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

This is the authors' abstract. We don't add key points for this paper.

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. Systematic review of randomised controlled trials (RCTs) and quasi-RCTs following Cochrane/GRADE methods. Meta-analysis was not feasible due to few studies. 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). 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. • The benefits and harms of hospital environmental decontamination remain uncertain. • These inconclusive findings should not be taken as evidence of no effect. • Well-designed randomized trials of cleaning and disinfection strategies are needed. • Future trials should measure patient-relevant outcomes, including safety. • Robust non-randomised studies can complement the randomised evidence base.