New survey illustrates challenges linked to healthcare environmental hygiene in facilities worldwide

Association for Professionals in Infection Control

Arlington, Va., May 26, 2022 – A global, pilot study published today in the American Journal of Infection Control (AJIC), provides the first, quantified overview of the strengths and challenges associated with healthcare environmental hygiene (HEH) practices in healthcare facilities (HCFs) around the world. Study researchers will use the findings to further enhance an in-development self-assessment tool that will help facilities benchmark and improve their HEH.

“We were surprised to find that 98 percent of the facilities participating in our survey were majorly lacking in one or more of the World Health Organization’s multimodal improvement strategies for infection prevention and control practices,” said Alexandra Peters, Ph.D., Can, University of Geneva, and first author on the published study. “This survey suggests that challenges with key components of HEH, including staff education and training, workplace culture, and access to adequate products and equipment, remain ubiquitous regardless of geography or income level. These results reinforce the need for a self-assessment tool to help HCFs worldwide identify HEH challenges and necessary resources.”

HEH is an important component of infection prevention and control (IPC) that comprises the cleaning of all surfaces in hospital rooms. It is reliant on multiple factors, including adequate cleaning products and supplies; best practices-based protocols; training, education and quality control; and the institutional safety climate. Departments responsible for HEH face numerous challenges, including limited budgets, an unstable workforce, and a lack of access to safe and effective products.

Under the direction of Prof. Didier Pittet of the University of Geneva Hospitals and Faculty of Medicine, Dr. Peters and several colleagues designed a pilot study to evaluate the strengths and challenges in HEH programs around the world and across resource levels. The study also evaluated a preliminary version of the Healthcare Environmental Hygiene Self-Assessment Framework (HEHSAF), a 39-question tool designed by global experts to help facilities’ HEH programs evaluate their current strengths and challenges and their improvement over time. Researchers sent the preliminary HEHSAF to 743 HCFs between April and June 2021; 51 HCFs from 35 countries ultimately participated in the study.

Overall, 98% (50 out of 51) of participating HCFs lacked in some or all of the five components of the multimodal IPC improvement strategy, independent of income level. Other key findings include:

  • 71% of respondents felt that their facility gave enough importance to HEH and 47% felt that the budget allocated for cleaning and disinfection was adequate.
  • 67% of HCFs reported that necessary HEH products and supplies were always available, 27% said they were sometimes available and 6% said they were never or rarely available. Among the 90% of HCFs that reported HEH equipment and supplies were available, 16% could still not perform adequate sterilization because equipment was not in good working condition.
  • Just over 50% of HCFs reported that their protocols were based on best practices and updated regularly.
  • Only 22% of HCFs provided or required (if staff was outsourced) comprehensive formal HEH training upon hiring; 28% did not provide or require any formal training at all.

“This study highlights environmental hygiene needs that are similar to those we identified more than 25 years ago for hand hygiene promotion at the time we introduced alcohol-based hand gels in hospitals,” said Prof. Pittet, who is also chair of the Clean Hospitals Initiative, leading the WHO Hand Hygiene promotion initiative “SaveLives:CleanYourHands”, and lead senior author of the study published today.

“These findings provide the global IPC community with a baseline for HEH assessment, and should encourage focus, improvement, and investment in HEH globally to reduce healthcare-associated infections and their implications,” said Linda Dickey, RN, MPH, CIC, FAPIC, and 2022 APIC president. “The final HEHSAF will be an invaluable tool to support this effort.”

About APIC

Founded in 1972, the Association for Professionals in Infection Control and Epidemiology (APIC) is the leading association for infection preventionists and epidemiologists. With more than 15,000 members, APIC advances the science and practice of infection prevention and control. APIC carries out its mission through research, advocacy, and patient safety; education, credentialing, and certification; and fostering development of the infection prevention and control workforce of the future. Together with our members and partners, we are working toward a safer world through the prevention of infection. Join us and learn more at

About AJIC

As the official peer-reviewed journal of APIC, The American Journal of Infection Control (AJIC) is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. Published by Elsevier, AJIC also publishes infection control guidelines from APIC and the CDC. AJIC is included in Index Medicus and CINAHL. Visit AJIC at

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