In the high-stakes world of healthcare, what you don’t see can harm, or even kill. One of the biggest risks facing hospitals today is not a new virus or a rare disease, but something far more familiar: infections acquired during a hospital stay. Known as healthcare associated infections (HAIs), these are infections patients pick up while receiving medical treatment. They kill more people than traffic accidents every year and cost healthcare systems billions. But there is hope, and it starts with cleaning.

The invisible enemy: HAIs

Roughly 7 out of every 100 patients in high-income countries acquire at least one HAI during their hospital stay. In low- and middle-income countries, this number doubles to 15 per 100 patients. These infections are particularly dangerous in wards where patients already have weakened immune systems, like oncology, intensive care, neonatal, and burn units.

Even more shocking: 1 in 10 patients affected by an HAI will die from it. And yet, around one-third of these infections are preventable. That’s where professional cleaning and disinfection teams come in, not just as support staff, but as critical players in infection prevention and control (IPC).

When antibiotics no longer work

For decades, antibiotics were seen as the miracle solution to infection. But bacteria are clever. With overuse and mis-use, especially in healthcare and food production, bacteria are “learning” how to resist our most powerful drugs. A phenomenon called antimicrobial resistance (AMR) which is a growing global crisis.

These “superbugs” can defend themselves in many ways: strengthening their cell walls, pumping out antibiotics before they work (efflux pumps), or even changing their own structure to make drugs ineffective. Once in a hospital, these resistant organisms can spread rapidly, especially if cleaning protocols are not watertight.

Resistant fungi and viruses: a new chapter

It is not just bacteria. Micro-organisms like Candidozyma Auris (a yeast that resists multiple antifungal medications, formally called Candida Auris) and for example certain strains of HIV are proving difficult to treat. These organisms often resist multiple treatments and are hard to identify quickly. Cleaning staff must be extra vigilant: these microbes are tough, persistent, and of course invisible.

HAIs in the Middle East region are a growing concern

HAIs in the Middle East represent a significant challenge, with notable prevalence rates, high associated mortality, and substantial economic burdens. The situation is further exacerbated by the rising threat of antimicrobial resistance. Addressing these issues requires concerted efforts in infection prevention and control measures, antimicrobial stewardship programs, and continuous surveillance to mitigate the impact of HAIs in the region.

A survey across seven Middle Eastern countries (Egypt, Saudi Arabia, UAE, Lebanon, Oman, Kuwait, and Bahrain) found a 28.3% overall infection rate in acute-care hospitals, 11.2% were healthcare associated infections (HAIs), and 16.8% were community acquired(2)

A surprising twist: are disinfectants causing more harm than good?

Disinfectants are essential to infection prevention, but emerging research is raising alarms. Some studies, including those from the Dutch Health Council(1) and Australian scientists, show that bacteria can develop resistance to disinfectants, especially those containing benzalkonium chloride (BAC). Even more troubling: these disinfectants might make bacteria more resistant to antibiotics too.

This doesn't mean we should stop disinfecting. It means we must use disinfectants wisely and selectively, following guidelines and combining chemical disinfection with proper mechanical cleaning.

Tomorrow’s hospitals: smart, safe, and clean

The hospitals of the future aim to be smarter, safer, and more sustainable. But without robust infection prevention, these ideals fall apart.

Hospitals today face three major worries:

1. AMR to medication: “superbugs” are no longer science fiction.
2. AMR to disinfectants: a new and rising concern.
3. HAIs: unfortunately still common, deadly and expensive.

Dangerous disinfection

Disinfection saved and saves many lives. Correct hand hygiene, one of the most important ways to prevent cross contamination, is a must. Nobody will deny that. Disinfection of contaminated surfaces is also important. However disinfecting surfaces in a wrong way or when it is not needed can be dangerous. There is a risk we create stronger micro-organisms causing illness and death. The question is, should the cleaning staff and nurses who have cleaning tasks as well “clean” with ready to use disinfection wipes all the time? Or is disinfection not always needed and cleaning sufficient enough. And when cleaning is sufficient, using microfiber cloths/mops moistened with water only is in many times a better solution than using a cleaning detergent. Dutch and Belgium IPC experts say yes, good cleaning is better that unnecessary disinfection. Which means that we have to disinfect only when it is needed, which of course does not mean that we don’t have to disinfect anymore at all. That is obvious.

The path forward

So what can be done?

Clean with purpose

Professional cleaning must be recognized as a front-line healthcare activity, not an afterthought.

Use disinfectants wisely

Avoid overuse and stick to proven-effective protocols. Only disinfect when needed, otherwise clean professionally.

Educate and train staff repeatably

From cleaners to clinicians, awareness saves lives.

Invest in research

We need better products and smarter strategies.

Work together

Global cooperation is key. Pathogens don’t respect borders.

What about professional cleaning?

It looks like it is time to improve. Important questions are, “do we clean as professionally as we should” and “do we really have to disinfect so much”. Probably not. In most cases the knowledge is there, we have the protocols and we know how to clean and disinfect. The major thing we have to change, is our behavior in cleaning and disinfection: do what we have to do, do it consistently and do it according to the instructions. Ask yourself if this really happens in your organization. Not because you believe it, but because you checked it. It is possible that over time good intentions devaluate. Because of cost savings, lack of education, less operational guidance by supervisors and architectural obstacles which hinders the cleaning and disinfection. 

Final thoughts

Cleaners in healthcare settings aren’t just "cleaning staff", they are infection prevention fighters. Every wiped surface, every cleaned floor, every properly discarded wipe is a step toward safer care. In the fight against superbugs and HAIs, cleaning professionals are more than a part of the solution. They are the solution.

About the author

Ing. P.B. (Paul) Harleman 

Global Application Manager Vileda Professional 

Chief editor Vileda Professional Hygiene Magazine

Member of honor of the Dutch Association for Cleaning Research (VSR) 

www.vileda-professional.com