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!
Reflections on Infection Prevention and Control 
All good thoughts and reasoning.
I prefer the term that I’ve used for years: process. Can also be used in the past tense: processed. Or as an adjective: processing.
Process includes cleaning (physical removing of dirt, grime, biofilm, and bacteria or viruses), disinfecting, and using the proper tools, techniques and time.
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Makes complete sense. This is the term I have used to encompass cleaning & disinfection and I use the same anology in training!
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There’s nothing new under the sun!
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Hi John, I like the idea of ‘process’ but doesn’t it need a noun before it (e.g. cleaning process, disinfection process…or environmental hygiene process). Also some connotations with ‘processing’ (i.e. decontamination) of medical equipment to be aware of.
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The phrase “Environmental hygiene” has been around for a while and has a different definition than the one you suggest, i.e. “Practical control measures used to improve the basic environmental conditions affecting human health, for example clean water supply, human and animal waste disposal, protection of food from biological contamination, and housing conditions, all of which are concerned with the quality of the human environment.” (from: from IUPAC Glossary of Terms Used in Toxicology, 2nd Edition (2007) by National Library of Medicine, Division of Specialized Information Systems).
There is also an entire journal dedicated to Occupational and Environmental Hygiene.
Feel free to re-define the term if that meets your needs but don’t expect it to solve our semantic or cleaning and disinfection problems!
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Great definition John, I really like the term “Environmental Hygiene” and your article is very well presented.
In Ontario Canada, the Provincial Infectious Diseases Advisory Committee (PIDAC) best practices for environmental cleaning for prevention and control of infections for all health care setting, came up with the following definitions in 2009:
Hotel clean: A measure of cleanliness based on visual appearance that includes dust and dirt removal, waste disposal and cleaning of windows and surfaces. Hotel clean is the basic level of cleaning that takes place in all areas of a health care setting.
Hospital clean: The measure of cleanliness routinely maintained in client/patient/resident care areas of the health care setting. Hospital Clean is “Hotel clean” with the addition of disinfection, increased frequency of cleaning, auditing and other infection control measures in client/patient/resident care areas.
The third edition of this document was released last May 2018 and the same definition exists. I have been an active member of PIDAC for Environmental Cleaning and think your term “Environmental Hygiene is great.
Thanks for sharing,
Keith
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Excellent! Now it is clear that the hospital is a hotel, only cleaner
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Excellent! Now it is clear that the hospital is a hotel, only cleaner
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If we talk about disinfection in the context of preventing and combating infectious diseases, from the point of view of the epidemiology of infectious diseases, disinfection is nothing more than the elimination of infections (infectious factor), decontamination. This is the first.
Disinfection is carried out in three ways: physical, chemical and biological. As is known, methods are implemented in different ways. Thus, the physical method consists of the use of mechanical energy, the use of high-temperature and electromagnetic radiation of different ranges. Cleaning is nothing more than a mechanical method of the physical method of disinfection, since mechanics is a branch of physics. This is the second.
And finally the third. Disinfection is the removal of an infectious agent from non-living surfaces. Elimination of the infectious agent from living surfaces is called antiseptic
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As you know John, I totally agree with you – and have struggled for ages with this issue of finding terminology to fit “modern” concepts related to IPC which are significantly different from concepts used say 100 or even 20 years ago. Current terminology is no longer adequate to meet current needs
• Like you, wWhen I read papers about environmental cleaning and disinfection in hospitals, I find that the same words used to mean different things – even in the same paper – , and it’s very confusing. Sometimes I think they mean cleaning refers to the removal of dirt – and th next they seem to be using it to mean both cleaning and disinfection
• But I don’t agree with you (and other hospital infectionists) saying “cleaning must precede effective disinfection” – I would say cleaning must be seen as a part of reducing contamination to safe levels – it is when it comes to hands . Bloomfield carling and Exner have proposed a hygiene framework approach which approached these processes which starts from considering “ what constitutes a safe residual level for the process I am about to undertake. . Then saying “how do we do this in the most sustainable fashion”. In some cases it can be done by cleaning alone which produces the required log reduction – and if this is not enough, we must then follow it with disinfection (or use combined disinfectant/cleaner. I am always confuse that we insist that the log reduction produced by disinfectants must be measured – but never investigate the log reduction by detergent or other mechanical methods. People often say soap and water is all you need – but how do they know – it rarely measured – just taken for granted – very odd. We are obsessed by the relative LRs of hand sanitizers but rarael measure the effectiveness of handwashing with soap – we seem to just assume that “it works”. Try looking for panel test assessing the effectiveness of HWWS in reducing viruses on hands – and there is very little. But there is panel test data showing that AHRs are relatively effective on norovirus contaminated hands, which seems to be ignored. I have heard many “infection preventionists” say that AHS are ineffective against NV on hands?
• You say ‘Environmental hygiene’ would be a good partner to hand hygiene. Hand hygiene can be performed either using soap and water (cleaning) or using sanitizers, 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”…I agree – they are all part of a multibarrier approach which minimizes our exposure to pathogens and they all work on the same principle – removal, kill – or removal plus kill
• ‘You say – “But how on earth do you ‘verb’ ‘environmental hygiene’ (e.g. “the hospital room was environmental hygiened.”)?” In 1997 when the International Scientific Forum on Home Hygiene started to develop hygiene for home and everyday life, we knew that we needed a word to distinguish cleaning to remove dirt and cleaning to reduce microbes to safe levels – so we adopted the terms “cleaning” and “hygienic cleaning” The term hygiene cleaning means reducing microbes on hands and surfaces to a safe level – by whatsoever means – which could be removal, or by kill, or removal plus kill. We have found that although it is not perfect, it works – people immediately see that you are talking about something different from visible cleanliness. I have recently begun to see that term appearing in healthcare sector publications
We invite you to read our recent paper available online: Bloomfield SF, Carling PC, Exner M. A unified framework for developing effective hygiene procedures for hands, environmental surfaces and laundry in healthcare, domestic, food handling and other settings. GMS Hyg Infect Control. 2017;12:Doc08. DOI: 10.3205/dgkh000293, URN: urn:nbn:de:0183-dgkh0002937 Available at: http://www.egms.de/en/journals/dgkh/2017-12/dgkh000293.shtml.
So I agree with the term environmental hygiene – but this should include hand hygiene. Since they both wok together – not as separate interventions
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Oh – and by the way – it would seem logical to me use the word disinfection (and disinfectiong) to refer to ALL methods of reducing infectious microbes to a safe level, whether mechanical (cleaning) or chemical (disifectants).
But when I was on the CENTC216 committee in 1990 – the german delegation were adamant that we stick rigidly to the “Robert Koch ” definition, i.e. disinfection means ONLY inactivation by chemical disinfectants. When I asked what term I should then use to define reduction by mechanical removal to a safe level – no one seemed at all concerned as long as the traditions laid down by Koch were preserved.
Thus a golden opportunity to bring terminology up to date was lost – and I suspect also lives have since been lost due to our inability to communicate accurately with each other
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You say – It’s vital that our terminology doesn’t conflate cleaning and disinfection” – that is, disinfection and cleaning should be divided?
You say – So, ‘environmental hygiene’ is a simple intuitive phrase that would naturally describe hospital cleaning, disinfection, or a combined process.” – that is, disinfection and cleaning should be combined?
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You say – “we don’t think of all items that are commonly cleaned and disinfected in hospitals as ‘surfaces’ (e.g. curtains, blood pressure cuffs)” – this means that curtains and blood pressure cuffs do not have a surface?
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