More Isn't Always Better: Evidence-Based Approaches to Environmental Hygiene

In healthcare, the instinct to meet complexity with more complexity may be one of the biggest barriers to effective environmental hygiene programs. More products. More protocols. More claims. More steps. It feels like the responsible move, but the evidence suggests otherwise: when it comes to cleaning and disinfection, more isn't always better.

A scene that will feel familiar

Imagine an Infection Preventionist (IP) arriving on a busy med-surg unit to round on compliance, but almost immediately, the distractions begin. A daily disinfectant is sitting in a C. diff isolation room where a sporicidal disinfectant should be. An EVS team member asks a question, and a glance at their dilution bucket leads to a pH check but the result isn’t what it should be. Down the hall, shared equipment moves from room to room with what might generously be called an inconsistent wipe-down.

In a single walkthrough, there are multiple products, competing protocols, unclear accountability and visible gaps in execution. The IP’s original goal has been completely eclipsed.

This is not a hypothetical. It is a daily reality in facilities across the country and is a direct consequence of layering more complexity onto an already complex environment.

When "more" becomes a risk factor

In practice, “more” frequently produces the opposite of its intended effect. More products on an EVS cart can create greater cognitive load and more room for error.^1,2 More disinfectant claims, particularly those targeting pathogens of low transmission relevance, can create confusion about what actually matters in daily practice. More protocol steps mean lower compliance, not because teams lack commitment, but because the barriers to consistent execution become too high in a busy, real-world setting. The result is more variation, more friction between teams, and ultimately, more opportunities for the gaps that put patients at risk.

What the research supports

Standardized, frequent disinfection of high-touch surfaces is foundational.

• Gerba et al. demonstrated how quickly contamination can move through a healthcare environment. After a harmless viral surrogate was placed on a single high-touch surface, it spread to 40–60% of hands and surfaces across the facility within two to four hours.³ These findings underscore the need for targeted environmental cleaning and rapid decontamination of high-touch surfaces.
• A 2025 CLEEN study led by Professor Brett Mitchell reinforced the same principle: Enhanced daily disinfection, not additional products, stronger chemistries, or more elaborate protocols, was associated with a more than 34% reduction in healthcare-associated infections (HAIs) and significant cost savings. These outcomes were achieved by dedicating three hours per day to consistent disinfection of shared medical equipment using 2-in-1 detergent disinfectant wipes.⁴

Disinfectant claims should reflect real-world infection prevention priorities.

• On multi-drug resistant organisms (MDROs), the data are consistent. Antimicrobial resistance does not appear to change a pathogen's susceptibility to disinfectants.⁵ Antibiotics work by targeting specific biological processes inside the cell. Disinfectants operate through a broader, harder-to-evade mechanism. Disinfectants demonstrate equivalent efficacy against both wild-type and antimicrobial-resistant strains of bacteria.⁵ There is no need to chase more aggressive chemistries as organisms evolve; what needs to be chased is consistency and compliant use.
• Tuberculocidal (TB) claims no longer reflect disinfectant efficacy and should not be used to drive product selection.⁶ In 1997, OSHA clarified that EPA-registered disinfectants with HIV-1 and Hepatitis B virus kill claims are fully acceptable for surface decontamination of blood and other potentially infectious materials, removing any TB claim requirement entirely.⁷
  The takeaway: we don't need hyper-specialized products for every microbial scenario. We need the right products, targeting the pathogens that matter, used the right way.

Ready-to-use (RTU) wipes can help reduce friction in daily environmental hygiene workflows.

• The 2023 and 2025 CLEEN studies showed that improved cleaning and disinfection, particularly using disinfectant wipes on shared medical equipment, was associated with a measurable reduction in HAIs.^4,8
• Research comparing RTU wipes to dilutable disinfectants found significant reductions in preparation time, improved compliance scores, greater coverage of high-touch surfaces, and strong EVS preference for the wipe format.⁹

A framework for doing less, better: FOCUS

Translating this evidence into practice requires a framework. To make evidence-based environmental disinfection actionable, I introduced F.O.C.U.S., a risk-based hierarchy to organize environmental hygiene priorities without adding burden to teams that are already stretched.¹⁰

F: Focus on high-risk, high-touch surfaces and shared equipment. These are the primary drivers of transmission. Getting these right consistently can be more effective than attempting to disinfect every surface with maximum intensity.
O: Optimize cleaning frequency through standardized daily disinfection. Not terminal cleaning only. Not "when there's time." Daily, predictable, repeatable disinfection that doesn't depend on ideal conditions to be executed.
C: Consolidate products. Fewer products that work across multiple needs. Products that can be used in multiple care settings and have broad pathogen coverage without over-specialization mean less confusion, more confidence, and better adherence.
U: Use simple, real-world workflows. The best protocol is the one that can be followed during a busy shift. Removing friction isn't about lowering standards; it's about making it possible to meet the standards already in place. Simple, repeatable processes can help reduce variation and improve adherence across diverse users and settings.
S: Simplify to support consistency. The right action should be the easy action. Products need to be accessible at the point of care. When multiple teams share responsibility for cleaning and disinfection, simplification is a clinical necessity, not a shortcut.

The strategy is simple

Healthcare environments are becoming more complex: higher-acuity patients, a broader range of pathogens of concern and increasing pressure on EVS and clinical teams. But our approach to environmental hygiene doesn't have to follow that trajectory. Environmental hygiene programs that perform are built on three foundations:

1. A clear understanding of where transmission occurs
2. A commitment to cleaning the right surfaces at the right frequency
3. Use of products and protocols that teams can execute consistently

When programs are built this way, compliance feels achievable. Workflows feel manageable. And the teams responsible for execution feel supported rather than overwhelmed. Simplification isn't a compromise; it's a strategy to support our collective efforts for infection prevention and control.