Linda Lybert is a health care surface safety expert, executive director of the Healthcare Surfaces Institute, and president of Healthcare Surface Consulting. She focuses on surfaces and their role in the acquisition and transmission of pathogens, as well as how they can cause health care–associated infections.

Linda Lybert

A depiction of ultraviolet energy as a purple wave on a black background

Environmental contamination plays a measurable role in the transmission of multidrug-resistant organisms (MDROs) and other health care-associated pathogens. While manual cleaning and chemical disinfection remain foundational, variability in execution introduces residual risk. Ultraviolet-C (UV-C) disinfection, when deployed as an adjunct to manual terminal cleaning, has been shown to reduce environmental bioburden and decrease transmission of target organisms. This article examines the clinical evidence, financial implications, and operational strategies that position UV-C as a critical second-step intervention in high-acuity health care settings.

Manual Disinfection Is Foundational but Variable

Environmental services programs are essential to infection prevention infrastructure. However, even well-trained teams operating within structured protocols face inherent variability, including:

• Missed high-touch surfaces
• Inconsistent adherence to disinfectant dwell times
• Differences in room configuration and furniture positioning
• Human fatigue during high-throughput periods
• Variability in soil load and biofilm presence

Multiple studies demonstrate that patients admitted to rooms previously occupied by individuals colonized or infected with MDROs face increased acquisition risk, even when standard cleaning protocols are followed.

Manual cleaning is essential. It is not infallible.

Evidence Supporting UV-C as Adjunct Disinfection

The Benefits of Enhanced Terminal Room (BETR) Disinfection study, a multicenter randomized controlled trial, demonstrated that adjunct UV-C disinfection reduced transmission of target MDROs when added to standard manual cleaning protocols.

Additional investigations have demonstrated:
• Reduced environmental contamination following UV-C implementation


• Laboratory-confirmed efficacy of UV-C devices against key health care pathogens


• Reduced contamination of health care workers’ hands following enhanced environmental disinfection


• Persistent variability in manual cleaning thoroughness across acute care facilities

Review literature consistently supports no-touch disinfection systems, including UV-C, as effective adjunct technologies within comprehensive infection prevention programs.

UV-C disrupts microbial DNA and RNA, preventing replication. When applied after thorough manual cleaning, it reduces residual contamination on exposed surfaces in a consistent and measurable manner.

Strategic Deployment: Where UV-C Has the Greatest Impact

UV-C should not be deployed indiscriminately across all room types. High-performing programs target their use in:

• Isolation room discharges involving MDROs, 


• Oncology and transplant units
• Intensive care units
• Immunocompromised populations
• Outbreak response areas

In these settings, incremental reductions in environmental contamination can translate into meaningful risk reduction. A layered defense is particularly important when patient vulnerability is high.

Financial Considerations: Investment vs Risk

Health care leaders appropriately evaluate cost relative to measurable benefit. However, a single health care-associated infection may result in:

• Extended length of stay
• Centers for Medicare & Medicaid Services penalties
• Increased readmission risk
• Litigation exposure
• Reputational damage

The financial impact of a single preventable HAI can exceed the cost of months of adjunct UV-C deployment. When evaluated as risk mitigation rather than capital expenditure, UV-C becomes a strategic investment in system resilience.

Maintaining Throughput: Operational Integration Without Delay

A common objection to UV-C deployment is concern regarding room turnaround time. Successful integration requires workflow design rather than device placement alone.

Effective programs:
• Deploy UV-C selectively in high-risk discharges
• Stage rooms efficiently before initiating cycles
• Utilize parallel processing, such as documentation, cart reset, and supply restocking, during UV cycles
• Coordinate closely with bed management
• Track cycle time metrics and compliance

Modern UV-C devices can complete cycles in minutes, depending on room size and protocol. When embedded into discharge workflows, they enhance protection without compromising throughput. The key is integration rather than addition.


• Reduces residual contamination after manual cleaning
• Delivers consistent energy across exposed surfaces
• Provides measurable and repeatable disinfection cycles
• Strengthens interdisciplinary confidence


• Replace manual cleaning
• Remove organic soil
• Eliminate shadowed surfaces
• Compensate for weak process design

Manual cleaning remains the first step. UV-C reinforces the process.

Multiple studies now show that UV-C disinfection can damage common health care polymers and surface finishes, with important implications for infection prevention.

Call for Material Compatibility Evaluation

Emerging research on UV-C and material degradation indicates that repeated exposure can cause discoloration, embrittlement, cracking, and surface roughening in plastics such as Acrylonitrile Butadiene Styrene (ABS), nylon, and polycarbonate, which are widely used in health care environments.

 These changes are not just cosmetic: microcracks, roughened textures, and degraded coatings can create microbial reservoirs, protected niches where organisms can find “safe harbor” out of the direct line of sight of UV-C and mechanical cleaning.

Because of this, any facility planning to implement or expand UV-C disinfection should treat material compatibility as a core design and procurement requirement, not an afterthought. This includes the following:

• Conducting a careful evaluation of all surfaces and equipment in areas where UV-C will be used against published data on UV-C induced polymer damage


• Selecting products made from materials that tolerate UV-C disinfection, drawing on manufacturer testing, accelerated exposure data, and third-party studies


• Engaging in proactive discussions with manufacturers before purchase to confirm compatibility with planned UV-C doses and frequencies

By integrating material compatibility review into both UV-C implementation and product selection, health care organizations can avoid creating new microbial harborage points, protect capital assets, and ensure that UV-C functions as a reliable adjunct to manual cleaning rather than inadvertently undermining surface integrity.

High-reliability industries rely on layered defense systems. Aviation does not depend on a single instrument. Nuclear facilities do not rely on a single containment layer. Historically, health care relied primarily on manual environmental disinfection.

UV-C represents a shift toward redundancy, not because frontline teams are insufficient, but because health care environments are complex and pathogen transmission is multifactorial. Systems must account for human variability. Layered protection strengthens reliability.

Manual disinfection remains the cornerstone of environmental infection prevention. Yet in high-acuity health care environments, where pathogen burden is high, patients are vulnerable, and operational pressures are constant, reliance on a single layer of defense is no longer sufficient.

The evidence is clear: When layered onto standardized cleaning protocols, adjunct UV-C disinfection reduces environmental contamination and lowers transmission of targeted multidrug-resistant organisms. More importantly, it reduces variability, an often overlooked but critical driver of preventable harm.

Health care leaders are not deciding whether to replace manual cleaning. They are deciding whether to reinforce it.

Strategically deployed UV-C is not an optional enhancement or a symbolic technology purchase. It is a measurable risk-reduction strategy. It protects patients at their most vulnerable moments. It supports environmental services teams by strengthening the reliability of their work. It signals to clinicians, regulators, and patients that infection prevention is engineered—not assumed.

In an era defined by antimicrobial resistance, public reporting, reimbursement pressures, and rising expectations for safety, resilience is built through layered safeguards. High-reliability health care systems do not accept preventable variability when proven mitigation exists.

Reducing variability is leadership.
Investing in layered protection is stewardship.
Deploying UV-C strategically is not excessive; it is evidence-aligned risk management.

Moreover, a broader understanding of surface ecology reinforces the urgency of adjunct technologies such as UV-C. Pathogenic organisms can persist on and within diverse health care surfaces for extended periods—even after cleaning—due to material properties, biofilms, and design complexities that impede effective disinfection.

 By acknowledging that some surface materials inherently support microbial survival or resist thorough cleaning, UV-C becomes even more critical as a second-step intervention to address these persistent reservoirs, complementing manual efforts and surface selection strategies in the fight against healthcare-associated infections.

Anderson DJ, Chen LF, Weber DJ, et al. Enhanced terminal room disinfection and acquisition of multidrug-resistant organisms and 

Rutala WA, Kanamori H, Gergen MF, Sickbert-Bennett EE, Weber DJ. Enhanced disinfection leads to reduction of microbial contamination and hospital-acquired infection rates. 

Weber DJ, Kanamori H, Rutala WA. No-touch technologies for environmental decontamination: focus on ultraviolet devices and hydrogen peroxide systems. 

Sickbert-Bennett EE, Gergen MF, Weber DJ, Rutala WA. Comparative efficacy of multiple ultraviolet-C light devices against healthcare-associated pathogens. 

Kundrapu S, Sunkesula VCK, Jury LA, et al. Daily disinfection of high-touch surfaces in isolation rooms to reduce contamination of healthcare workers’ hands. 

Carling PC, Parry MF, Von Beheren SM. Identifying opportunities to enhance environmental cleaning in 23 acute care hospitals. 

Otter JA, Yezli S, Perl TM, Barbut F, French GL. The role of no-touch automated room disinfection systems in infection prevention and control. 

Suh D, Hockett S, Dukes KC, Perencevich EN, Marra AR. Impact of UV-C on material degradation: a scoping review. 

McGreer M. Testing the effects of UV-C radiation on materials. 

de Brouwer H, Anbuchezhian N. The effects of UVC irradiation on the properties of thermoplastics. 

Malpartida-Carrillo V, Tinedo-López PL, Salas-Quispe JE, Fry-Oropeza MA, Amaya-Pajares S, Özcan M. Effect of ultraviolet-C light disinfection on the dimensional stability of dental impression materials: a scoping review. 

Lybert L, Rohde RE. Why surface materials matter in health care settings. American Society for Microbiology. January 2024. Accessed February 28, 2026. 

https://asm.org/articles/2024/january/why-surface-materials-matter-in-health-care-settin

Teska P. Damage to common health care polymer surfaces from UV-C. National Institute of Standards and Technology. Accessed March 19, 2026. 

https://www.nist.gov/document/panel-abstract-teska

UltraViolet Devices Inc. UV-C and surface compatibility: UVDI-360 room sanitizer. 2022. Accessed March 19, 2026. 

https://www.uvdi.com/wp-content/uploads/2022/02/UV-Materials-Compat_UVDI-360_MKTFM-341-REV-D.pdf

Essentra Components. UV and its effect on plastics: an overview. 2018. Accessed March 19, 2026. 

https://www.essentracomponents.com/en-us/news/manufacturing/injection-molding/uv-and-its-effect-on-plastics-an-overview

Articles

New evidence suggests UV-C disinfection may do more than reduce pathogens. Repeated exposure can also damage common health care plastics, potentially creating microcracks and roughened surfaces that harbor microorganisms. Experts say material compatibility must become part of every UV-C infection prevention strategy.

UV-C as a Critical Second Step in Reducing HAIs: Why Adjunct Disinfection Is a Strategic Investment in High-Risk Health Care Environments

Cleaning and disinfection are critical and will always be an essential focus as health care professionals work to mitigate the spread of health care–acquired infections (HAIs). Yet, as new advances in disinfectants and disinfection technology continue to emerge, an overlooked issue continues to intensify and must be addressed.

Surface material and product damage caused by surface disinfection incompatibility impedes effective cleaning and disinfection, costs health care facilities millions of dollars annually, and creates dangerous safety issues for patients and health care personnel. There are many different materials and textiles within a health care facility, and they cannot all be cleaned and disinfected the same way. When they are, damage occurs. First, at a microscopic level, and then it continues until the damage is clearly visible.

It is impossible to deal with a microbial issue at a macro level. We all know microbes can’t be seen. Visual inspections following disinfection do not provide information about what remains on and in surfaces at a microbial level. Surface damage caused by incompatible disinfection methods—cracks, fissures, and pits—provides microscopic reservoirs for microbial attachments, colonization, and biofilm formation. This provides pathogens a potential safe harbor away from the biocides used to disinfect the surfaces, placing patients and health care personnel at risk for contracting infections.

Many factors influence microbial attachment. It is critical to have a basic understanding of what can remain on surfaces after cleaning and disinfection. Well-documented research provides insight into the role surfaces play in acquiring and transmitting microbes that cause deadly infections. In a February 2021 

, Zheng et al describe in detail how microbes attach to surfaces.

Surface damage can support microbial attachment, colonization, and ultimately, biofilm formation. Biofilm is a complex matrix of extracellular polymeric substances that protect against environmental adversities. Once biofilm is formed, killing the bacteria or removing the biofilm that protects them is extremely difficult, as is disinfecting damaged surfaces where microbial reservoirs have been created. The selection of surfaces that are compatible with disinfectants used in the health care setting is critical during the design of products or the built environment.

A Case Study on Surface Disinfection Incompatibility

Because of the complexity of this problem, many facilities pay high costs for repair, replacement, and ongoing maintenance for medical equipment. In many cases, the cause of the problem is overlooked. In a jointly released case study,

 the Healthcare Surfaces Institute (HSI) and the Association of Healthcare Value Analysis Professionals conducted a deep-dive analysis to understand the root cause of damage to a medical device.

A large midwestern hospital, with approximately 700 licensed beds and over 1.2 million patient encounters yearly, purchased several hundred state-of-the-art, noninvasive optical sensor medical device monitoring systems. There was visible damage to the monitoring systems within 2 years because of chemical exposure during the disinfection process. Such damage is susceptible to unreachable microbial reservoirs that inhibit disinfection, creating severe liability and costs for the hospital and manufacturer.

The Challenges and Gaps That Were Identified

The medical device company identified a lack of understanding and discussion about infection prevention products and guidelines used within the hospital. Although the medical device company met with many key decision makers, there was no central point of contact for them to work through, resulting in a breakdown of communication and the lack of involvement of critical experts during the evaluation process. Also, health care experts were excluded from initial meetings before the damage occurred; had they been consulted, it is possible some issues could have been avoided.

The case study also provided a clear example of the lack of guidelines and testing requirements for surface materials and products. When the medical device company applied for US Food and Drug Administration (FDA) 510(k) clearance, which is a process that evaluates a device’s safety against comparable legally marketed devices, they had testing done for surface disinfection and compatibility. The company was left to determine which cleaning agents to recommend for testing. Only 1 disinfectant was tested. The case study found that the hospital’s infection prevention and control guidelines did not support the use of the only disinfection method prescribed by the medical device manufacturer. The hospital was left to find an alternative for disinfection after purchasing the devices.

The fact that there are no guidelines or minimum testing requirements to validate surface disinfection compatibility is a problem. Minimum testing should require all categories of US Environmental Protection Agency (EPA)-registered hospital-grade disinfectants. There are hundreds of proprietary disinfectant products on the market in addition to no-touch technologies, and it would be cost prohibitive to test all disinfectants. However, by testing the categories of disinfectants, foundational information can be gained. Going beyond the minimum testing and working with the disinfectant companies from which hospitals purchase products will be essential.

Also discovered during this investigation were conflicting instructions for use (IFU) and care and maintenance manuals. The IFU provided information for the possible use of 2 other disinfectants. However, in small print was a warning against the use of the alternative disinfectant selected by the hospital, as there was concern that it may cause corrosion. Unfortunately, the small print was not noticed until the damage had occurred.

It was also determined that not all health care personnel were trained for cleaning and disinfection, such as their nursing staff disinfecting part of the device during patient care. They did not have access to the information they needed and were not offered the basic training.

Materials were not tested or evaluated for cleanability during the surface material selection process and before product development. It is currently not common for raw material manufacturers to test their materials for surface disinfection compatibility before selling them to manufacturers, which is missing a vital step. Product designers must have this information to support that the product’s design can be cleaned and disinfected without damage.

It was noted that medical suppliers benefit from having coordinated access to clinical staff for feedback on successes and potential device improvements. It is important to include critical information about the cleaning and disinfecting agents and processes used within the hospital. The information gained will support the manufacturer as they identify disinfectants for testing.

Before purchasing the monitoring device, the hospital’s evaluation and selection process would have benefited from active participation from a diverse group of health care professionals responsible for infection prevention, including environmental service, infection prevention, biomedical, nursing, and clinical professionals. All these professionals evaluate products differently, and the combined knowledge and discussion provides valuable insight into potential challenges and successes.

In the past 6 months, several medical device manufacturers faced FDA recalls for surface disinfectant incompatibility issues that caused risk to patients. Each of the recalls resulted in a requirement to do additional testing for surface disinfection compatibility and the rewriting of IFUs. Recalls are costly and could be avoided if guidelines and minimum testing recommendations were identified and followed.

Infection preventionists can help drive more awareness about surface disinfection compatibility. We can start with collaboration with health care personnel, biomed, raw material suppliers, device manufacturers and designers, and disinfectant manufacturers. We can bring together all the different groups working on surfaces to help health care facilities understand the importance of surface disinfection compatibility, surface disinfectant testing, IFUs, and how they are all tied together. We must work together to achieve the following:

Develop a minimum standard for surface disinfectant compatibility that tests categories of disinfectants instead of proprietary products.

 If categories of disinfectant chemistries are tested rather than specific brand names, this helps simplify and clarify IFUs. This allows health care facilities to determine whether the products they already use are compatible with their equipment and medical devices. HSI has developed minimum testing standards, using 7 categories of EPA-registered, hospital-grade disinfectants. By bringing this issue to the forefront and addressing the issue at a microbial level, we will begin to see sustainable solutions to mitigate the spread of HAIs.

Designate a single point of contact within a health care organization to facilitate collaboration between manufacturers and health care professionals and to communicate important matters to all parties.

 Health care facilities and systems have equipment and medical devices that are damaged or placed out of service for reasons not always known to staff. Having 1 “point person” to report equipment and device issues to, such as damage from cleaning products, would be invaluable.

Establish a greater understanding of real-life challenges health care professionals face when working to mitigate the spread of infections within the health care setting. 

Medical device designers and manufacturers and disinfectant manufacturers do their best to create products that help keep patients and staff safe. However, sometimes there is a disconnect between the users and the vision research and development had in mind. A product with multiple nooks and crannies—although helpful in the design and build of a device—can pose a nightmare for cleaning and disinfection.

­­­­Build awareness around the selection of surface materials during the design phase by medical device manufacturers based on surface disinfection compatibility.

 Raw materials must meet minimum standard requirements. The number of different types of medical devices and equipment is overwhelming. When you consider all the possible surface material components, such as plastics, metals, and coatings, it’s not hard to see how easily surface disinfection incompatibility can happen.

Create guidelines for product reviews before purchase, as well as checklists for health care selection teams within the health care setting that provide essential information for product value analysis professionals.

 Infection preventionists already have guidelines or checklists to help evaluate disinfectants. They also need tools for assessing surface disinfection compatibility to determine whether a surface material or product can be safely cleaned and disinfected without causing damage that can harbor and transmit dangerous pathogens.

Medical device suppliers should provide maintenance training, including a review of cleaning and disinfection for all users of their equipment or devices.

The lack of attention paid to surface disinfection compatibility with patient care equipment and devices results in damage, failure, and recalls of expensive—and sometimes critical—patient care equipment. Addressing the issue of surface disinfection compatibility can help prevent these financial losses. However, understanding how critical the issue of surface disinfection compatibility is to protect patients and keep health care personnel safe when handling patient care equipment and devices is more important. Infection preventionists can help drive the change needed to address surface disinfection compatibility in health care.

Zheng S, Bawazir M, Dhall A, et al. Implication of surface properties, bacterial motility, and hydrodynamic conditions on bacterial surface sensing and their initial adhesion. 

. 2021;9:643722. doi:10.3389/fbioe.2021.643722

Surface disinfection incompatibility with medical devices creates potential patient risks. Healthcare Surfaces Institute. September 2021. Accessed March 11, 2022. https://www.healthcaresurfacesinstitute.org/case-studies/surface-disinfection-incompatibility-with-medical-devices-creates-potential-patient-risks/

The surface material and product damage caused by new advances in disinfection technology must be addressed for patient safety.

Linda Lybert

Articles

UV-C as a Critical Second Step in Reducing HAIs: Why Adjunct Disinfection Is a Strategic Investment in High-Risk Health Care Environments

Surface Disinfection Incompatibility Does Not Support Effective Cleaning and Disinfection