Healthcare equipment as a source of nosocomial infection: a systematic review

Nosocomial infections (NIs) result in significant financial and individual costs, with large numbers of patients acquiring infections annually. Healthcare equipment has been identified as a likely source of these infections, and research indicates that up to one-third of all NIs may be prevented by adequate cleaning of equipment. Thus, this systematic review aimed to determine levels of contamination on healthcare equipment, to identify viable cleaning protocols and to establish the methodological quality of current evidence. Published and unpublished studies from January 1972 to December 2004 were identified in eight major databases. Methodological quality was evaluated using the hierarchy of evidence and a quantitative critical appraisal tool. Data were extracted and analysed using five major outcome measures. Fifty studies were identified investigating a range of healthcare equipment, of which 23 were included in the review. Methodological quality ranged from 6.5 to 9.5 out of 14 for observational studies and from 6.5 to 9.5 out of 15 for repeated measures studies. The included studies reported that 86.8% of all sampled equipment was contaminated, with 70% alcohol reducing the levels of contamination on equipment by 82.1%. Healthcare equipment is a significant source of NI. High levels of contamination are present on a wide range of healthcare equipment. However, the majority of contamination and hence any risk of acquiring a NI can be reduced substantially by regular cleaning of equipment with 70% alcohol. Further research is required into the role of community healthcare equipment in NI.