Factors associated with environmental service worker cleaning practices in health care settings: A systematic review of the literature

Am J Infect Control. 2021 Jul;49(7):919-927. doi: 10.1016/j.ajic.2021.01.001. Epub 2021 Jan 9.


Introduction: Health care-associated infections can be reduced through better environmental disinfection practices. Central to effective disinfection is the environmental service worker (ESW). The aim of this systematic literature review was to identify factors associated with the disinfection practices of ESWs in health care settings.

Methods: A systematic literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses principles. Ten online databases and search engines were selected for the review of English-language studies published between 2000 and 2019.

Results: Thirty-one (31) eligible studies were identified. Environmental disinfection was associated with many factors (eg, knowledge, perceptions) as well as ESW exposure to education/training sessions. When education/training was combined with performance evaluation/feedback, significant improvement in ESW disinfection practices was reported.

Conclusions: To sustain improvements in disinfection practices, education/training sessions need to be continuous. The long-term commitment of an organization is also essential for continuous improvement in disinfection outcomes. While knowledge transfer is critical for behavior change, education/training also needs to focus on the skills and perceptions of ESWs. Future studies need to use a randomized controlled design with larger sample sizes to determine a true effect.

Keywords: Cleaning staff; Environmental disinfection; Feedback; Health care-associated infection; Infection control; Training.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Review
  • Systematic Review

MeSH terms

  • Cross Infection*
  • Delivery of Health Care
  • Disinfection
  • Health Facilities*
  • Humans