Environmental surface sampling in health and care settings: a scoping review of published guidance

Antimicrobial Resistance and Healthcare Associated Infection Scotland and its stakeholders have identified a lack of standardized methodology for healthcare environmental surface sampling and key challenges in practice. This scoping review aimed to map available guidance on surface sampling, identify gaps, and determine if a systematic Scottish National Infection Prevention and Control Manual literature review is indicated. Active, English-language guidance published since the year 2000 was included in this review, whilst narrative reviews, commentaries, editorials and letters were not. Cleaning validation was outwith the scope of the review. General and pathogen-specific terms were used to search relevant websites and organizations housing infection prevention and control guidance on this topic. Reference lists were also searched. Documents were screened for eligibility, and data were charted in Microsoft Excel for mapping and identification of themes. The 31 identified guidance documents primarily discuss surface sampling indications. Other themes are sampling sites, methods and interpretation of results, advantages, gaps and pitfalls. Guidance documents are pathogen-specific or address broader groups of organisms. Consequently, description of laboratory methods for specific organisms is limited. Only Candidozyma auris, Clostridioides difficile, Group A streptococcus, Staphylococcus aureus and Pseudomonas aeruginosa are discussed specifically. Direct sampling methodology, when and how to compare clinical and environmental findings, and when and how to use enrichment media or broth are poorly addressed. Consequently, future systematic literature review is indicated for identification, appraisal and collation of primary literature on growth and interpretation of clinically relevant organisms, alongside analysis of extant guidance. Where gaps in the topic area are confirmed, multi-disciplinary expertise can be used to supplement these with expert opinion.