IPs are keenly aware that SARS-CoV-2 is an important and concerning pathogen but the recent guidance change should not minimize the performance of standard cleaning / disinfection practices .”
Thompson ( 2020b ) asserts , “… an obsession with contaminated surfaces distracts from more effective ways to combat COVID-19 .”
Of concern is that the lay press is telling people not to be too worried about cleaning to prevent COVID-19 . Specifically , Thompson ( 2020a ) interviewed Goldman , noting , “ Goldman is extending his crusade against fomite fear from COVID-19 to other diseases . The old story is that if you make contact with a surface that a sick person touched , and then you touch your eyes or lips , you ’ ll infect yourself . While Goldman acknowledges that many diseases , especially bacterial diseases , spread easily from surfaces , he now suspects that most respiratory viruses spread primarily through the air , like SARS-CoV-2 does . ‘ For most respiratory viruses , the evidence for fomite transmission looks pretty weak ,’ Goldman said . ‘ With the exception of RSV , there are few other respiratory viruses where fomite transmission has been conclusively shown . For example , rhinovirus , one of the most common viruses in the world and the predominant cause of the common cold , is probably overwhelmingly spread via aerosols . The same may be true of influenza . Many experiments that suggest surface transmission of respiratory viruses stack the deck by studying unrealistically large amounts of virus using unrealistically ideal ( cold , dry , and dark ) conditions for their survival . Based on our experience with SARS-CoV-2 , these may not be trustworthy studies .’”
Thompson ( 2020a ) continues , “ Hygiene theater muddles the public-health message . If you tell people , ‘ This disease is on surfaces , on your clothes , on your hands , on your face , and also in the air ,’ they will react in a scattered and scared way . But if you tell people the truth — this virus doesn ’ t do very well on surfaces , so you should focus on ventilation — they can protect themselves against what matters . At the ideas level , the jealous protection of hygiene theater is an example of a larger American crisis . ‘ When the CDC doesn ’ t update its fomite language for months while scientists are screaming about aerosolized spread , it just seems like a case of the precautionary principle taking over ,’ Goldman said .”
Goldman acknowledges that in the healthcare setting , inappropriate or improper cleaning and disinfection ( such as improper dwell time ) can contribute to resistance issues , with the important distinction that “ This can contribute to AMR in bacteria . It has no such effect on viruses such as SARS-CoV-2 .”
Goldman does not see a shift in the science from surface contamination by SARS-CoV-2 to airborne transmission as being potentially harmful , in that some healthcare facilities may interpret the updated CDC guidance to place less importance on surface cleaning and disinfection .
“ The shift of attention from surfaces to airborne transmission is long overdue , and quite the opposite of harmful ,” he says . “ Possible impact microbially is to reduce selection and amplification of resistant bacteria , but this does not apply to viruses . There is no selection or amplification that can take place for virus that is outside of human hosts .” He adds , “ All that is required for non-airborne control is ordinary routine cleaning ( similar to what was performed before the pandemic ) and ordinary routine handwashing . This is a virus you get by breathing , not by touching .”
Elizabeth Monsees , PhD , MBA , RN , CIC , FAPIC , the antibiotic stewardship program manager at Children ’ s Mercy Hospital in Kansas City , Mo ., weighs in on the debate : “ The COVID-19 pandemic has improved our awareness of and attention to cleaning and disinfection practices , in addition to barrier devices , such as masks and eye protection . However , excessive cleaning can be harmful if people are not using products correctly , using them in poorly ventilated areas , etc . In non-healthcare settings , the CDC and other health professionals are encouraging practices that prevent disease transmission – beginning with cleaning with soap to physically remove surface contaminants then disinfecting to kill remaining germs . These practices should be employed in the prevention of coronaviruses as well as other transmissible agents that are routinely present or circulating in our communities .”
Monsees adds , “ Working in the antimicrobial stewardship space , I ’ m glad people are concerned about AMR . AMR occurs when bacteria become resistant to antibiotics designed to kill or inhibit growth . Most AMR occurs through inappropriate use , whether people , animals and or agriculture . Cleaning and disinfection can certainly reduce AMR spread . The linchpin of effective infection prevention programs is to identify risks and help healthcare teams use biocidal agents as intended by the manufacturer because when cleaning / disinfection are performed