How Hospitals Use Terminal Cleaning to Safely Reopen Patient Rooms
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After a patient with a serious infectious disease leaves the hospital room, the work isn’t over.
Before that space can safely care for another patient, it must undergo terminal cleaning—a carefully structured, evidence-based process designed to remove contamination and protect healthcare workers and future patients.
In a recent episode of Transmission Interrupted, host Jill Morgan, a nurse at Emory University Hospital, speaks with Cassie Prather, infection preventionist at Providence Sacred Heart Medical Center and Children’s Hospital in Spokane, Washington, and Erika Kurili, senior infection prevention specialist at Corewell Health.
Together, they discuss how hospitals clean and disinfect patient care areas—especially after treating high-consequence infectious diseases (HCIDs)—and why preparation, training, and proper technique are essential to doing it safely.
Key Concepts
What “Terminal Cleaning” Means
Terminal cleaning occurs after a patient leaves a room.
Its purpose is to:
- Remove visible contamination
- Thoroughly disinfect surfaces
- Safely prepare the room for the next patient
Routine vs. Terminal Cleaning
Routine cleaning
- Occurs daily while a patient is still in the room
- Focuses on high-touch surfaces
- Maintains a low level of contamination (bioburden)
Terminal cleaning
- Occurs after patient care ends
- Is significantly more thorough
- Includes all surfaces, equipment, and areas in the room
Using the Correct Disinfectant
Hospitals must select disinfectants that are effective against specific pathogens and meet regulatory standards.
Best practices include:
- Using products on EPA-approved pathogen lists
- Following the required contact time listed on the label
Cleaning Methodology Matters
Proper technique is essential to prevent spreading contamination during cleaning.
Standard principles include cleaning from:
- Clean → Dirty
- High → Low
- Outside → Inside of the room
Some Dangerous Pathogens Are Easier to Kill Than Expected
Certain high-consequence pathogens, including viruses like Ebola, are relatively fragile in the environment and can be effectively eliminated with proper disinfectants and technique.
Common Myths About Terminal Cleaning
Myth 1: Everything must be thrown away
Most equipment can be cleaned and reused, provided surfaces are intact and proper disinfection protocols are followed.
Myth 2: Rooms must sit empty for days
Some facilities wait 2–3 days before reusing a room, but this is typically due to staff recovery, logistics, or emotional decompression—not infection control requirements.
Myth 3: Stronger smells mean better cleaning
A strong smell does not mean a disinfectant is more effective.
For example, bleach may smell stronger but is not always necessary. The best disinfectant is the one proven to work against the specific pathogen.
Preparing the Room Before a Patient Arrives
Good preparation can make cleaning easier and more effective later.
Facilities should:
- Remove unnecessary equipment
- Avoid fabric furniture when possible
- Ensure mattress covers are intact
- Minimize cords and accessories
Who Performs Terminal Cleaning?
Approaches vary by hospital and may include:
- Environmental services teams
- Clinical care teams
- Specialized infection control cleaning teams
- External contractors
Regardless of the model, training is essential.
Training Is Critical
The most important factor in safe and effective cleaning is practice and preparation.
Facilities should:
- Train staff regularly
- Develop clear, standardized protocols
- Use observers to verify proper technique
- Educate staff on the science behind cleaning procedures
Key Takeaways
Our experts highlighted three priorities for effective terminal cleaning:
1. Use the Correct Disinfectant
Staff must understand:
- Which pathogens a product kills
- The required contact time
2. Follow a Clear Cleaning Process
Protocols should be:
- Standardized
- Easy to follow
- Evidence-based and validated
3. Train Staff Repeatedly
Regular training helps ensure:
- Confidence
- Safety
- Consistency
About the Experts
Erika Kurili, MPH, CIC has been an infection preventionist in Region 5 with Corewell Health since 2020. She serves as the primary infection prevention contact for the Biocontainment Unit at Butterworth Hospital. Erika serves on the National Emerging Special Pathogen Training and Education Center (NETEC)’s Infection Prevention Workgroup. She is an active member of APIC and currently serves on the Nominating Committee for APIC – Great Lakes Chapter.
Jill Morgan, RN, has over thirty-five years of emergency and critical care nursing experience. She is on Emory’s Serious Communicable Disease Unit team and cared for all five of Emory’s viral hemorrhagic fever patients. She now serves as the site manager for the Emory biocontainment unit, has validated the unit’s processes and protocols on the autoclave inactivation of special pathogen waste and the safe doffing of complex PPE ensembles, and created the Emory Healthcare Test Kitchen to advance the science of healthcare worker safety.
Jill is a PPE subject matter expert and co-lead of the PPE Working Group for NETEC, the National Emerging Special Pathogens Training and Education Center, where she helps create and deliver education to healthcare workers, evaluates ensembles, protocols, and plans, and assesses the readiness of healthcare facilities. She is a member of ASTM, AAMI, ANSI, and APIC. In 2023, Jill was appointed to the National Academies Committee on Personal Protective Equipment.
Cassie Prather, MPH, CIC is a Clinical Educator in the Special Pathogens Unit (SPU) at Providence Sacred Heart Medical Center and Children’s Hospital, the Regional Emerging Special Pathogen Treatment Center (RESPT) for region 10 in Spokane, WA. Prather’s role includes education to frontline facilities, EMS engagement, competencies and transport capabilities, expanding environmental and clinical capabilities within the SPU, and assisting in maintaining readiness capability for the internal special pathogen team at Sacred Heart. She is a Master of Public Health graduate from Eastern Washington University. Cassie is an active participant in the local APIC chapter for the Inland Northwest, holding multiple board positions throughout the years.