Environmental Disinfection in Long-Term Care Facilities-A Scoping Review.

Background

Long-term care facility (LTCF) residents are highly susceptible to healthcare-associated infections, and prevention is challenging given frailty, dementia, communal living, and resource constraints. Environmental surface and air contamination contribute to transmission. Novel no-touch automated disinfection technologies have been studied in hospitals, but evidence specific to LTCFs is scarce. This scoping review summarizes recent LTCF-focused interventions, their effectiveness, and implementation considerations.

Methods

This scoping review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. We searched PubMed, Medline, Embase, CINAHL, and Scopus for observational or experimental studies evaluating environmental disinfection in LTCFs/nursing homes, excluding body decolonization, non-LTCF settings, and reviews/protocols. Two reviewers independently screened and extracted data via Covidence. This review has been registered on OSF (Open Science Framework).

Results

Of 1491 records, 7 studies met the inclusion criteria (6 from the USA, 1 from Australia): one cluster randomized trial, one interrupted time series studies, three prospective observational studies, and two pre-post designs. Interventions included physical methods (HVAC-integrated UV/UVGI, continuous UVGI) and chemical approaches (dry hydrogen peroxide, room fogging plus chlorine dioxide wipes, hydrogen peroxide wipes). Outcomes were heterogeneous (surface SARS-CoV-2 RNA, COVID-19 attack/case rates, airborne/surface microbial loads, and one clinical endpoint-acute respiratory illness). Several studies reported reductions in environmental or airborne bioburden; however, UV-based studies did not demonstrate statistically significant reductions in clinical infections. Certainty was limited by small numbers, non-randomized designs, and diverse outcome measures.

Conclusions

No-touch automated disinfection methods appear promising as supplements to standard infection prevention control bundles for reducing environmental contamination in LTCFs. Nevertheless, consistent clinical benefits are unproven. Rigorous, LTCF-tailored, adequately powered trials with standardized clinical and environmental outcomes, plus implementation and cost-effectiveness evaluations, are needed.