I’ve been struggling for years to find the best ‘catch-all’ term to describe hospital cleaning or disinfection or both. And, after much thought, I’ve settled on a proposal to share with you, dear reader: “environmental hygiene”.
The reasons for this are as follows:
- Whenever you read a paper about environmental cleaning and disinfection in hospitals you encounter a new glossary. In fact, it’s worse than that – you encounter the same words used to mean different things, and it’s very confusing.
- One of the few things that almost everybody agrees on is that cleaning refers to the removal of dirt – of the biological and non-biological variety. And yet, we often talk about “environmental cleaning” to encompass both cleaning and disinfection, which doesn’t make sense.
- Most agree that disinfection means reducing microbial contamination to a safe level through chemical or physical (e.g. steam or UV light) processes. It’s vital that our terminology doesn’t conflate cleaning and disinfection because cleaning must precede effective disinfection (or be part of a combined process).
- ‘Environmental decontamination’ is a strong candidate for describing cleaning or disinfection or both. But when we say “decontamination”, our minds are drawn to endoscopes and sterilisers!
- Hygiene is usually defined as ‘practices to maintaining health and preventing disease, especially through cleanliness.’ So, ‘environmental hygiene’ is a simple intuitive phrase that would naturally describe hospital cleaning, disinfection, or a combined process. It has the added benefit of not being used commonly, so we have an opportunity to coin a phrase here!
- ‘Environmental hygiene’ would be a good partner to hand hygiene. Hand hygiene can be performed either using soap and water (cleaning) or using sanitisers, usually alcohol-based (disinfection). Similarly, environmental surfaces can be either cleaned using a detergent, or disinfected using a chemical agent. Also worth remembering that hands are really just another surface that get around, are frequently contaminated, but are rarely cleaned or disinfected…
- ‘Environmental hygiene’ would also be a good partner to ‘food hygiene’.
- There’s perhaps an argument that ‘surface hygiene’ would be a better term. But we don’t think of all items that are commonly cleaned and disinfected in hospitals as ‘surfaces’ (e.g. curtains, blood pressure cuffs).
- But how on earth do you ‘verb’ ‘environmental hygiene’ (e.g. “the hospital room was environmental hygiened.”)? Fortunately, we have lots of experience with verbing hand hygiene (e.g. “99% of staff complied with hand hygiene” [ha ha, as if…]).
Table: Aligning hand and environmental hygiene
|Hand hygiene||Environmental hygiene|
|Cleaning||Soap and water||Detergent|
|Disinfection||Usually alcohol-based sanitisers||Chemical disinfectants|
So, here it is: a proposal that ‘environmental hygiene’ is used as a catch-all term to describe hospital cleaning, disinfection, or both. Can you foresee any problems with this terminology? Do you know of another phrase in common parlance that fits the bill (that I’m not aware of)? Can you think of a better phrase? Comments welcome, as ever.
p.s. with thanks to Alexandra Peters and Didier Pittet for challenging my thinking on this subject!