Improperly disinfected surfaces in healthcare settings remain a major contributor to healthcare-associated infections (HAIs). Despite guidance from training, backed by extensive scientific data detailing which disinfectants eliminate harmful pathogens, surface contamination continues to challenge infection prevention efforts. Disinfecting a surface effectively is far more complex than it appears. Multiple clinical studies and forums have revealed best practices in the selection and use of disinfectants to eliminate pathogens successfully, including the SARS-CoV-2 coronavirus, from surfaces. Successful disinfection begins with understanding surface disinfection compatibility. Incompatibility causes damage The simplest definition of surface disinfection compatibility refers to whether a particular disinfectant can be safely and effectively used on a specific surface material. Many disinfectants degrade or damage common healthcare surfaces. Over time, this damage creates microscopic cracks, pits, and fissures that form microbial reservoirs where microbes can hide and multiply, safe from the biocides used to destroy them. When disinfectants compromise a surface, they unintentionally create environments that protect microorganisms instead of eliminating them. Microscopic damage allows pathogens to attach, grow, and transfer to other surfaces, patients, and healthcare workers. The systemic gaps at play Although surface damage begins on a microscopic level, its consequences increase quickly. The healthcare industry currently faces several systemic gaps that make managing surface disinfection compatibility difficult: Lack of mandatory testing standards. Regulations that require surface materials or products to be tested for compatibility with disinfectants prior to use in healthcare are nonexistent. Lack of standardized cleaning or disinfection guidelines. Without benchmarks, it’s nearly impossible to validate whether surfaces can withstand repeated exposure to hospital-grade disinfectants. While all healthcare facilities provide cleaning and disinfection guidelines in infection prevention protocols, these guidelines often conflict with manufacturer instruction for use (IFUs) or directions for use (DFUs). Inconsistent manufacturer (IFUs/DFUs). Care and maintenance guidelines are often written for nonclinical environments and fail to reflect the realities of healthcare use. Design-phase disconnects. Healthcare facilities are not built for cleaning and disinfection. Facility leaders routinely select surfaces and products for healthcare environments without considering the manufacturer instructions for use or without thoroughly reviewing the testing, validation, and compatibility data. These gaps not only make it difficult to ensure that surfaces remain both cleanable and safe over time, they create problems with serious financial and clinical consequences. Study examines real-world impacts A recent case study co-published by the Health Surfaces Institute (HSI), a division of ISSA, and the Association of Healthcare Value Analysis Professionals found a link between disinfectants and surface damage. A large Midwestern hospital discovered that the bleach-based disinfectant outlined in its infection prevention and control protocol was damaging a commonly used medical device. The disinfectant was incompatible with the device manufacturer’s validated cleaning instructions leaving no compliant option for disinfection. As a result, the hospital incurred more than US$4 million in repair and replacement costs within two years of purchasing the medical device, and the device manufacturer incurred $140,000 in testing and replacement costs. Additionally, regulatory agencies fine healthcare facilities if they don’t follow IFUs/DFUs, and these fines can be substantial. Beyond the financial burden, the situation posed ongoing patient safety risks due to repeated use of damaged medical devices. Moving toward a solution ISSA Healthcare and the HSI are addressing surface disinfection compatibility challenges head-on. ISSA Healthcare’s testing and validation task force has developed a patented test method for validating surface disinfection compatibility for plastics, which will be implemented into a testing program currently under development. This program will set new benchmarks for validating surface disinfection compatibility—helping facility managers, designers, and manufacturers make informed decisions to ensure cleanability before purchasing healthcare materials and products, thus reducing infection risks for patients and staff. Stay Informed To follow updates and learn more as certification programs launch, sign up for the Healthcare Surfaces Institute’s newsletter at issa.com/healthcare.
Although you cannot see biofilm, its presence affects the cleaning and disinfection of healthcare environments. On a microscope slide, biofilm looks like a dense, slimy community of microbes glued together. On real-world surfaces, it is an invisible barrier that can protect pathogens from the very products intended to remove them. Understanding how biofilm forms, and how modern healthcare surfaces help it persist, is essential to maintaining clean, safe healthcare environments. How biofilm forms Most microbes in nature do not live as free-floating single cells. They prefer to attach to surfaces and form structured communities encased in a self-produced matrix of extracellular polymeric substances (EPS)—a mix of polysaccharides, proteins, lipids, and extracellular DNA. The process typically starts when planktonic (free) cells encounter a surface. The cells’ primary attachment to the surface is weak and reversible, but as they produce adhesins and begin to secrete matrix material, the attachment becomes stronger and irreversible. Once attached to a surface, the microbes multiply and organize into microcolonies. These colonies grow into mature, three-dimensional biofilms with channels that allow nutrients and waste to move through the structure. Within this matrix, cells change their gene expression, slow their growth rate, and coordinate behavior through quorum sensing. The final biofilm stage is dispersion: Some cells escape the matrix and return to a free-floating state, ready to colonize new surfaces. This continual cycle is one reason environmental contamination can reappear even after cleaning. Why biofilm resists cleaning From a microbiology perspective, biofilm’s highly effective survival strategy has major implications for the cleaning and disinfection of healthcare surfaces. Surface-attached cells and biofilms are significantly less susceptible to biocides, antibiotics, and physical stress (scrubbing) than their free-floating counterparts. The EPS matrix acts like a physical and chemical shield, slowing the penetration of disinfectants and binding or neutralizing the active ingredients before they reach cells deep in the biofilm. The organisms inside a biofilm are physiologically different than single microbes. Many grow more slowly and may enter a stress-tolerant state that protects them from agents that target rapidly dividing cells. On top of that, biofilms on environmental surfaces are often mixed communities. Different species can protect one another, share resistance genes, and create microenvironments that further reduce the impact of cleaning and disinfectant products. The result is a surface that looks visually clean yet still harbors a well-established biofilm that survives routine cleaning and disinfection cycles. In this state, vegetative bacteria can persist for weeks or months on hospital surfaces and may not be evenly recovered during environmental sampling. Biofilm on dry surfaces Biofilm is often associated with wet environments—drains, tubing, and indwelling devices—but research published in the Journal of Hospital Infection found that biofilms can also form on dry hospital surfaces. Microbes can survive in a desiccated state in dust, organic residues, and microenvironments on surfaces, then use intermittent moisture from cleaning processes, spills, or human touch to grow and rebuild their matrix. Healthcare surfaces can unintentionally support attachment and biofilm formation. Many common materials have microscopic scratches, pores, or seams that create protected niches where moisture and soil accumulate, protected from disinfectants. Surface energy, texture, and chemistry can increase microbial adhesion, especially when combined with the organic load (body fluids, skin cells, product residues) that inevitably build up in clinical environments. Repeated cleaning with detergents that remove loose soil, but do not disrupt the biofilm matrix, can leave a “conditioned” surface behind—a thin layer of organic material that improves microbial attachment the next time organisms land there. Over time, these conditioned surfaces can enable dry-surface biofilms to become a persistent source of contamination in patient rooms and on high-touch areas and equipment surfaces. Rethinking clean Knowledge of biofilm on healthcare surfaces changes the basic question from “Did we wipe the surface?” to “Did we disrupt and remove the attached community?” Traditional testing methods and product claims based on planktonic microbes do not always reflect real-world performance against surface-attached cells and biofilms. Effective cleaning strategies must consider: Surface design and material selection that reduce microbial attachment and make biofilm formation more difficult. Cleaning chemistries and tools validated for their ability to break up biofilm matrix, not just kill free-floating organisms. Procedures that emphasize mechanical action, correct contact time, and routine disruption of high-risk biofilm reservoirs (for example, around sink areas, bed rails, and shared equipment). Biofilm may be invisible, but its impact on environmental hygiene and patient safety is very real. By understanding how microbes attach, organize, and protect themselves on surfaces, healthcare leaders can better evaluate disinfectants, redesign cleaning processes, and work with environmental services teams to move beyond “looks clean” to environments that are truly clean at the microscopic level. Learn More at the ISSA Show Join the Healthcare Surfaces Institute at ISSA Show North America for the panel discussion, Biofilm: Beyond Disinfection—Breaking Through the Protective Matrix in the Healthcare Environment, on Monday, Nov. 16, 11:30 a.m. to 12:30 p.m., featuring Darrel Hicks and Nancy Schlossberg.
One in 43 long-term care (LTC) residents acquires a healthcare-associated infection, according to the Centers for Disease Control and Prevention. This risk makes cleaning LTC facilities a distinct challenge. “It’s a combination of healthcare, hospitality, and interactive residential cleaning,” explained Gosia Baran, president and owner of Elmhurst, Illinois-based Helping Hands Cleaning Services. “Since LTC residents are elderly, we must focus on their health. Quality must be raised because residents with compromised immune systems are vulnerable to diseases that may spread there.” Susceptible residents LTC facilities, unlike schools or offices, are never empty. “We must be very careful when we clean, how we clean, and who is around,” said Dominika Wandachowicz, Helping Hands Cleaning Services’ business development manager. For example, a vacuum cord could pose a hazard for residents in wheelchairs or who are unsteady on their feet. Team members may need to wear face masks in rooms housing residents with low immunity or use specific cleaning solutions around those who cannot tolerate fragrances. Jef Gordon, 4M Building Solutions regional vice president–operations, serves the Northeast, which is 4M’s highest-concentration area for long-term healthcare clients. He agrees that older adults with weakened immune systems are far more susceptible to infection, which means cleaning for health—not just appearance—must be the standard. “All-purpose products and general protocols don’t cut it in long-term care settings,” Gordon explained. “The chemicals, disinfectants, and procedures all need to be matched to a healthcare-level threat environment.” Additionally, teams must be trained to recognize at-risk residents, such as individuals with memory loss or Alzheimer’s, for example, and to handle unexpected situations, such as incontinence, with both skill and sensitivity. “Cleaning staff in these facilities are often in more daily contact with residents than doctors or nurses,” Gordon said. “That level of access carries real responsibility.” Facility complications Stratus Clean also recognizes that LTC facilities face unique challenges in maintenance and cleanliness. For example, the Occupational Safety and Health Administration (OSHA) requires LTC facilities to have an up-to-date written Infection Prevention & Control Program (IPCP) and a bloodborne pathogens (BBP) exposure control plan. LTC facilities also face budget challenges in maintaining the cleanliness required to ensure compliance with the IPCP and BBP plan. “While creating the plan is easy, execution and regular monitoring of the plan is more difficult,” explained Doug Flaig, Stratus Clean CEO. “This is especially true if the staff is doing the cleaning and there is a high rate of employee turnover.” Gordon finds that government reimbursement structures in many facilities create constant budget pressure. Furthermore, as operating expenses rise, reimbursements rarely keep pace. “These facilities are also among the most heavily regulated environments we work in, with requirements at both the state and federal levels that don’t exist in commercial settings,” he explained. Specific LTC facility requirements can include: Extensive background checks, including tuberculosis testing and vaccination requirements. State-mandated annual training. Rhode Island and Massachusetts, for example, require specific programs covering dementia care and resident-abuse prevention. Annual state survey audits conducted by the local department of health. These unannounced inspections are carried out by healthcare professionals, including registered nurses and social workers. “The result can affect a facility’s ability to take on new residents, so it places pressure on every department, housekeeping included,” Gordon said. Residential living also creates challenges, including an inability to move residents’ furniture for deeper cleaning, cluttered or decorated environments, and resident interference with cleaning staff. As LTC residents can wander throughout the facility, an ill patient can quickly spread illness. Residents can also resist hygiene practices, putting their peers at risk. These conditions necessitate frequent maintenance and disinfection of shared spaces to prevent the spread of pathogens. The most problematic areas are high-touch surfaces, such as doors, light switches, railings, elevator buttons, common area surfaces, therapy devices, chairs and other furniture, and TV remotes. Memory care areas require an even higher level of support and sanitation due to residents not remembering events, for example, if they vomited during the day in their room or had a bodily fluid accident in the shower. An overlooked area for infection is the common kitchen and dining areas. “Ensuring tables are cleaned between resident usage and following the seven principles of the Hazard Analysis and Critical Control Points plan will help ensure that the food cycle is not a risk to residents and staff,” Flaig said. With residents frequently spilling liquids and dropping other items, cleaning teams must also constantly monitor floors to avoid slip-and-fall accidents, Baran added. Established protocols 4M Building Solutions starts addressing these challenge areas before cleaning a single room. The building service contractor’s (BSC) transition process includes structured meetings with leadership at every level to establish expectations from day one. Facilities typically see measurable change, including: Standard operating procedures that are documented and followed. Posted work and training schedules. Daily oversight from a dedicated on-site manager. Weekly drop-ins from a regional manager auditing the work. “We maintain accountability through district manager oversight and regular safety audits,” Gordon said. “We also ask clients directly what frequency and level of service they’re looking for, including reporting. Expectations are very reasonable; people just want to know someone is paying attention.” Stratus Clean also addresses the challenges through a strong partnership program with the LTC facility team or primary BSC provider. The BSC builds customizable solutions, including: Porter services to monitor and clean high touch surfaces daily while residents are awake. Alignment with the IPCP and BBP exposure control plan to track and monitor compliance. Advanced communication of regularly scheduled cleaning plans to ensure deep cleaning of resident rooms with the residents’ compliance. Regular inspections of the facility by local management to ensure compliance with the scope of work and sanitation requirements. Training teams that look beyond cleaning to identify other issues that could pose risks. For example, a resident who has many products or extension cords plugged into a single outlet in their room, which could result in an electrical short. Helping Hands Cleaning Service ensures teams follow established protocols through frequent supervision. Additionally, day and
This summer’s World Cup will host millions of visitors across 16 cities in the U.S., Mexico, and Canada for 104 soccer matches. From June 11 to July 19, FIFA projects 6 million in-person attendees, with each host city welcoming approximately 450,000 visitors. Take a moment to consider the sheer magnitude of the cleaning tasks required by this sporting event. Soccer fans attending the competition venues will certainly notice if spaces are clean. But the challenge goes beyond sports arenas. Built environments in the 16 host cities will be at maximum capacity. Jammed airports, train stations, and transportation hubs will welcome visitors from around the world. Bustling hotels and restaurants will attend to the visitors’ comfort. Fans will fill the stadiums, hungry and thirsty, expecting a thrilling game. These fans will probably not be thinking about locker room cleanliness. However, the manufacturers, distributors, and professional cleaners that comprise the Making Safer Choices Community of Practice—led by ISSA, Penn State College of Medicine, and the City of New York School of Medicine—encourage facility service providers to pause and think about the locker rooms, the space where elite athletes last huddle before competitions. The environmental conditions of these spaces will impact athletes’ health and, ultimately, the games. A locker room’s environmental conditions are influenced by a myriad of factors, from the room’s structure and layout and the activities performed there to the cleaning products chosen and practices utilized to clean it. Proper locker room cleaning and disinfection can help protect soccer players from illnesses, skin conditions, and indoor air contaminants that will affect their performance. Team norovirus penalties An estimated 2,500 norovirus outbreaks occur in the U.S. each year, according to the Centers for Disease Control and Prevention. Infected people shed high viral loads, and crowded conditions encountered in sports competitions foster outbreaks. Norovirus outbreaks can lead to vomiting, diarrhea, and dehydration severe enough to prevent athletic competition, as happened during the 2026 Milan Cortina Winter Olympics. Norovirus rapidly spreads through direct, person-to-person contact and through contact with contaminated surfaces, such as gym equipment. Thorough hand washing with soap is effective in removing the germs, but the virus is resistant to alcohol-based hand sanitizers. Yellow card skin concern Skin injuries, typically abrasions, are common in soccer, with the risk of injuries dependent on factors such as a player’s position and the playing turf. A systematic review published in the Orthopaedic Journal of Sports Medicine revealed 0.8 to 6.1 injuries per 1,000 player hours, potentially resulting in time lost from participation and a need for medical attention. Athletes are also at risk of heat-related rashes due to inflammation, pressure, and friction. When creased skin becomes inflamed, blisters can form and break, resulting in a skin barrier breakdown that increases the risk of secondary infection. Secondary infections occur when microbes infect already-damaged skin. Microbial skin infections are a major concern in contact sports and can be spread by contact in locker rooms, on buses and benches, and during practice and competition, according to a study on athlete skin conditions published in The American Journal of Sports Medicine. Examples of these infections include bacterial infectious rashes, cellulitis, folliculitis, abscesses, cutaneous fungal infections (tinea), and herpes simplex. This risk of secondary infections demands a rigorous sanitation of locker rooms. However, exposure to harsh volatile organic compounds (VOCs) found in some cleaning and disinfecting products can trigger respiratory irritation and asthma. To protect breathing zones, cleaning crews should avoid using spray products. Asthma fouls According to numerous studies, asthma is a chronic health condition common among elite athletes. Research published in the journal Allergy found that 8.3% of U.S. Olympians between 2002 to 2010 had asthma but still competed at the highest levels. A 12-year survey of 659 Italian Olympic athletes published in Current Opinion in Allergy and Clinical Immunology revealed a 14.7% prevalence of asthma and 49% sensitization to inhalant allergens. An examination of 1,375 athletes before the 2022 Beijing Olympic Games, published in Frontiers in Allergy, found an asthma prevalence of 16.5%. Asthma management guidelines emphasize the importance of identifying and avoiding asthma triggers. Indoor triggers include cleaning products encountered as aerosol mists and fumes or as gas vapors. Poor indoor air quality affects athletes in all sports. A study of NFL quarterbacks and MLB pitchers, published in the International Journal of Environmental Research and Public Health, linked environmental particulate air pollution with athletic performance, specifically on errors made by pitchers, interceptions thrown by quarterbacks, and overall quarterback performance when competing in areas with poor air quality. To lower the risk of athletes encountering asthma triggers and air pollution in locker rooms and stadiums, housekeeping teams can choose cleaning products that meet the Environmental Protection Agency’s Safer Choice Label requirements. Visit epa.gov/saferchoice for a list. Score a healthy hat trick Teams come to the World Cup to win. Fans come to watch epic contests. Although crowds are part of the event’s magic, large groups can increase the spread of germs, leaving athletes vulnerable. Appropriate facility management protocols that prioritize cleaning and disinfection with nontoxic products will be central to U.S. hospitality during this year’s World Cup. Cleaning professionals focused on techniques that help prevent infectious disease outbreaks and other health issues deserve a trophy for keeping everyone’s focus on the games.
What has the cleaning industry learned as it transitioned from the first pandemic year to the second? In this episode of BioTalk, a GBACtv production, learn the details about what went well and what didn't in 2021, and what we as an industry need to know right now. Infection prevention experts Patty Olinger, the executive director of the Global Biorisk Advisory Council (GBAC), a division of ISSA, and Dr. Paul Meechan, the former head of safety with the U.S. Centers for Disease Control and Prevention (CDC) and who now serves on the GBAC scientific advisory board, discuss these topics with ISSA Media Director Jeff Cross. This webcast also digs into the science and the layered support when it comes to cleaning, disinfection, and air purification, and how the omicron variant shouldn’t be considered just another type of “cold”. Olinger and Meechan also discuss the possibility of the end of the pandemic. This webcast is brought to you by our sponsor Breezy.
Nearly half (47%) of U.S. employees said their organization has integrated artificial intelligence (AI) tools to improve productivity, efficiency, or quality, up from 41% in the first quarter, Gallup reported. Individual AI use at work also has grown steadily this year. More than half of U.S. workers (52%) now use AI in their role, with 30% using it frequently (a few times a week or more) and 15% utilizing it daily. Among AI users, the most common uses of AI are writing and editing (51%), search or research (49%), and general assistance or problem-solving (39%). Gallup found AI’s most common workplace role remains knowledge support: helping employees draft, revise, find information, and work through general questions or problems. However, AI is only used for data science or analytics by 18% and presentation or slide deck creation by 17%. Still 68% of employees who use AI for writing and editing said it has improved their productivity. Gallup found the broader pattern seen in the study is that employees using AI at work most often begin with writing or research applications, while more technical or task-specific applications are associated with the strongest productivity ratings. Among employees using AI for one or two purposes, 45% reported it has had a somewhat or extremely positive impact on their productivity. That grows to 66% among those using it for three or four reasons, to 78% among those using it for five or six purposes, and to 90% among those using it for seven or more purposes. Gallup believes organizations may get more out of AI when employees are supported in applying it across a wider range of job-relevant tasks, rather than treating it only as a general-purpose writing or search tool.
Wildfires are now the leading source of unhealthy levels of air pollution for pregnant women in the U.S., Reuters reported. Researchers also reported in Frontiers in Environmental Health that wildfire smoke is linked with adverse birth outcomes. They studied about 64.5 million pregnancies in 48 states from 2003 to 2019, analyzing neighborhood exposure to tiny airborne particles 2.5 micrometers or less in diameter that travel deep into the lungs and bloodstream. Major sources of PM2.5 pollution include vehicle exhaust, industrial emissions, and wildfires. Prenatal exposure to PM2.5 declined substantially between 2003 and 2019, but wildfire smoke's contribution more than doubled from about 3.7% to 8.2%. By 2019, wildfire smoke was the main contributor to high-pollution days during U.S. pregnancies. That year, about two-thirds of "exceedance days"—when PM2.5 pollution exceeded 35 micrograms per cubic meter—were due to wildfire air pollution. The burden also falls disproportionately on low-income, rural, and Indigenous communities. Researchers said healthcare providers in fire-prone regions should include wildfire risk assessment and education in prenatal care, focusing on communities with limited perinatal healthcare infrastructure. Enhanced air quality monitoring, early warning systems, and the distribution of climate adaptation technologies like air filters, masks, and clean air shelters may help reduce wildfire-related PM2.5 burdens.
When property damage occurs, many facility managers and business owners immediately ask the same question: Should I file an insurance claim? They're asking the wrong first question. Before making financial or insurance-related decisions, property owners should first understand the full extent of the damage with a professional assessment. Early assessment and immediate mitigation help protect not only the property and its contents, but also the property owner's long-term financial interests. Visible damage is often only part of the story. Water may spread behind walls and beneath flooring, smoke and soot can penetrate hidden areas, and mold can develop in spaces property owners cannot readily see. Without a professional assessment, homeowners and businesses may underestimate the extent of damage, delay necessary mitigation efforts, or make financial decisions based on incomplete information. PuroClean advised facility managers and business owners to follow a clear sequence after discovering property damage: Stabilize the situation: When it is safe to do so, stop the source of the damage and protect the property from further loss. This may include shutting off the water supply, contacting emergency services, or moving valuable belongings out of the affected area. Obtain a professional property assessment: Have a reputable restoration company evaluate the property to determine the full extent of the damage, including issues that may not be visible, such as hidden moisture, smoke residue, or conditions that could lead to mold growth. A thorough assessment provides the information needed to make informed recovery decisions. Understand your options: Review the assessment findings, including the scope of damage, estimated restoration costs, and restoration recommendations, as compared to your personal insurance coverage. Make an informed decision: Determine whether filing an insurance claim or self-paying is the most appropriate solution for your situation. Every loss is different, and every insurance policy is different. The best decision should be based on the scope of the damage, your policy, and your long-term financial interests. Restoration and insurance are complementary parts of the recovery process. A professional assessment helps establish the true extent of the damage, while insurance helps determine how that loss may be handled under the policy. "The goal isn't to encourage or discourage filing an insurance claim," said Nick Hindle, PuroClean chief information officer. "It's to ensure everyone starts with the same understanding of the damage. A professional assessment establishes the facts early, creating a stronger foundation for property owners, restoration professionals, and insurance partners to work together toward the best possible outcome."
Individuals with disabilities and their caregivers will have access to safe, accessible facilities under a new Illinois law. House Bill 4379 will expand Illinois’ Equitable Restrooms Act by requiring certain newly constructed public buildings and state-owned facilities to provide access to adult changing stations. Adult changing stations provide a safe, sanitary space for caregivers assisting older children and adults with disabilities who require personal care support. House Bill 4379 was signed into law on Aug. 7 and is effective Jan. 1, 2027. Under the law, qualifying public buildings constructed on or after Jan. 1, 2029 will be required to provide access to at least one adult changing station. The law also establishes accessibility, maintenance, and signage standards, incorporates Americans with Disabilities Act requirements, and expands coverage to include certain state-owned facilities. “Many families find themselves without appropriate facilities in public spaces and are forced to cut outings short or skip them altogether,” said State Senator Lakesia Collins (Democrat-Chicago). “With this law we can give those families the facilities needed to live in our communities and participate without additional stress of wondering whether facilities are available.”