A New Frontier: The Dangers of Pathogens on Soft Surfaces

By Chris Kukla

While nearly half of the surfaces in healthcare facilities are soft surfaces, such as privacy curtains, soft surface decontamination is often overlooked in todays fast-paced healthcare environment. Studies have shown that just as on hard, nonporous surfaces, bacteria, viruses, and fungi can all thrive on soft surfaces for extended periods of time and contribute to the transmission of microorganisms.

According to a recent survey administered by the Association for Professionals in Infection Control and Epidemiology (APIC) which asked infection preventionists how often privacy curtains in their facilities are cleaned, 37 percent of respondents answered only when visibly soiled, 13 percent answered every month, 13 percent answered every three months and another 13 percent answered once per year.(1) 

If left unaddressed, contaminated soft surfaces can pose a risk of infection and can undermine any hard surface disinfection routines your facility may have as well as put patients, families and staff at risk.

All soft surfaces in healthcare settings have the potential to harbor microorganisms, and multiple studies have found pathogenic bacteria on privacy curtains, upholstered furniture, bed linens, and employee uniforms and lab coats. One particular study found that 92 percent of privacy curtains were contaminated with infectious bacteria within one week.(2) Because bacteria have been found to survive for up to three months on common fabrics used in hospitals, such as polyester and cotton,(3) infection preventionists and environmental services teams need to start thinking about a complete approach to environmental decontamination beyond hard-surface disinfection.

Not only is there evidence showing that pathogens can survive on soft surfaces, but there are studies supporting the link between soft surfaces and infection transmission. These studies have found that bacteria can be transferred to upholstery and fabric cushions, and then to people.(4-5) When healthcare workers touch a contaminated soft surface, their hands can carry microorganisms to other surfaces as well as directly to patients contributing to the spread of pathogens that can cause healthcare-associated infections. This means that every time a healthcare worker touches a soft surface, they could put patients and others at risk for infection.

Kelly Reynolds, MSPH, PhD, a researcher and associate professor in the College of Public Health at the University of Arizona, has conducted extensive research on how soft surfaces play a role in cross contamination and infection transmission. She recently presented research at AHE EXCHANGE 2013, which found that regularly treating fabrics and upholstered furniture with a product that is Environmental Protection Agency (EPA) registered to kill bacteria on soft surfaces, such as Clorox Healthcare® Hydrogen Peroxide Cleaner Disinfectants,* can help to minimize patient and healthcare worker infection risks.
While more research is still needed in this area, the compelling statistics to date make it clear that each healthcare facility should evaluate their infection prevention protocol and determine how best to incorporate simple soft surface decontamination efforts.

To help ensure your facility has a comprehensive approach to preventing the spread of pathogens, incorporate soft surface decontamination into your facilitys regular environmental cleaning practices. This includes targeting soft surfaces in patient and exam rooms (privacy curtains), waiting and reception areas (couches, chairs) and workstations (office chairs, mouse pads). Steps you can take include:
1. Routine laundering of privacy curtains, linens, employee uniforms and other soft surfaces in your facility.
2. Use of an EPA-registered product to kill bacteria on soft surfaces between laundering and on soft surfaces that cannot be laundered.
3. Hand hygiene practices by healthcare professionals during and between patient care.

*100 percent polyester and 100 percent cotton. Use product as directed. Soft-surface claim has been registered by the federal EPA and may not be available in all 50 states. Check with your sales representative for updates in your state. 

Chris Kukla is a scientist at Clorox Professional Products Company with several years of healthcare R&D experience in product development and technical services. He is a member of the Michigan Society for Infection Prevention and Control and holds a BS in biomedical engineering from Michigan Technological University and an MBA from Northwood University. For more information and educational materials on soft surface solutions from Clorox Healthcare, visit http://www.cloroxhealthcare.com/SoftSurface.

References:
1. DeAngelis DL, Khakoo R, DeAngelis DL. Hospital privacy curtains: Cleaning and changing policies are we doing enough? Am J Infect Control. 41 (2013):S25-S145.
2. Ohl M, Schweizer M, Graham M, Heilman K, Boyken L, Diekema D. Hospital privacy curtains are frequently and rapidly contaminated with potentially pathogenic bacteria. American Journal of Infection Control. 40:10 (2012): 904-906.
3. Neely AN and Maley MP. Survival of enterococci and staphylococci on hospital fabrics and plastic.  J Clin Micro. 38.2 (2000):724-726.
4. Neely AN. Persistence of microorganisms on common hospital surfaces. Infection Control Resource. 4.4.
5 Noskin GA, Bednarz P, Suriano T, Reiner S and Peterson LR. Persistent contamination of fabric-covered furniture by vancomycin-resistant enterococci: implications for upholstery selection in hospitals. Am J Infect Control. 28.4 (2000):311-3.