Infections are a major complication of hospitalisation, but techniques for measuring cleanliness of the hospital environment are not standardised. We found that hospital surfaces vary widely in their level of contamination, but that very few had hazardous organisms. There is a need for better understanding of the methods for testing environmental cleanliness, including comparison of  ATP detection and quantitative microbiology.

Consistent accurate methods to evaluate environmental cleanliness are required to evaluate cleaning interventions and support quality improvement activities. This review explores and evaluates methods used to evaluate cleaning in healthcare facilities. Fast, reproducible and cost effective methods are needed for routine environmental cleaning.

Surface disinfectant constitutes a basic prevention strategy in hospital hygiene. Cleaning procedures using only detergents, especially for areas with frequent hand and skin contact, are inadequate. They often lead to insufficient inactivation and spread of facultative pathogens. The ‘Hygiene Requirements for the Cleaning and Disinfection of Surfaces’ recommendations of KRINKO combined with quality assurance via the VAH disinfectant list guarantee safe surface disinfection practise.

Outbreaks of nosocomial infections are common problems in hospitals and need a multidisciplinary approach. Two cases of infections with K. pneumonia and VRE respectively are described in a tertiary care hospital and their handling demonstrated in a standardised procedure including a change in the cleaning process. Pathogen transmission could be stopped in both outbreaks indicating the importance of the cleaning concept.