Decontamination of environmental surfaces in hospitals to reduce hospital-acquired infections: a systematic review.

BACKGROUND

The impact of hospital surface decontamination on hospital-acquired infections (HAIs) remains uncertain. We assessed the effects of hospital surface decontamination, through cleaning, disinfection, or both, on patient-centred outcomes.

METHODS

A systematic review of randomised controlled trials (RCTs) and quasi-RCTs was conducted following Cochrane/GRADE methods. Meta-analysis was not feasible because of few studies.

RESULTS

We included 11 RCTs conducted between 2007 and 2017 in high-income countries. Seven had financial conflicts. At most one RCT provided data per review outcome. Certainty of evidence was very low across all comparisons: quaternary ammonium compound (QAC) versus detergent on HAIs (incidence rate ratio [IRR]: 0.95, 95% confidence interval [CI]: 0.69-1.31); probiotic versus detergent on HAIs (IRR 0.96, 95% CI: 0.69-1.32); phenolic versus detergent on HAIs (relative risk [RR]: 1.13, 95% CI: 0.57-2.24); QAC versus probiotic on HAIs (IRR: 1.00, 95% CI: 0.72-1.39); increased high-touch surface disinfection frequency on methicillin-resistant Staphylococcus aureus colonisation (odds ratio [OR]: 0.98, 95% CI: 0.58-1.66); ultraviolet light on colonisations by vancomycin-resistant enterococci (IRR: 1.00, 95% CI: 0.79-1.25) or Clostridioides difficile (IRR: 1.58, 95% CI: 0.97-2.58), or HAIs (IRR: 1.10, 95% CI: 0.48-2.51); copper surfaces on HAIs (RR: 0.64, 95% CI: 0.36-1.14), bloodstream infections (RR: 0.30, 95% CI: 0.08-1.05), or all-cause mortality (RR: 0.91, 95% CI: 0.63-1.33).

CONCLUSION

Evidence from RCTs on hospital surface decontamination and patient outcomes remains uncertain. These inconclusive findings on cleaning or disinfection do not indicate evidence of no effect but highlight the need for new RCTs.