The Evolution of Health Care Environmental Hygiene: A Long Overdue Shift in Infection Control

Clean Hospitals Corner with Alexandra Peters, PhD

Dear Infection Control Today^® (ICT^®) readers,

I am honored to have been asked to write the monthly column “The Clean Hospitals Corner.” I hope to explore some of the aspects of the field that I find especially relevant or interesting and share some of my passion for it with you

I want to use this platform to explore various topics: to talk about new technologies, look into implementation strategies, keep updated on the latest news, or delve into challenges faced in clinical settings. The format is still flexible, and I am happy to use this forum to explore topics you want to know more about or answer some of your questions.

The fact that health care environmental hygiene even gets a column in a prestigious infection prevention magazine attests to the recent changes we have seen in the field in the last 10 years. Yet, these changes feel like they have been long overdue. If you walk down the street and ask the first person you meet whether they think it is essential that hospitals are cleaned well to protect patients, their answer is almost always a resounding “yes.”

However, medical professionals and hospital administrators sometimes give different answers. The reason for this difference is that although there is long-standing biological plausibility about the importance of the health care environment to patient safety, the literature lagged decades behind. The main reason was that most people doing important research in infection prevention weren't as interested in the health care environment as in other subjects.

Reasons for this lack of interest are also multiple and couched in their socio-cultural contexts. We often hear environmental services (EVS) referred to as “housekeeping” services, and many health care facilities don't view those who clean as medical professionals. Traditionally, cleaning health care facilities were often managed in the same way as cleaning a hotel. It was considered “women’s work” and treated as an entry-level job for relatively uneducated, often immigrant populations who were willing to work long, hard hours with dangerous chemicals and alongside infectious people for low wages. The EVS workforce in much of the world remains predominantly female and often has a low level of education.

Thankfully, some pioneers in the field fought to get environmental hygiene recognized as a key domain in IPC. I want to dedicate this first column to Professor Stephanie Dancer, MD, MBBS, MSc, BSc, FRCPath, DTMH, FRCP(Ed), who is a consultant microbiologist in National Health Service Lanarkshire and Professor of Microbiology at Edinburgh Napier University, Scotland, who refers to health care environmental hygiene (HEH) as the “Cinderella of infection control” and whose work laid the foundations for many of the recent advances in the field. Only through the work of people like Dancer and her peers could HEH finally get an actual “seat at the table” in infection control and prevention.

Over the last 10 years, the literature has finally been able to show not only that the health care environment is a key factor in the transmission of pathogens but also that improvements in the health care environment can reduce health care-associated infections. We have seen the recent development of national guidelines and a huge upswing in the amount of research in the field (partly helped by COVID-19, of course, but not only).

So now the real work begins: HEH programs need to be analyzed globally, tools for improvement need to be developed and implemented, and facilities need to understand the value of investing in a field that traditionally was one of the first places they would cut budgets. Globally, of course, it is still early days: Quality is generally low, and there is virtually everything left to do. Although, in some ways, that is intimidating, it also means that every effort we make will likely have a measurable impact. Measuring improvement is much more complicated when the level of quality in a field is already quite high. This means that whatever you can do in your facilities, even on a ward level, will positively impact staff and patients.

If HEH is the “Cinderella of infection control,” then Professor Dancer is certainly its fairy godmother, and it’s time to go to the ball. If you want an excellent overview of the history of the field, then you can read her synopsis “Hospital Cleaning: Past, Present, and Future” here.

I look forward to going on this journey with ICT’s readers and am excited to be part of a field whose time has come.

Feel free to email me at Alexandra.peters@unige.ch.