Even with traditional health hygiene habits, which were refined and enhanced during the COVID-19 pandemic, hospitals have not been able to eradicate microorganisms that put both already sick patients and health professionals at risk. One study published in the American Journal of Infection Control found that health care surfaces harbored a large bioburden despite compliance with routine disinfection policies.
The study discovered both pathogenic and non-pathogenic microorganisms, some well known and others not, and warned that even harmless germs can become more dangerous and infectious in hospital environments. The least-known pathogens are skin flora and environmental bacteria that, in the right environment, can transform into infectious agents and cause serious conditions such as meningitis, brain abscesses, endocarditis, and bacteriemia. 
The most contaminated surfaces were:
- Bed and stretcher rails
- Workstations-on-wheels (used by nurses to transport medications, dressings, syringes, and other medical supplies to treat patients in their rooms)
- Manikins used for medical training
In total, the study researchers isolated 60 different types of pathogens, 18 of which were well known and seven of which were classified by the US Centers for Disease Control and Prevention (CDC) as important to monitor and attempt to eliminate or neutralize in the health care setting.
Pathogens, especially bacteria, are known to become resistant in health care settings. In a recent report, the World Health Organization (WHO) declared that antimicrobial resistance is directly responsible for 1.27 million global deaths each year, and multidrug resistance in bacteria found in hospitals plays a key role in this public health crisis.
Some Gram-positive bacteria such as Staphylococcus aureus (including methicillin-resistant versions) and Gram-negative bacteria such as Acinetobacter baumannii can survive on surfaces longer, whereas others like Haemophilus influenzae tend to have shorter survival times. In any case, contact with one of these bacteria is practically inevitable.
According to the CDC, one in every 31 patients will develop at least one health care-associated infection (HAI), including infections by antibiotic-resistant bacteria, while receiving treatment for an unrelated condition. Hospitalized patients staying in a bed previously occupied by a person with a hospital-acquired infection were 25% more likely to develop one of these infections.
For many patients, especially those in intensive care units or who have vulnerable immune systems, the risk is even higher.
Disinfection strategies and adherence to protocols during the patient’s stay and after discharge are key to keeping these invisible microorganisms under control. However, new studies are going further and analyzing the necessary environment more globally, from cleaning surfaces with appropriate disinfecting detergents to using appropriate construction materials. Some of the proposed strategies include:
• Developing products aimed at cleaning and eliminating the hospital microbiome, setting aside the aggressive chemical products we currently use that have the potential to help opportunistic microbes (ready to invade recently exposed surfaces), thereby putting patients at risk, as well as damage medical devices.
• Thinking about preventing these infections from the medical facility’s very foundations. For example, certain ceramics used to build rooms or bathrooms have cracks that provide an environment where microbes can adhere and reproduce, in addition to being difficult to clean. Antimicrobial materials should be developed.
• Educating that all toilets should be flushed with the lid closed to avoid spreading germs. Every time a toilet is flushed, an invisible plume of aerosolized water droplets and pathogens from human waste rises up to five feet in the air. These particles can remain suspended for a short time before “landing” on surfaces within a five-foot radius of the toilet: walls, doors, knobs, and even sinks and paper towel dispensers.
• Knowing the specifications for each medical device to ensure proper cleaning— not just to eliminate germs, but also to avoid causing even imperceptible damage to the device, which could ultimately harm the patient. For example, each end of an endoscope has seven different surface materials and connection points. There are guidelines for reprocessing these devices, including the CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, and they must be strictly followed to achieve perfect sterilization.
Experts say that there should be greater awareness about the need to eliminate these microbes long before disinfecting a surface. This means more collaboration efforts between health professionals, builders, manufacturers of hospital disinfection products, and other actors.
To achieve surface cleaning with as few germs and as much efficiency as possible, everyone participating in decision-making and equipping, running, and disinfecting health facilities must be well informed about how microbes invade, reproduce, and interact with diverse surfaces, materials, and devices.
This story was produced using content from original studies or reports, as well as other medical research and health and public health sources cited in links throughout the article.
