Tackling Biofilms on Healthcare Surfaces

biofilm is any group of microorganisms in which cells stick to each other and often these cells adhere to a surface. These adherent cells are frequently embedded within a self-produced matrix of extracellular polymeric substance (EPS). Source - Wikipedia

According to the Center for Biofilm Engineering at Montana State University, biofilms form when bacteria adhere to surfaces in aqueous environments and begin to excrete a slimy, glue-like substance that can anchor them to all kinds of material – such as metals, plastics, soil particles, medical implant materials and, most significantly, human or animal tissue. The first bacterial colonists to adhere to a surface initially do so by inducing weak, reversible bonds called van der Waals forces. If the colonists are not immediately separated from the surface, they can anchor themselves more permanently using cell adhesion molecules, proteins on their surfaces that bind other cells in a process called cell adhesion.

J. Darrel Hicks explores the issues and challenges of biofilms as they pertain to their removal by EVS professionals in healthcare in his latest article here. 

Myth #1: Biofilm is a buildup of organic or biological matter.

Not so, since even as skin flakes, skin oils and other organics provide "germ-food," they do not constitute biofilm.

Fact #1: Biofilm is actually the “house” microbes build for themselves.

It’s a somewhat slimy, polymeric house but it provides them shelter and protection from the elements themselves, including disinfectants.

Myth #2: Biofilm can be removed using the right disinfectant and dwell time.

Not true. Biofilms have been known to survive submerged under Quaternary ammonium compound for 20 minutes or more. One study found that bacteria in dry surface Biofilm are unlikely to be killed by 20,000 ppm chlorine! This raises a serious question on the reliance of disinfectants for hospital decontamination as it relates to Biofilm removal.

Fact #2: Frequent and systematic scrubbing is the best way to prevent and remove Biofilms from environmental surfaces.

As noted by the Cleaning Industry Research Institute (CIRI): "...old-fashioned scrubbing is sometimes the best 'intervention' when it comes to Biofilm."

Myth #3: Biofilm is found only in wet or damp conditions.

Fact #3: Evidence of Biofilm and bacteria embedded in thick extracellular protein substances on 41 of 44 dry surfaces tested. Bacteria embedded in Biofilms can be up to 1,000 times more resistant to disinfectants. 

Because Biofilm protects itself with a tough, thick matrix that makes up two-thirds of the film, its removal will require new approaches to hospital cleaning and disinfection. One of the best methods of breaking through Biofilm's matrix is agitating, brushing or scrubbing the surface (i.e., good old fashioned "elbow grease") to which it is attached. Amicro-denier microfiber cloth is an essential tool for breaking through Biofilm matrix while applying cleaning and disinfecting solutions. Cotton cloths do nothing to disturb the thick matrix or remove the Biofilm from a surface.


The Green Clean Institute educates and certifies healthcare environmental services technicians in their role in providing safe, clean and disinfected surfaces for patients and residents. Part of that education involves the proper removal of Biofilm as part of processing patient/resident spaces.

If you are on LinkedIn, join in here on the conversation about this little known subject.