Stay tuned in the coming days for an unfolding look at the key environmental hygiene issues and trends coming out of the 2026 annual meeting of the Association for the Healthcare Environment (AHE).

The Sept-Oct 2026 issue of Healthcare Hygiene magazine, to be released in early September, will also feature a focus on environmental hygiene. Until then, be sure to check out the Environmental Hygiene columns from Healthcare Hygiene magazine HERE

A session presented at AHE Exchange26 (New Orleans, August 16–19, 2026) by Bernardino Guerrero, deputy director of environmental programs service/healthcare environment and facilities programs, and Trina Zabarsky, RN, MSN, CIC, FAPIC, infection preventionist at the Northeast Ohio VA Healthcare System, both of the U.S. Department of Veterans Affairs, Veterans Health Administration, offered one of the more granular looks at disinfection practice presented at this year’s summit — and the data behind it should give every EVS and infection prevention leader pause.

Guerrero and Zabarsky framed their presentation, “Disinfection in the Healthcare Environment: Challenges, Barriers, and Solutions,” around a deceptively simple premise: disinfection failures in healthcare facilities are rarely failures of intent. They are failures of system design — in training, in product standardization, in dispensing equipment, and in the adoption pathways for newer technologies. The session’s real value lay in how directly it named those systems and backed its recommendations with published, peer-reviewed evidence rather than vendor talking points.

Where Disinfection Breaks Down

The presenters organized common obstacles into several categories that will be familiar to anyone managing an EVS department, but rarely quantified this precisely.

Knowledge gaps topped the list — inconsistent training and competency assessment, limited staff understanding of which products are indicated for which pathogens, and a proliferation of products with differing contact times that creates confusion at the point of care. Layered on top of that are variations in technique, where inconsistent cleaning practices directly undermine disinfectant efficacy, and inconsistent contact times, where staff either don’t know the required dwell time for a given product or are pressured by fast patient turnover to wipe surfaces dry before the disinfectant has had time to work.

The presenters were also candid about a category that gets less attention in typical EVS training curricula: inadequate disinfectant concentrations. This is where the session’s evidence base became most compelling.

The Numbers Behind “Dilution Dysfunction”

Citing a November 2024 study published in Infection Control & Hospital Epidemiology — co-authored by Zabarsky and Guerrero themselves, alongside Cadnum, Kaple, Eckstein, Saade, Ray, Yassin, and Donskey — the presentation shared findings from an evaluation of automated disinfectant dispenser systems across 10 hospitals. Of 107 automated dispensers tested, only 52 delivered a “just right” concentration. Twenty-six delivered disinfectant at too high a concentration, 14 delivered too low a concentration, and 15 dispensed no disinfectant at all — effectively water.

The picture for in-use disinfectants tested directly (80 samples) was somewhat better but still concerning: 49 were within the correct range, 13 were too low, 14 contained no disinfectant, and 4 turned out to be the wrong product entirely.

The study’s authors, and the presenters echoing them, drew a direct conclusion: improved monitoring of automated disinfectant dispensers is needed. Contributing factors identified included cloths left soaking in solution — which leads to a phenomenon called quat binding, where quaternary ammonium compounds are absorbed by cloth fibers and depleted from the working solution — along with faulty dispenser connections, empty reservoir bottles, and a general lack of routine quality assurance testing. The presenters pointed to simple, low-cost verification tools already available to EVS departments: quat test strips and pH test paper, both of which can confirm whether a diluted solution falls within its expected concentration range before it’s used on a patient care surface.

What “Fixing” Training Actually Looks Like

Rather than treating training as a single onboarding event, the session pushed for something more durable: initial and annual competency assessments, collaboration with professional organizations and chemical manufacturers on process- and product-specific instruction, and simulation-based, hands-on training. Notably, the presenters called out a common but flawed default — the informal “train the way I was trained” shadowing method, where new EVS staff simply observe and mimic a more senior colleague without any standardized competency check. That approach, they argued, propagates whatever errors already exist in current practice rather than correcting them.

To reinforce knowledge over time, the presenters recommended job aids, competency validation, performance feedback, on-the-spot recognition, and structured QA monitoring using tools such as fluorescent markers (applied before cleaning and checked under black light for missed surfaces), ATP monitoring (swabbing after cleaning to detect residual organic material), and direct observation with real-time coaching.

Adjunct Technologies: Real Promise, Real Limits

A substantial portion of the session addressed emerging and adjunct disinfection technologies — always with the caveat, repeated across nearly every category, that none of these tools replace manual cleaning and disinfection. They supplement it.

Ultraviolet-C devices were presented in two forms. Traditional UV-C at 253.7 nm has the deeper evidence base: broad-spectrum efficacy against healthcare-associated pathogens, reduced reliance on human technique, and usefulness during outbreak response. Its limitations are practical — it requires direct line-of-sight exposure, shadowing significantly reduces efficacy, and rooms must be unoccupied during treatment, which creates workflow and time constraints. A related VA study, published in Infection Control & Hospital Epidemiology in 2025 (Dukes, Hockett Sherlock, Goedken, et al., with Guerrero and Zabarsky among the co-authors), examined the facilitators and barriers to UV-C adoption for patient room cleaning across VA hospitals through qualitative analysis — underscoring that the technology’s success depends as much on workflow integration as on the hardware itself.

Far UV at 222 nm is the newer entrant, with demonstrated efficacy against airborne pathogens and the potential to operate continuously in occupied spaces without requiring room closure — a meaningful operational advantage. But the presenters were direct about its limitations: fewer evidence-based trials than traditional UV-C, no long-term human exposure data currently available, and the same shadowing vulnerability as its predecessor.

The session also covered electrostatic sprayers, misting systems, and fog/vapor technologies, which offer shorter contact times and are increasingly available in ready-to-use formulations that reduce dilution error — directly addressing the concentration problems documented earlier in the presentation. Antimicrobial surfaces (copper, silver, chlorhexidine gluconate, zinc, titanium dioxide, and nanomaterials) and enhanced chemicals, including continuously active disinfection (CAD) products, rounded out the technology overview. A 2020 study by Redmond, Silva, Cadnum, Carlisle, and Donskey, also cited in the reference list, evaluated a continuously active disinfectant specifically for mobile equipment disinfection — a category of surface that traditional cleaning protocols often struggle to address consistently.

The Real Barrier Isn’t the Technology

Perhaps the most useful section of the presentation for EVS and IP leaders navigating budget conversations was the frank accounting of why adjunct technologies stall in adoption. The list was long and organizational rather than technical: limited room turnover time, staffing shortages and turnover, perceived workflow complexity, upfront equipment costs, uncertainty about return on investment, lack of standardized implementation guidance, insufficient leadership support, difficulty securing stakeholder buy-in, and — notably — staff concern that new technology signals a reduction in headcount rather than an enhancement of protection.

The presenters’ proposed countermeasures track closely with sound change-management practice: identify executive, infection prevention, and EVS champions; build a clear business case; pilot in high-risk areas before facility-wide rollout; solicit frontline staff feedback early and often; collect baseline and post-intervention data to demonstrate measurable outcomes; and repeatedly reinforce — to staff and leadership alike — that these tools supplement, rather than substitute for, the technician’s own cleaning and disinfection work.

The Takeaway

What distinguishes this session from a typical product-agnostic disinfection overview is its willingness to quantify failure. A near-25-percent rate of incorrect concentration across more than 100 tested automated dispensers is not a minor operational footnote — it is a patient safety finding with direct implications for every facility relying on automated dilution systems without a routine QA testing program. Combined with the qualitative UV-C adoption research and the clear-eyed accounting of organizational barriers, the presentation offers EVS and IP departments a genuinely evidence-based roadmap rather than a technology sales pitch.

References:

Cadnum JL, Kaple CE, Eckstein EC, Saade EA, Ray AJ, Zabarsky TF, Guerrero BJ, Yassin MH, Donskey CJ. Dilution dysfunction: evaluation of automated disinfectant dispenser systems in 10 hospitals demonstrates a need for improved monitoring to ensure that correct disinfectant concentrations are delivered. Infection Control & Hospital Epidemiology. 2024;45(11):1362-1365.

Dukes KC, Hockett Sherlock SM, Goedken CC, Racila AM, Walhof JF, Suh D, Goto M, Guerrero BJ, Zabarsky TF, Perencevich EN. Facilitators and barriers for the use of ultraviolet-C disinfection for patient room cleaning at VA hospitals: a qualitative analysis. Infection Control & Hospital Epidemiology. Published online 2025:1-4.

Redmond S, Silva SY, Cadnum J, Carlisle M, Donskey C. Evaluation of a Continuously Active Disinfectant for Disinfection of Mobile Equipment. Infection Control & Hospital Epidemiology. 2020;41(S1):s225-s226. doi:10.1017/ice.2020.770

This article is based on a session presented at AHE Exchange26, the AHE Education & Solution Summit, New Orleans, August 16–19, 2026. The views expressed by the presenters reflect their own analysis based on published research and industry practice, and do not necessarily represent the official position of the U.S. Department of Veterans Affairs or the Veterans Health Administration.

A session presented at AHE Exchange26 (New Orleans, August 16–19) by Robert Campbell, PharmD, BCSCP, vice president of accreditation certification program development and management at The Joint Commission, delivered a message that environmental services professionals have long argued for themselves: the physical environment is not a peripheral compliance concern. It is, by Joint Commission’s own data, the single most frequently cited category in hospital accreditation surveys — and cleanliness sits at the center of it.

Campbell’s presentation arrived at a moment of significant institutional change for The Joint Commission, which is rolling out Accreditation 360, described in the session as the most substantial evolution of its accreditation process since the Medicare program began in 1965. But rather than treating EVS as one item among many swept up in that transformation, the session gave the discipline a spotlight rarely afforded it in accreditation-focused presentations.

“Before the First Clinical Interaction, the Environment Speaks”

The presentation opened with a framing that will resonate with anyone who has spent a career arguing that EVS is clinical infrastructure, not janitorial overhead. Clean spaces, Campbell emphasized, are welcoming, safe, and memorable — they set a tone of trust and dignity, reduce risk through reliable readiness, and leave a lasting impression of quality before a single clinical interaction takes place. The framing positioned environmental services not as a support function operating in the background, but as the first and most immediate signal an organization sends about whether it is, in fact, ready to care for the patient in front of it.

The Numbers That Make the Case

The presentation’s most consequential disclosure was quantitative. According to data Campbell shared from 2026 Joint Commission accreditation surveys, the physical environment is the top-scored regulatory category across all surveys conducted. Specifically, 44 percent of hospital accreditation surveys and 30 percent of critical access hospital accreditation surveys included a physical environment observation related specifically to cleanliness.

That statistic reframes the conversation for hospital leadership in a way editorial coverage and training materials rarely manage to do. It isn’t a hypothetical risk. It is, at present, the most commonly cited compliance gap in the accreditation process — meaning EVS performance is functioning as one of the more decisive variables in whether a hospital passes or fails its survey outcomes cleanly.

Where Infection Control and Environment of Care Meet

Campbell’s presentation included a Venn diagram that captures something EVS advocates have struggled to articulate cleanly: Infection control and the environment of care are distinct programs with distinct scopes, but they overlap substantially, and that overlap is where EVS lives.

Infection control, in the Joint Commission’s framing, centers on preventing and reducing healthcare-associated infections through hand hygiene, surveillance and monitoring, personal protective equipment, cleaning and disinfection, and immunization. Environment of Care centers on providing a safe, functional, and healing environment through safe design and construction, equipment safety and maintenance, water safety, waste management, and hazard prevention. The intersection — where the two circles meet — is described as a safe, clean environment, risk reduction, evidence-based practices, quality and patient safety, and staff education and accountability. The session’s own language for this space was direct: this is where the two programs are “stronger together for safer care.”

For EVS leaders making the case for departmental investment or standing on interdisciplinary committees, this framework offers something concrete: an accrediting body’s own acknowledgment that environmental services sits at the structural junction of two programs that hospitals are required to maintain, rather than being a subordinate function of either one.

The Standards Behind the Statistics

The session walked through several specific standards that translate the “clean and orderly” mandate into enforceable requirements, and the specificity is instructive for any EVS director building or auditing a compliance program.

Under the infection prevention and control standard (IC.04.01.01, EP 2), the infection preventionist bears responsibility for developing and implementing hospital-wide surveillance and control policies, documenting program activities, delivering competency-based training to staff — including contracted personnel — and collaborating across departments including sterile processing and water management. That standard alone underscores how tightly IP and EVS functions are meant to be integrated at a policy level, not simply coordinated informally.

The physical environment standard (PE.01.01.01, EP 3) requires that hospital premises remain clean and orderly, defined to include properly stored equipment and supplies, prompt attention to spills, and generally neat conditions. A related set of standards (PE.02.01.01, EPs 1 through 4) governs hazardous materials and waste specifically: hospitals must maintain a current written inventory of the hazardous materials they use, store, or generate; hold the permits, licenses, manifests, and safety data sheets required by law; label hazardous materials and waste with contents and hazard warnings; and develop policies addressing safe handling, storage, transport, and disposal — including precautions and PPE requirements in the event of a spill or exposure.

Staff orientation and competency requirements round out the framework. Under National Performance Goal 12 (staff orientation, EPs 1 and 2), hospitals must orient staff to relevant policies, job-specific duties — including infection prevention responsibilities — and patient rights, with completion documented and performance evaluated at least once every three years. A parallel human resources standard (HR.11.04.01, EP 1) requires that staff competence be initially assessed and documented at orientation, then reassessed on the same three-year cycle at minimum.

Education, Training, and Competency are Not the Same Thing

One of the more useful frameworks Campbell presented distinguishes among three terms that are frequently used interchangeably in EVS training programs but answer fundamentally different questions. Education focuses on knowledge acquisition — degree programs, continuing education, reading standards — and answers “what do I know?” Training focuses on skill development through onboarding, workshops, and simulations, answering “how do I do it?” Competency focuses on performance demonstration through direct observation, return demonstrations, and audits, answering the question that actually matters for patient safety: can I do it correctly and reliably?

The presentation’s core assertion here is one that should inform every EVS training program in the country: knowledge alone does not equal competence. Education provides knowledge, training builds skills, but only competency validates the consistent application of both in actual practice. A technician who has completed a course and can describe proper disinfection technique has not yet demonstrated that they perform it correctly, every time, under real working conditions — and Joint Commission’s standards explicitly require the third step, not just the first two.

Practical Scenarios Surveyors Are Trained to Probe

The session’s scenario-based content offered a rare, direct look at the kinds of questions a surveyor may actually ask on the floor. On chemical security and safety: are chemicals secured against unauthorized access, is required PPE available for the chemicals in use, are resources readily available in the event of accidental exposure, and has anything relevant been incorporated into the workplace violence risk assessment? In psychiatric and behavioral health units specifically, the same questions apply with additional scrutiny given patient population risk, alongside a check for policy conflicts with items prohibited in those units. In security-sensitive and restricted-access areas, surveyors may ask whether staff are trained to prevent tailgating and whether staff know who is and isn’t authorized to access a given space — a detail with direct EVS relevance given how frequently housekeeping carts and staff move through restricted corridors.

On routine cleaning itself, the presentation flagged the questions surveyors are prepared to ask directly: when is routine room and surface cleaning required, what is the process, what chemicals are used, and — pointedly — what are the dilution requirements for those chemicals? The same line of questioning extends to terminal cleaning and to isolation precautions, where PPE requirements and chemical use both vary by isolation type, and dilution requirements again surface as a specific compliance checkpoint. For readers following Healthcare Hygiene’s ongoing coverage of automated dispenser performance and disinfectant concentration failures, this is a notable convergence: dilution accuracy isn’t only an infection-prevention efficacy question, it’s an active line of accreditation surveyor inquiry.

Candor About the Relationship

Campbell’s presentation included a candid section titled “Sometimes the Truth Hurts,” acknowledging that many hospital leaders did not realize Joint Commission wanted a more collaborative relationship, that the organization has heard clear feedback on modernizing its technology to reduce administrative burden, and that some long-circulated “urban legends” about survey requirements — down to questions as specific as whether staff can keep water bottles or IV fluids in a trauma bay — have proven persistent and difficult to dislodge. Consistency, the presentation noted, remains one of the organization’s most frequently cited Requirements for Improvement against itself.

That admission, paired with the Accreditation 360 initiative’s stated goals of streamlining processes, better supporting healthcare organizations, and more efficiently sharing best practices across the healthcare ecosystem, suggests an accrediting body attempting to recalibrate its own relationship with the organizations it oversees — a dynamic worth watching as EVS and IPC departments navigate survey preparation under the new framework.

Why This Matters for EVS

Taken as a whole, the session offers EVS leaders something they can bring directly into budget and staffing conversations: an accrediting body’s own data showing that physical environment and cleanliness observations are the most common finding in hospital surveys today, a standards framework that treats EVS competency validation as a documented, recurring requirement rather than a one-time onboarding task, and explicit surveyor scenarios that test exactly the kind of process knowledge — dilution requirements, contact times, chemical security — that has occupied much of this publication’s own recent coverage. The message from Joint Commission’s own accreditation leadership is consistent with the argument EVS advocates have made for years: the environment is not incidental to care. It is often the first and most consequential thing a patient, a family member, or a surveyor actually observes.

This article is based on a presentation delivered by Robert Campbell, PharmD, BCSCP, Vice President, Accreditation Certification Program Development and Management, The Joint Commission. Standards references (IC.04.01.01, PE.01.01.01, PE.02.01.01, NPG.12.05.01, HR.11.04.01) reflect Joint Commission requirements as presented in the session materials, current as of 2026.