A disinfectant dispenser that delivers the wrong concentration, shared equipment without clear cleaning responsibility, or restricted areas inaccessible to environmental services can expose gaps in environmental hygiene programs. In this interview with Infection Control Today® (ICT®), Doe Kley, MPH, RN, T-CHEST, LTC-CIP, CIC, discusses disinfectant efficacy, practical cleaning challenges, and shared accountability. Drawing on research and infection prevention experience, she emphasizes that everyday practices matter in addressing antimicrobial resistance. “Everyone has a role in preventing transmission,” Kley says. “Effective environmental hygiene isn’t a supporting role in this fight – it’s a frontline intervention.”

ICT: You open by saying the post-antimicrobial era “isn’t coming, it’s here.” For someone outside health care, what does that look like day-to-day? And what convinced you that it’s already happening rather than a future risk?

Doe Kley, MPH, RN, T-CHEST, LTC-CIP, CIC, infection prevention fellow of clinical and scientific affairsfor Clorox Purell ProCare: That’s the CDC’s language, not mine—and I use it because the data backs it up. You know, resistance is rising faster than we can answer it. In the last decade, only about 22 new antibiotics reached the market. In contrast, up to 50 new drugs are coming out each year for things like diabetes, depression, and even weight loss. 

Meanwhile, antibiotic resistance climbed nearly 40% between 2018 and 2023. Did you know that in the US, 1 in 7 bacterial infections is now resistant, costing about 48,000 lives and $5.7 billion a year? And what’s scarier is that by the year 2050, experts predict that AMR [antimicrobial resistance] will kill more people than all cancers combined.

But what convinced me isn’t the projection of AMR; it’s the history. Methicillin came into widespread use in 1959, and the first resistant [Staphylococcus] appeared in 1960, just 1 year later. Consider that bacteria reproduce roughly every 20 minutes, whereas we humans only reproduce maybe twice in a lifetime. This replication speed is directly tied to how quickly antimicrobial resistance can emerge and spread. The math was never in our favor. What’s at stake isn’t just treating infections; it’s whether surgery, transplants, and chemotherapy remain safe to perform.

ICT: Most people hear “antibiotic resistance” and think about overprescribing. You argue that the hospital environment itself is half the story. How did you come to that view, and what do surfaces and shared equipment contribute that prescribing habits can’t explain?

DK: So antibiotic stewardship is essential, but it’s only part of the solution, and here’s what gets missed: Resistant organisms don’t just live and replicate inside the patient’s body; they live and replicate on surfaces. 

For perspective, a 2024 Rutala study found that 65% of resident rooms and half of common areas in long-term care facilities were positive for at least one MDRO [multidrug resistant organism]. Another 2024 study found that within just 4 hours of disinfection, Candida auris had already recontaminated 20% of surfaces. And the consequence is measurable: Being admitted to a room previously occupied by someone who harbored an MDRO raises the risk of acquiring that same organism by 1.5 to 3.5 times.

Prescribing habits can’t explain that. What prescribing also can’t explain is gene sharing. While these organisms sit in the environment, they trade resistance genes with unrelated bacterial species. So, the environment isn’t just a reservoir; it’s where resistance spreads and evolves.

Disinfectant #1 had no Klebsiella claim, and while disinfectant #2 (a ready-to-use sporicidal) had a Klebsiella claim, it did not have an NDM-1-specific claim. And that’s the moment. People pause because neither disinfectant has the resistant strain on its label.

That pause is the whole lesson. You don’t need an NDM-1-specific claim. The claim for the susceptible strain covers the resistant one. And the sporicidal wipe wins on every other dimension too: broader spectrum, faster contact time, and no risk for dilution error.

Audiences respond well because it’s not abstract; they see the consequence play out. In the first path, the next patient admitted to the room acquires the NDM-1 pathogen. In the second path, the patient goes home in just 3 days with no complications. When participants make the choice themselves, it lands differently than when they are told the principle.

ICT: You recommend a sporicidal disinfectant for every discharge clean, not just isolation rooms. That’s a real workflow shift. How do you make that case to a skeptical hospital leader, and what evidence moves them?

DK: I would start by defining the problem, which, in this case, is that we simply don’t know. Meaning, we don’t always know what pathogens a patient may have been harboring. 

We only apply enhanced measures when we’re aware a patient is carrying something, but all too often we are not aware until sometime later, and the damage is already done. In the scenario I used in this presentation, the patient wasn’t even on contact precautions until the culture came back on the day of discharge. And that’s not unusual.

To convince my leadership, I would lean into the available evidence. I would point to the plethora of studies that have demonstrated the risk to the next patient admitted to a room previously occupied by a patient colonized or infected with a drug-resistant or a C difficile infection. These studies have demonstrated that the risk can be up to 3.5 times higher than had the prior occupant not been harboring a drug-resistant pathogen.

Another study worth sharing is a 2019 Donskey study, which showed that when bleach replaced the quat for all discharge cleans, C difficile contamination in non-C difficile rooms dropped from 24% to 5%.  

I would also share this important data that always gets a leader’s attention: the human and financial costs of AMR infections, which are associated with up to 70% higher mortality, up to 24% longer stays, and roughly 29% higher costs. 

Finally, I would remind the leadership team that cleaning with a sporicidal agent is the highest level of clean you can offer the next patient admitted to a room. Remember, sporicidal disinfectants are considered intermediate-level disinfection—just 1 step below high-level disinfection and 1 step above low-level disinfection. 

ICT: You shared a personal story that reminded participants not to overlook ancillary departments. Can you reshare that story here for us?

Absolutely! At my last hospital, I had wandered down to Radiology, where MRIs are performed. As you know, this is a highly restricted area for safety reasons. You know, those magnets don’t play around! It’s so restricted that I asked the radiology manager about cleaning. I learned they didn’t even permit EVS in the space! Rather, the radiology staff, untrained in C&D, were doing the cleaning!

Guess how they mopped the floors? They dropped disinfecting wipes on the floor and shuffled around the room with their feet!

Obviously, as an IP, this was completely unacceptable, so working together:

•       We trained EVS staff on MRI safety, 

•       We purchased non-ferrous aluminum cleaning tools that were dedicated to the department, and 

•       We mapped out cleaning responsibilities.

The key takeaway from this story is that IPs and EVS must look behind every door in every department!

ICT: What’s the one thing you’d want every EVS professional to hear from this: what’s their role in preserving antibiotics for the next generation?

DK: I want them to know how absolutely vital their role is in patient safety. You know, IPs and EVS professionals don’t prescribe antibiotics — but they certainly help protect them. Every transmission prevented is potentially a life saved and an antibiotic preserved for someone who’ll need it, possibly even years from now. Effective environmental hygiene isn’t a supporting role in this fight – it’s a frontline intervention working on 2 fronts: preventing infections so fewer antibiotics get used, and containing resistance so it doesn’t reach the next patient. 

(Edited for readability and length)