Best Practices for Environmental Cleaning in Global Healthcare Facilities with Limited Resources

The materials on this page were created for use in global healthcare facilities with limited resources, particularly in low- and middle-income countries. Environmental cleaning resources designed for U.S. healthcare facilities can be found at Healthcare Environment Infection Prevention.

  1. Allegranzi B, Begheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, Pittet D. 2011. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. The Lancet; 377:9761.
  2. Weber DJ, Rutala WA, Miller MB, et al. 2010. Role of hospital surfaces in the transmission of emerging healthcare-associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species. Am J Infect Control 38:S25–S33.
  3. Otter JA, Yezlli S, Salkeld J, French G. 2013. Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings. American Journal of Infection Control; 41: S6-S11.
  4. Huang SS, Datta R, Platt R. 2006. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Archs Intern Med; 166:1945-1951.
  5. Drees M, Snydman DR, Schmid CH, et al. 2008. Prior environmental contamination increases the risk of acquisition of vancomycin-resistant enterococci. Clin Infect Dis; 46:678-685.
  6. Nseir S, Blazejewski C, Lubret R, Wallet F, Courcol R, Durocher A. 2011. Risk of acquiring multidrug-resistant Gram-negative bacilli from prior room occupants in the intensive care unit. Clin Microbiol Infect; 17:1201-1208.
  7. Datta R, Platt R, Yokoe DS, Huang SS. 2011. Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants. Archs Intern Med; 171:491-494.
  8. Shaughnessy MK, Micielli RL, DePestel DD, et al. 2011. Evaluation of hospital room assignment and acquisition of Clostridium difficile Infect Control Hosp Epidemiol; 32:201-206.
  9. Ajao AO, Johnson K, Harris AD, et al. 2013. Risk of acquiring extended spectrum b-lactamase-producing Klebsiella species and Escherichia coli from prior room occupants in the intensive care unit. Infect Control Hosp Epidemiol; 34:453-458.
  10. Mitchell BG, Digney W, Ferguson JK. 2014. Prior room occupancy increases risk of methicillin-resistant Staphylococcus aureus acquisition. Healthcare Infect; 19:135-140.
  11. Kramer A, Schwebke I, Kampf G. 2006. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis; 6:130.
  12. Dancer SJ. 2014. Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination. Clin Microbiol Rev; 27:665-690.
  13. Falk PS, Winnike J, Woodmansee C, Desai M, Mayhall CG. 2000. Outbreak of vancomycin-resistant enterococci in a burn unit. Infect Control Hosp Epidemiol 21:575-82.
  14. Rampling A, Wiseman S, Davis L, Hyett AP, Walbridge AN, Payne GC, et al. 2001. Evidence that hospital hygiene is important in the control of methicillin-resistant Staphylococcus aureus. J Hosp Infect 49:109-16.
  15. Wilcox M., Fawley W., Wigglesworth N., Parnell P., Verity P., Freeman J. (2003) Comparison of the effect of detergent versus hypochlorite cleaning on environmental contamination and incidence of Clostridium difficile J Hosp Infect 54: 109–114.
  16. Denton M, Wilcox MH, Parnell P, Green D, Keer V, Hawkey PM, et al. 2004. Role of environmental cleaning in controlling an outbreak of Acinetobacter baumannii on a neurosurgical intensive care unit. J Hosp Infect 56:106-10.
  17. Hayden MK, Bonten MJ, Blom DW, Lyle EA, van de Vijver DA, Weinstein RA. 2006. Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis 42:1552-60.
  18. McMullen K., Zack J., Coopersmith C., Kollef M., Dubberke E., Warren D. (2007) Use of hypochlorite solution to decrease rates of Clostridium difficile-associated diarrhea. Infect Control Hosp Epidemiol 28: 205–207.
  19. Dancer SJ, White LF, Lamb J, Girvan EK, Robertson C. 2009. Measuring the effect of enhanced cleaning in a UK hospital: a prospective cross-over study. BMC Med 7:28.
  20. Wilson AP, Smyth D, Moore G, Singleton J, Jackson R, Gant V, et al. 2011. The impact of enhanced cleaning within the intensive care unit on contamination of the near-patient environment with hospital pathogens: a randomized crossover study in critical care units in two hospitals. Crit Care Med 39:651-8.
  21. Grabsch EA, Mahony AA, Cameron DR, Martin RD, Heland M, Davey P, et al. 2012. Significant reduction in vancomycin-resistant Enterococcus colonization and bacteraemia after introduction of a bleach-based cleaning-disinfection programme. J Hosp Infect 82:234-42.
  22. Mitchell BG, Hall L, White N, Barnett AG, Halton K, Paterson DL, Riley TV, Gardner A, Page K, Farrington A, Gericke CA, Graves N. 2019. An environmental cleaning bundle and health-care-associated infections in hospitals (REACH): a multicenter, randomized trial. The Lancet Infectious Diseases.
  23. WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP), 2019. WASH in Health Care Facilities: Global Baseline Report 2019. WHO:Geneva.
  24. Rutala WA, Weber DJ. 2016. Monitoring and improving the effectiveness of surface cleaning and disinfection. American Journal of Infection Control 44: e69-e76