While there are multiple steps that facilities can take to protect patients and staff including proper hand hygiene and observing barrier precautions, effective surface disinfection is a crucial step in eliminating germs and reducing opportunities for cross-contamination and HAIs. Attention should be paid to the role of environmental surfaces throughout the facility – especially those surfaces commonly considered as germ "hot spots."

Germs that can cause colds, flu, infections and other health problems can live on surfaces just waiting to be picked up by unsuspecting (clean) hands. While nothing beats good old-fashioned handwashing as a way to break the chain of transmission, proper attention to surface sanitation can also help minimize the transfer of microorganisms that can occur via hand contact between contaminated surfaces and the people who touch them.

In fact, according to the CDC, cleaning and disinfecting environmental surfaces in healthcare facilities is fundamental in reducing the potential contribution of those surfaces to the incidence of HAIs. In addition to proper hand hygiene, such cleaning and disinfecting can help to minimize the transfer of microorganisms that can occur via hand contact between contaminated surfaces and patients.

Environmental surfaces can be divided into two parts: medical equipment surfaces such as knobs or handles on machines, carts, and similar equipment, and housekeeping surfaces, such as floors, walls and tabletops. Housekeeping surfaces can be further divided into those with minimal hand contact (referred to as "low-touch" surfaces) such as walls and window blinds, and those with frequent hand contact and can be considered germ hot spots ("high-touch" surfaces) including doorknobs, bedrails, light switches and toilets.

The number and types of microorganisms present on environmental surfaces are influenced by:

• The number of people in the environment.

• Amount of activity in the environment.

• Amount of moisture (microorganisms are present in great numbers in moist organic environments, but some can also persist under dry conditions).

• Presence of material capable of supporting microbial growth.

• Rate at which organisms suspended in air are removed.

• Type of surface and orientation (horizontal or vertical).

Even in the absence of visible soiling with blood and/or body fluids, housekeeping surfaces may serve as germ reservoirs in the chain of infection. In fact, methicillin-resistant Staphylococcus aureus (MRSA) can survive for weeks to several months on almost all surfaces, and may cause skin and surgical infections. C. difficile bacteria can live for years on environmental surfaces. Vancomycin-resistant enterococci (VRE) bacteria are very hardy and can live for several days on surfaces. And noroviruses can survive on virtually any hard surface for up to 12 hours.

Most, if not all, housekeeping surfaces require regular cleaning with soap and water or a detergent/disinfectant and removal of soil and dust, according to guidelines from the CDC. High-touch housekeeping surfaces in patient-care areas should be cleaned and/or disinfected more frequently than surfaces with minimal hand contact. Horizontal surfaces with infrequent hand contact require cleaning on a regular basis, when soiling or spills occur, and when a patient is discharged from the facility.

Cleaning (the removal of all foreign material such as dirt, body fluids, and lubricants from objects by using water with detergents or soaps and by washing or scrubbing the object) is the necessary first step of any sterilization or disinfection process. It is needed to render the environmental surface safe to handle or use by removing organic matter, salts, and visible soils – all of which interfere with microbial inactivation. In fact, the physical action of scrubbing with detergents and surfactants and rinsing with water removes large numbers of microorganisms from surfaces.

After cleaning, disinfection may be performed to eliminate many microorganisms from surfaces and bleach is an effective solution for achieving routine disinfection. However, for surfaces that may have been exposed to hardy microorganisms such as the spore form of C.difficile, drug-resistant bacteria (MRSA, VRE) and tuberculosis, new technologies will soon be available that can literally pierce the outer membrane of a target spore, destroy the internal component and kill the pathogen, helping to break the chain of transmission.