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.
During the past five years, the janitorial services industry has expanded amid intense competitive pressure and shifting customer expectations, IBISWorld’s Janitorial Services in the U.S. report found. A surge of new entrants rushed in to capture post-pandemic demand, driving establishment growth faster than revenue and leaving providers to fight over contracts in a highly fragmented market. Clients, particularly businesses, have pushed hard on pricing and treated cleaning as a cost center even as they requested more frequent or specialized services, tightening the squeeze on providers. At the same time, higher labor costs have limited profit growth as many companies struggle to pass on rising expenses. Revenue has grown at a compound annual growth rate (CAGR) of 2.7% during the past five years and is expected to reach US$112.4 billion in 2026, with revenue rising by an estimated 1.7%. Some individuals have recently entered the janitorial services space to capture new revenue streams driven by heightened concerns about cleanliness among businesses and households. The growing demand has encouraged more individuals and small operators to launch janitorial businesses, even as cleaning budgets have increased modestly. Establishments and enterprises have grown at a steady rate since 2021, markedly faster than revenue growth. While clients want more frequent cleaning, they still negotiate on price and treat janitorial services as a cost to be contained. As of 2026, over 1.2 million janitorial service establishments operate in the U.S. Stringent cleanliness demands and tech innovations are reshaping the janitorial landscape, offering new growth avenues. Janitorial companies are aligning their services with these evolving norms while leveraging internet-connected devices and robotics to enhance efficiency. Additionally, climate concerns and shifts in consumer preferences are accelerating the push for eco-friendly cleaning products. Larger businesses are most likely to invest in green alternatives, while smaller providers may trim nonessential expenses to meet environmental standards and changing customer expectations. Looking ahead, the industry’s trajectory will be shaped by the continued normalization of hybrid work models alongside more consistent in-office attendance. Many companies have steadier building utilization and reinforcing demand for commercial cleaning as employers prioritize visible hygiene and workplace experience. At the same time, hybrid work remains embedded in corporate strategy, leading organizations to optimize and, in some cases, reduce their real estate footprints. Portfolio consolidation, space reconfiguration, and selective office closures continue to influence demand patterns. Janitorial providers benefit from more predictable occupancy in active spaces but must adapt to leaner office portfolios, shifting usage patterns, and a growing emphasis on flexible, demand-responsive service delivery. They stand to benefit from increased activity in occupied spaces but must adjust to variable traffic patterns and greater demand for flexible, usage-based service models. Over the next five years, revenue is forecast to grow at a 2.0% CAGR, reaching $124.1 billion in 2031.
Office space leasing activity established a new post-pandemic high in the second quarter of 2026. The number of leases are up 27% over the trailing 12 months relative to the previous 5-year average, according to JLL. A significant uptick in absorption in the second quarter has driven over 30 million square feet of occupancy gains during the past 12 months. Total vacancy rates are declining aggressively, JLL reported. Availability also has declined rapidly for eight consecutive quarters. Still, the construction pipeline has only marginally increased for two straight quarters, remaining extremely depressed by historical standards. Newer buildings have become exceptionally rare in most markets, driving aggressive rent growth for high-end spaces and a growing share of ultra-high-rent leasing activity. Leasing volume with rent over $100 per square foot has reached record volumes in the past 12 months, and effective rents for new construction are growing over 20% on a rolling 12-month basis. Meanwhile, downtown office vacancy rates have slightly declined in the Chicago area for the first time since 2022, and the suburban vacancy rate has fallen for the first time since 2019, according to Crain's. Suburban Chicago available office space dropped from 33.4% to 33.1%, the first quarterly dip since before the pandemic. The improvement is aided by the redevelopment of office space, The Real Deal reported. Buildings that sat unused with little sign of being filled are actively pivoting into several other functions, bringing total square footage of all suburban office space down to 93.2 million square feet from 100.5 million square feet. Suburban Chicago office inventory and downtown office inventory share a common success: Premiere offices with great amenities and location are the most desired and have the lowest vacancy rates. The flight to quality is forcing Class A landlords to consider adding space to their properties and everyone below it to upgrade considerably if they want to be competitive in the market.
Healthy indoor air quality (IAQ) is crucial to the well-being of your facility’s inhabitants. But inefficient HVAC systems, dusty surfaces and toxic fumes can negatively affect air quality, making breathing difficult and triggering allergy and asthma symptoms. Join CMM on Oct. 21 at 1 p.m. CT for a free webinar— Breathe Easy: Improving Indoor Air Quality—sponsored by Global Industrial and TEAM Software by WorkWave. The webinar’s panel of air quality experts will help you move beyond guesswork and focus on practical, data-driven approaches to improving IAQ. You will discover how filtration, ventilation, cleaning practices and allergen control all work together to create healthier indoor environments without driving up energy costs. As a webinar participant, you will learn how to: Identify and understand common sources of indoor pollutants. Apply filtration and ventilation strategies effectively. Set up cleaning protocols that reduce airborne contaminants. Leverage data to measure and improve IAQ performance. Balance air quality improvements with energy-efficiency goals. The expert panel for this webinar includes: Kathleen Misovic, Managing Editor, CMM (Moderator) Sarita Ceon, Environmental Engineer & Quality Control Manager, CCMS-Custom Cleaning & Management Services Kenneth Mendez, President & CEO, Asthma and Allergy Foundation of America Paul Tisch, Vice President of Operations, SSC Services for Education The hour-long webinar will conclude with a Q&A session so participants can ask their most challenging IAQ questions. Don’t miss this opportunity to clear the air in your building. Register for CMM’s IAQ webinar here.