Affiliations: Dr. Alexandra Peters, PhD 

President of Clean Hospitals 
Institute of Global Health 

University of Geneva 

Geneva, Switzerland 

Since its founding in 2018 by Professor Didier Pittet, Clean Hospitals has been on a mission to make healthcare facilities safer through improved environmental hygiene. Under the leadership of Alexandra Peters, the organization has evolved from a small, research-focused initiative into a global network connecting academics, healthcare facilities, industry experts, and policymakers. From developing the widely used Healthcare Environmental Hygiene Self-Assessment Framework to launching Clean Hospitals Day and expanding access to low-resource settings, the organization is reshaping how hospitals approach hygiene, sustainability, and patient safety worldwide. In this interview, Peters shares insights on innovation, collaboration, and the path ahead. 

Clean Hospitals aims to make hospitals safer through improved environmental hygiene. How has this mission evolved since the organization's inception and what do you see as its most important achievement to date?  

We were founded by Professor Didier Pittet, who's done a lot of work globally in hand hygiene and is probably the reason why people use alcohol-based hand rub in hospitals. He wanted to do the same thing for environmental hygiene that he'd done for hand hygiene and so, we were founded in 2018 and I've been working with the organization since the beginning.  

At our inception we were much smaller, and only focused on environmental hygiene. We started to have stakeholders and bring together academics and so it was a progression over time, and the organization has evolved a lot. 

Now we have working groups, an international expert network, and we’ve opened the organization to healthcare facilities. Now we're not only focused on environmental hygiene but on hand hygiene as well, and we are working toward making a truly global network. 

There are three main achievements that I’d like to highlight. 

From an academic standpoint, our most important achievement is the healthcare environmental hygiene self-assessment framework (HEHSAF) https://cleanhospitals.com/hehsaf/, which is a validated survey and a self-assessment form that is available in 17 languages and is meant to be used worldwide regardless of income level of the healthcare facility. It allows facilities to benchmark their environmental hygiene programs over time and see where there's gaps or there's room for improvement.  

From a networking standpoint, our most important achievement is the network of experts that we've been able to bring together in environmental hygiene and hand hygiene. They give talks every month and a lot of them attend each other's talks. We have some of the best people in the world discussing very relevant topics in hygiene and it's very enriching for everyone who's part of that. 

And then, from an advocacy perspective, I would say the most important achievement is the founding of Clean Hospitals Day, which is becoming more and more visible worldwide with healthcare facilities and organizations from every continent participating in it. So, that's been growing really nicely as well.  

Environmental hygiene, as we know, encompasses many domains like surface cleaning, water quality, waste management. Which of these areas do you believe has seen the most innovation recently and where are the greatest challenges still present?  

Most innovation in environmental hygiene has focused on surface cleaning and disinfection, where significant research resources are being invested. However, the biggest challenge remains the variability across healthcare settings—different environments, patient profiles, and pathogens make it impossible to apply a single, universal cleaning and disinfection solution. 

There is no one-size-fits-all approach that works effectively in every facility. Success depends on strong training, contextual understanding, and implementing processes tailored to each setting—while ensuring safety, preventing pathogen spread, and minimizing environmental impact. 

Encouragingly, the industry is moving toward greener, more sustainable solutions and greater recognition of the healthcare environment’s critical role in patient safety—an awareness that has significantly increased over the past decade. At the same time, innovation continues in areas such as automated disinfection technologies, probiotics, and more environmentally friendly and surface-compatible disinfectants.

Clean Hospitals is bringing together lots of stakeholders from academics, industries, hospitals, and government entities. How do you facilitate collaboration between such diverse sectors?  

We facilitate collaboration in different ways, sometimes through meetings, or different working groups that are interesting to a number of different actors from healthcare, academia, and industry. And we really try to foster conversation and exchange between those people and sectors. 

For example, when we have our Think Tank talks, where academics speak on what they're working on in hygiene currently, very often there's people from industry, there's people from healthcare facilities, there's people from governmental bodies that are at those talks and discussing those issues. We're going to be facilitating exchange talks with IPC experts and members from the hospitals because there's so little exchange in environmental hygiene generally. Usually, people that are responsible for environmental hygiene just keep doing whatever the hospital's been doing for the last 20 years. And they're extremely busy-it's not like in medicine where you get this knowledge exchange and you get people training at different hospitals and different facilities or different universities. So, it's far more segmented, I would say. 

And we're trying to break those silos down and making it possible that people that generally wouldn't be having conversations are working together, so that they realize that they have common goals and they have insights to share with each other and get them working on projects that benefit everyone.  
 
Clean Hospitals Day is celebrated globally every year on 20th October. What inspired the creation of this Awareness Day and how do you think it has contributed to changing the culture around healthcare and environmental hygiene?  

I would say that the day was inspired by the WHO World Hand Hygiene Day, which Professor Pittet, our founder, was heavily involved with WHO in creating. And it's something that our team was always very involved with as well. And so, it seemed only natural to create a Clean Hospitals Day as well for environmental hygiene and for celebrating the people that clean and the people that keep our healthcare facilities safe. 

Because very often, environmental services staff are underpaid, they're undertrained, they're undervalued, and in many instances, they're the only healthcare workers that don't need any kind of training and certification. A lot of what we do in healthcare for cleaning and disinfection has just been sort of brought over from the restaurant or hotel industries, and that's not appropriate. So, it is a professional field and it needs to be professionalized on a global level. 

That's something that we want to bring attention to with Clean Hospitals Day and thank the people that are doing the work often for really substandard pay and in relatively bad conditions.  

Evidence and research are central to your work. Can you share any example of how Clean hospitals research has influenced policies or practices in healthcare facilities?  

Since Clean Hospitals was founded, we’ve published 65 peer-reviewed papers in environmental and hand hygiene. However, it’s often difficult to determine how academic research is translated into real-world practice and what tangible impact it has on healthcare facilities. 

Where we’ve seen the most direct and visible results is through the Healthcare Environmental Hygiene Self-Assessment Framework (HEHSAF). Hospitals have actively reached out to us with questions, shared specific challenges they are facing, and asked for guidance on resources or improvement strategies. This direct engagement makes it clear that HEHSAF is the area where our research is most effectively being converted into policies and practical actions. 

Its importance lies in a simple principle: you cannot improve what you do not measure. The self-assessment framework enables healthcare facilities to systematically evaluate their environmental hygiene practices, identify weaknesses, and map gaps within their systems. From there, it becomes the responsibility of each facility to decide how to address those gaps—whether through policy changes, resource allocation, or targeted interventions. 

In many regions, environmental hygiene still remains underfunded or under-prioritized. What strategies do you use to convince hospital leaders and policymakers to invest more in this area?  

I would say environmental hygiene is under-prioritized in all regions. We did a pilot study a few years ago to see how well hygiene practices were being implemented. And out of 51 facilities from 35 countries that we looked at, 50 of them showed really big issues in their environmental hygiene programs. 

There hasn't been a single healthcare facility that I visited around the world where there weren't big issues. And I think it's because the level of evidence for environmental hygiene is relatively new. It's really only in the last 10 years that people are really paying attention and starting to invest in that. 

And even if you read the older guidelines, you realize that there was this lack of knowledge about the healthcare environment. I believe it's the way that you convince hospital leaders and policymakers to invest is with economic arguments. And we are getting more papers that show return on investment for investing in hygiene and avoiding healthcare associated infections. 

Sustainability is becoming a major focus in healthcare. How does Clean Hospitals integrate sustainability into its hygiene recommendations and training programs?  

In our training programs, we address the growing reliance on disposable products in healthcare. Over the past 10–15 years, there has been a strong shift toward single-use items—gowns, endoscopes, curtains, cleaning cloths—based on the belief that disposal eliminates infection risk. 

While disposables certainly have their place, their use should not be automatic. Relying on them by default can become a shortcut rather than a carefully considered decision. 

Instead, their implementation should follow a proper risk assessment to determine when single-use items are truly necessary and when reusable alternatives are safe and appropriate. Integrating sustainability into hygiene practices is complex, and many see it as conflicting with infection prevention. However, with the right expertise and contextual analysis, it is possible to balance patient safety with more sustainable solutions. 

Looking ahead, what are your key strategic priorities for Clean Hospitals over the next few years, especially expanding access to low-resource settings?  

Over the past few months, we’ve launched two key initiatives: building a global network of country leads and opening Clean Hospitals membership directly to healthcare facilities. 

To expand access in low-resource settings, membership has been kept highly affordable - just 25 Swiss francs per year. If even that is a barrier, we are exploring industry funding to support facilities that lack the means to join. 

Environmental hygiene is a powerful starting point for improving healthcare globally because it is not as resource-dependent as many assume. While a basic minimum-such as clean water and essential supplies -is necessary, strong programs can be built with limited resources through proper training and implementation. In fact, high-resource settings do not always achieve better results, often due to gaps in execution rather than funding. 

Our goal is to include as many facilities as possible, fostering knowledge exchange, education, and peer support - creating a global platform where healthcare teams can share challenges, ask questions, and strengthen environmental hygiene practices together.