Regardless of the health care setting, environmental cleaning is one of the foundational components of any infection prevention program. Acute care hospitals and ambulatory settings both have surfaces and devices that can contribute to the transmission of pathogens. 

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Although many acute care components of an environmental cleaning program can and should be utilized in the ambulatory setting, there are a number of items that require a different approach. Here are two examples:

Infrastructure and dedicated resources. The acute care setting has had formal infection prevention programs in place for years. There are established guidelines and regulatory resources dedicated to best infection prevention practices in the acute care setting. Programs in the ambulatory setting are in their infancy. In the last few years, though, dedicated resources that address the needs of the ambulatory setting have been developed.

For instance, the Association for Professionals in Infection Control and Epidemiology offers training courses specifically dedicated to infection prevention professionals who practice in the ambulatory setting.

Difference in patient care areas. Patients occupy rooms for longer periods of time in acute care settings. The environmental services (ES) staff perform daily cleaning that is scaled down, but similar to terminal cleaning of a patient room. In general, acute care ES workers are less rushed to complete daily cleaning because they are not waiting for the area to be occupied immediately by another patient.

Patient care areas in the ambulatory setting are not always private rooms. It is often a shared environment in which patients are separated by curtains. Multiple patients are seen in a short period; therefore, the care areas need to be cleaned more frequently during the day. Terminal cleaning, including all high-touch surfaces, is performed after the facility is closed.

Barbara Connell is vice president of clinical services at Medline Industries Inc., Northfield, Ill. She can be reached at