Rodney E. Rohde, PhD, SV/SM/MB(ASCP)CM, FASc

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

Introduction: A High-Touch Surface Hiding in Plain Sight

Cubicle curtains are among the most frequently touched—and often overlooked—surfaces in healthcare settings. From exam rooms to inpatient bays, they are constantly touched by patients, clinicians, and visitors. Yet, cleaning and replacement guidelines for curtains remain among the most inconsistent and least regulated aspects of environmental infection control.

Most regulatory agencies defer to internal policy when it comes to curtain changes, often stating they should be replaced “when soiled” or “after contact with infectious material.” However, these vague directives leave a dangerous gray area. Without clear mandates, practices vary widely, even within the same facility. And that inconsistency can lead to risk.

What the Guidelines Say—and Don’t Say

Despite the well-documented role of environmental surfaces in pathogen transmission, cubicle curtain guidelines remain soft.

, and many state health departments stop short of specifying a change frequency.

Language typically reads: “Change when visibly soiled” or “after contact with infectious material or isolation patients.”

The onus is placed on the facility to define frequency, leading to wide variability.

Some hospitals change curtains monthly, others quarterly. In many places, it is only done when they appear dirty.

This lack of standardization creates a gap in infection prevention—one that cannot be closed without more explicit guidance and a culture of consistency.

Why Best Practice Should Be Quarterly—and Measurable

Curtains are a high-touch, low-priority item in many infection prevention plans. But they shouldn’t be.

Studies have shown that pathogens can survive on curtain surfaces for days or even weeks, especially in high-use areas.

Curtain changes once per quarter offer a reasonable balance between safety, cost, and operational feasibility.

Electronic tracking systems can log change dates, issue reminders, and produce audit reports to ensure compliance.

Consistent tracking of curtain changes creates accountability across EVS, nursing, and infection prevention teams. It also makes compliance easily auditable for regulatory visits.

The Rise of Cubicle Curtain Commercialization

The cubicle curtain industry has evolved dramatically in recent years:

 (eg, from On The Right Track or Standard Textile) that are designed for extended multimonth use, not single use

 to distinguish usage cycles or infection risk

 that blend reusable mesh with replaceable curtain panels

Many hospitals have outsourced curtain changes to third-party vendors. Some of these vendors provide barcoded cloth curtains that are laundered and scanned in and out for tracking. Others focus on programs that replace only the curtain panel, 

eaving the mesh in place. This is a growing and concerning practice.

While outsourcing this task is understandable given staffing and workflow constraints, it is critical to partner with companies that understand infection prevention standards. That includes adherence to hand hygiene, clean vs dirty transport practices, and proper curtain-handling protocols during change-outs.

Manufacturers who promote snap-on curtain systems often do so to support these outsourced models. While efficient, these systems are designed for ease of change—not necessarily for infection prevention. Without specific guidance on how to clean or replace the mesh, this approach may inadvertently undermine patient safety.

As demand grows, so does innovation—and not all innovations are created equal.

The Mesh Problem: Dust, Disturbance, and Risk

Some newer systems feature a snap-out panel that allows the curtain to be changed while leaving the mesh header intact. While this may reduce labor and laundry costs, it introduces a critical oversight.

Mesh is located at the ceiling to allow for sprinkler deployment and smoke detection, but it is often excluded from cleaning protocols.

It collects dust, which can harbor pathogens such as 

, Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococcus(VRE), 

, as well as viruses such as influenza and SARS-CoV-2. Studies have also identified bacteria such as 

; and even viral particles such as influenza in health care dust samples.

Movement of the curtain during daily use can disturb this dust, potentially dispersing harmful particles into the air.

“If we wouldn’t leave an HVAC vent uncleaned for a year, why are we okay ignoring the curtain mesh that hangs inches from a patient’s headspace?”

While the mesh is overhead, its contamination still poses a risk, especially in spaces where airflow can redistribute particulate matter.

Recent testing by On the Right Track Systems, using AATCC Test Method 100, evaluated traditional curtain mesh headers for contamination. The results were concerning:

, the mesh only demonstrated a 55% reduction in bacterial growth after 24 hours—indicating significant survival of a known multidrug-resistant organism. To be clear, a 55% reduction is not considered a safe reduction in bacterial load. For disinfectants used on soft surface textiles, 

 testing for a minimum mean 4.0-log reduction in qualifying bacteria relative to controls within 10 minutes ± 5 seconds. A 4.0 log reduction is 99.99%.

, a high-concern fungal pathogen, a 99.8% reduction was seen, but residual contamination remained at 5.0 x 10^5 CFU/sample after 24 hours.

These findings confirm that curtain mesh can harbor and retain pathogens, reinforcing the need for validated cleaning or replacement protocols.

Leaving mesh behind may save money, but without a validated cleaning protocol or replacement cycle, it compromises the very infection control goals these systems aim to support.

 on mesh contamination, including microbial load and dust analysis

 on how frequently mesh should be cleaned or replaced

 between infection prevention experts and curtain vendors to validate new systems before broad adoption

Infection prevention teams, environmental services leaders, and hospital administrators must work together to demand better data and push for tighter regulatory standards. This is not just a product issue; it is a patient safety issue.

Conclusion: Curtains Are Not Cosmetic—They Are Clinical

Cubicle curtains are not decorative elements. They’re functional, high-contact surfaces that play a direct role in infection transmission—and they must be treated as such.

As with other surfaces, one truly should view a building or similar spaces and its surfaces 

as a living environmental organism with the potential to cause harm

As innovation in this space continues, the health care industry must balance efficiency with safety. Without clear policies, defined cycles, and validation of new curtain systems (including mesh), we risk letting convenience overtake care.

The industry needs leadership. It needs data. Most of all, it needs to stop treating cubicle curtains like an afterthought. Because when it comes to infection prevention, there is no room for gray areas—only clean lines.

Hidden in plain sight, cubicle curtains are among healthcare’s most-touched—and least regulated—surfaces. Vague “change when soiled” guidance leaves dangerous gaps, as dusty mesh headers and inconsistent replacement cycles quietly seed transmission, underscoring the need for quarterly, trackable swaps and evidence-based standards.

The Curtain Call: Rethinking Cubicle Curtain Protocols in Infection Prevention

Inconsistent cleaning and disinfection practices continue to pose significant risks to patient safety in health care environments. Despite broadly aligned guidelines from agencies like the CDC, the World Health Organization, the Association for Professionals in Infection Control and Epidemiology (APIC), and the Association of periOperative Registered Nurses (AORN), critical operational differences and accessibility barriers persist. 

This article examines the need for internal standardization, the role of professional memberships, regulatory frameworks from The Joint Commission, Centers for Medicare & Medicaid Services (CMS), The Occupational Safety and Health Administration (OSHA), and US Environmental Protection Agency (EPA), and the vital importance of viewing cleaning as a clinical service, not a commodity. Grounded in both personal experience and real-world examples, it emphasizes that 

 and offers a blueprint for health care facilities to lead with safety, consistency, and trust.

Introduction: Why Standardization Matters

Environmental cleaning and disinfection are foundational pillars of infection prevention. Yet, while the clinical community emphasizes protocols and stewardship, the healthcare environment itself remains vulnerable to inconsistencies. Even among recognized leaders like the CDC,¹ WHO,² APIC,³ and AORN,⁴ guidance varies enough to create confusion on the front lines.
In today's environment of emerging and reemerging pathogens, 

, and heightened regulatory oversight, internal standardization of cleaning and disinfection practices is not optional. It is a foundational investment in patient safety, staff confidence, and organizational resilience. Simply stated, 

all surfaces matter in the war on pathogen transmission in health care and community settings

A Landscape of Best Intentions—and Missed Alignment


Even minor inconsistencies around cleaning frequency, chemical selection, training expectations, and auditing methods can lead to operational drift, unless a facility sets and enforces its own consistent standard.

Access to Standards Is Always Best Practice, Not a Barrier

While foundational guidelines from agencies like the CDC¹ and WHO² are freely accessible, health care-specific cleaning standards often require membership or purchase:

AORN’s perioperative cleaning guidelines

⁴: membership or purchase required, updated annually.

¹³: surface safety, materials compatibility, validated cleaning protocols.

Disclosure: The author serves on the Healthcare Surfaces Institute Advisory Council under ISSA.


Membership isn’t a hurdle; it’s a strategic investment.
Direct access connects facilities to validated education, best practices, and peer collaboration critical for resilient infection prevention programs.

Real-World Consequences (with HealthPlus Case Study and National CMS Deficiency Data)

Case Study: HealthPlus Surgery Center, Saddle Brook, New Jersey⁹

In 2018, HealthPlus Surgery Center temporarily closed after the NJ Department of Health found critical lapses in sterilization and infection prevention protocols. Over 3,700 patients were notified of potential exposure to HIV, Hepatitis B, and Hepatitis C. While sterilization was a primary issue, inadequate environmental hygiene also surfaced as a major breakdown.


Failure to verify and enforce infection control protocols, including cleaning and disinfection, can escalate rapidly into a patient safety crisis.

National Trends: CMS Data on ASC Deficiencies⁸

CMS data from 2023 to 2024 shows infection prevention failures are the most frequently cited deficiencies across ambulatory surgical centers.

Failure to follow standardized cleaning protocols

Lack of documentation for terminal and between-case cleaning

Improper disinfectant use and dwell time compliance


Infection prevention lapses, including improper cleaning, are systemic risks, not isolated mistakes.

Agencies Advancing Health Care Cleaning Standards

Recognizing environmental hygiene as a pillar of patient safety, national and global organizations lead initiatives to close gaps:

: Certifications (CHEST, CSCT, CHESP) advancing healthcare cleaning competence.

International Sanitary Supply Association (ISSA) + Healthcare Standards Institute (HSI) + International Executive Housekeepers Association (IEHA)

: Interdisciplinary surface safety and facility leadership training.

: STAR Facility Accreditation, outbreak preparedness and response.

: International collaboration for health care hygiene research and advocacy.


Active participation with these agencies represents a strategic investment in health care excellence and resilience.

Regulatory Standards Reinforce the Need for Consistency

Regulatory agencies shape health care cleaning requirements:

: Mandates cleanliness validation under the Environment of Care standards.

: Requires safe, sanitary environments under Conditions of Participation.

: Bloodborne pathogens, PPE, and chemical handling safety.

: Disinfectant registration (List N, List K) ensuring efficacy against health care pathogens.


Compliance fulfills the fundamental obligation to protect patients, staff, and the community.

Facilities must own their environmental hygiene processes:

: Use EPA-registered, pathogen-appropriate disinfectants (tuberculocidal, fungicidal, sporicidal as needed).

: Implement two-step cleaning, validated dwell times, and clear Standard Operating Procedures (SOPs).

: Certification, annual competencies, ongoing education.

: Membership and direct access to standards ensure adherence to current best practices.

: Regular inspections benchmarked against internal SOPs, not industry averages.

Collaborative relationships with a medical laboratory

 for microbiological sampling and understanding of the pathogen burdens with the facility.


Standardization empowers staff, strengthens infection prevention, and builds operational resilience.

In-House or Outsourced, Cleaning Is Patient Care

Whether environmental services are in-house or contracted, cleaning is a 

Are staff health care-certified (CHEST, CSCT)?

Are SOPs aligned with the CDC, AORN, and CMS?

Is association engagement (ISSA, AHE, HSI) maintained?

Are outbreak response protocols established?


Having worked as both a customer and a provider, we’ve seen firsthand that too often, facilities contract cleaning services to the lowest bidder, overlooking the real costs: increased health care-associated infections, surgical site infections, readmissions, reputational damage, and patient harm.


Environmental cleaning is not a commodity. It is patient care.


Outsourcing does not outsource responsibility for patient safety.
Facilities that treat environmental hygiene as clinical care will achieve stronger outcomes, safer environments, and greater community trust.

Environmental cleaning must be recognized as a frontline health care service—essential to infection prevention, patient outcomes, and healthcare resilience.

Standardization is not bureaucracy.
Standardization is protection.

Facilities that invest in clear, accessible cleaning protocols, supported by training, membership, and strategic partnerships, will lead in safety, innovation, and patient trust.

Outsourcing does not absolve responsibility.
Internal teams do not guarantee readiness.
Only a culture of continuous education, accountability, and excellence sustains real infection prevention.

We have spent our careers on both sides: as customers and now as service providers.
The lesson remains clear:

Cleaning is not ancillary to patient care.
Cleaning is patient care.

https://www.cdc.gov/healthcare-associated-infections/media/pdfs/environmental-cleaning-rls-508.pdf

Guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Care Facility Level

. World Health Organization. 2016. Accessed May 12, 2025. 

https://www.who.int/publications/i/item/9789241549929

Infection prevention: a perioperative nurse’s

guide to preventing infections in surgical settings

https://www.aorn.org/article/infection-prevention--a-perioperative-nurses-guide-to-preventing-surgical-site-infections

Association of periOperative Registered Nurses. 

Guidelines for Perioperative Practice: Environmental Cleaning

Inconsistent cleaning practices continue to jeopardize patient safety. Experts urge health care leaders to treat cleaning as clinical care—essential, standardized, and foundational to infection prevention.









Rodney E. Rohde, PhD, SV/SM/MB(ASCP)CM, FASc

Articles

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

The Curtain Call: Rethinking Cubicle Curtain Protocols in Infection Prevention

The Case for Standardizing Cleaning and Disinfection: Why Consistency Is Critical to Patient Safety

Even in Shadow of COVID-19, Influenza Poses Pandemic Threat