Doctoral thesis
Open access

Assessment of the role of healthcare environmental hygiene in patient safety and development of a facility-level self-assessment tool

ContributorsPeters, Alexandra
Number of pages91
Defense date2022-07-11


Healthcare-associated infections (HAI) are present in every healthcare setting around the world, and are a global issue that causes a high degree of mortality, morbidity, and cost.(1–3) Healthcare environmental hygiene (HEH) is an often overlooked and understudied field in infection prevention. Although hand hygiene is still recognized as the primary vector for HAI, HEH is a far more important aspect than is previously accepted; for a variety of reasons. As a field it is far more vast and heterogenous than hand hygiene; it comprises any areas associated with the healthcare environment including surfaces, sterilization and device reprocessing, air control, water control, waste management, laundry. All of these elements and environments have a range of products and practices used to clean and disinfect when and where needed. Issues affecting the quality of the cleaning and disinfection can stem from or be found in both the technical and human aspects of HEH, as well as the systemic and logistical context of healthcare facilities and the larger environment. Such issues may include efficacy of the chosen interventions, difficulty in quantifying the value HEH brings to a healthcare facility, and the training and management of human resources. The literature in the field of environmental hygiene is still in its nascent stages. Similarly to the field of hand hygiene 30 years ago, it’s importance needs to be quantified and analyzed, both in terms of its contributions to the global burden of mortality and morbidity as well as in its financial burden on health systems.


The objective of this work was to begin to assess the role of the healthcare environment in HAIs, analyze how to best assess the level and raise the quality of HEH globally, and to begin developing a “transposable model” of key components in environmental hygiene that can be implemented on a global scale.


We first began building up a public-private partnership focused on HEH in 2018. The main mission of the “Clean Hospitals” project is to improve patient safety through improved HEH. It does this by raising awareness of the importance of HEH, working to improve standards and practice on a global level, and conduct academic research needed to address gaps in the field. In the context of this project, the first objective was to conduct a systematic review to see whether there was enough evidence to be able to claim that improvements in HEH could improve patient outcomes. The next element was to work on developing the Healthcare Environmental Hygiene Self-assessment Framework (HEHSAF) for healthcare facilities in order to analyze their environmental hygiene prac

Citation (ISO format)
PETERS, Alexandra. Assessment of the role of healthcare environmental hygiene in patient safety and development of a facility-level self-assessment tool. 2022. doi: 10.13097/archive-ouverte/unige:165983
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