states. "When healthcare facilities are investing limited resources in infection prevention strategies, it would be helpful to know which strategy is likely to have the greater impact on preventing transmission."

To find the answer, researchers developed a model of infection transmission via hands of colonized healthcare workers and incompletely cleaned rooms in an ICU. Nurses and physicians had distinct hand hygiene compliance levels. Researchers simulated 175 parameter-based scenarios and compared the effects of changing hand hygiene and environmental cleaning rates on the transmission of Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci.

They found increasing hand hygiene compliance outperformed equal increases in thoroughness of terminal cleaning — a 10 percent increase in hand hygiene compliance and a 20 percent increase in cleaning thoroughness had the same effect on the reduction of organism transmission.

So, increasing hand hygiene compliance should be important for facilities with current low compliance rates, the researchers concluded. However, "environmental cleaning can have significant benefit for hospitals or individual...units that have either high hand hygiene compliance levels or low terminal cleaning thoroughness."

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