Impact of sanitizer-based disinfection of hospital environment and medical devices on clinical or microbiological outcomes: a systematic literature review.

Introduction: The health environment is an important reservoir for a multitude of microorganisms. Contact with environment surfaces contaminated with multidrugresistant organisms (MDROs) may be associated with healthcare-associated infections and higher hospital costs, morbidity, and mortality.(1) Objective: To perform a systematic review of clinical and microbiological outcomes associated with interventions based on use of sanitizers in hospital environment surfaces or medical devices. Methods: Published studies were identified through electronic literature search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and SCOPUS by three independent reviewers. All interventions based on use of sanitizers (in isolation or combined with other methods) and targeting the hospital environment or medical devices were included. No restrictions regarding patients and microorganisms were imposed. Bench studies, studies involving surface contamination with MDROs and animal studies were excluded. The quality of randomized controlled trials (RCTs) and non-randomized trials was assessed using the Cochrane Collaboration's tool and the Newcastle-Ottawa scale, respectively. Results: A total of 8,984 studies involving sanitizer interventions targeting the healthcare environment or medical devices were found. Of these, 26 were included in this review (Figure 1). Intervention effectiveness varied between studies. The five randomized studies which met the inclusion criteria involved the use of different sanitizers in disinfection: isopropyl alcohol swab, sodium hypochlorite (bleach), benzalkonium chloride swabs, quaternary ammonium disinfectant and UV-C light, bleach, and UV-C light, organosilane, hydrogen peroxide and silver vapor, and 65% ethyl alcohol. Environmental studies comprised two multicenter randomized trials and one single center randomized trial. All these studies assessed microbiological outcomes and only 6 included clinical outcomes. Studies focusing on medical device disinfection consisted of single center randomized trials and assessed microbiological outcomes. Selected studies involved the use of different chemical or physical-chemical cleaning and disinfection methods. Significant variation in cleaning and disinfection strategies in these settings reflect of lack of consensus on management of hospital rooms, medical devices and patients infected with MDROs. Conclusion: The efficacy of sanitizers was consistent across studies included in this systematic review. However, few RCTs were found, and most were limited to microbiological outcomes. More studies are urgently needed to evaluate the impact of environmental interventions on clinical outcomes. [ABSTRACT FROM AUTHOR]