The text message from my mother was deceptively simple: “Dad back in hospital. Infection from knee surgery.” What followed was anything but simple—six weeks of additional treatment, mountains of medical bills, and watching my father, a man who’d never taken a sick day in his life, battle an infection that never should have happened. The culprit wasn’t some exotic bacteria or rare complication. It was something far more mundane: a surface someone had missed during cleaning at the outpatient clinic where he’d had his procedure.
That experience turned me into an unlikely infection control evangelist and eventually led me to shadow Teresa Montoya, an environmental services manager whose team is responsible for cleaning six busy outpatient clinics. What I learned changed how I view every medical facility I enter.
The Unseen Battleground
“Most people notice if there’s a coffee stain on a waiting room table or trash overflowing in a bathroom,” Teresa tells me as we walk through a dermatology clinic before opening hours. “Almost nobody notices what actually matters for infection control.”
Let Us Clean Your Medical Location!
She runs a gloved finger along the arm of an examination chair, across the side of a cabinet, behind a computer monitor. These surfaces appear spotless to my untrained eye. But these aren’t the places Teresa worries about most.
“See this?” She points to the adjustment lever on a procedure lamp. “It gets touched multiple times during each procedure, often with contaminated gloves, but it’s easily overlooked during cleaning. Or this blood pressure cuff that might be used on 30 different patients daily. Or the edges of these privacy curtains that staff touch after patient contact.”
Teresa’s team isn’t just cleaning. They’re breaking invisible chains of transmission between patients who never meet each other but who could nevertheless share dangerous pathogens via these surfaces.
The Hierarchy of Danger
Not all clinic surfaces carry equal risk. Teresa’s team works with a mental hierarchy that would never occur to most of us:
Horizontal surfaces near patients collect more pathogens than vertical ones. Items touched during ‘dirty’ procedures are higher risk than administrative surfaces. Anything touched before handwashing but after patient contact is critically important. And porous materials like fabric or foam can harbor pathogens even when they look perfectly clean.”
This hierarchy explains why someone might thoroughly wipe down a countertop while missing the ultrasound control panel that actually presents a greater infection risk. It’s not negligence—it’s a fundamental misunderstanding of where danger lurks.
Beyond “Looking Clean”: The Science of Disinfection
The biggest revelation from my time with Teresa was how little “looking clean” has to do with actual infection control. Visual cleanliness and microbiological safety are entirely different standards.
The Invisible Timeline
“Proper disinfection has its own timeline that has nothing to do with convenience,” Teresa explains while demonstrating the proper cleaning of an exam room. She applies disinfectant to a surface but doesn’t immediately wipe it away. Instead, she moves methodically to other areas while the surface remains visibly wet.
“This disinfectant needs four minutes of continuous wet contact to kill the pathogens we’re targeting. Wipe it off too soon—which happens constantly when people are rushing—and you’ve essentially done nothing but make the surface look shiny.”
This critical “dwell time” varies by product and targeted pathogens. For some tough organisms like C. difficile spores, it can be up to ten minutes. In a world where clinics often schedule patients at 15-minute intervals, these biological realities create fundamental tensions between throughput and safety.
The Clean-to-Dirty Principle
Perhaps most surprising is the specific sequence required for effective infection control. “Always clean from cleaner areas to dirtier ones,” Teresa demonstrates. “If you clean the floor first, then touch the exam table, you’ve just transferred floor pathogens to a surface that will contact the next patient’s skin.”
This principle explains why proper cleaning moves from top to bottom, from least to most contaminated, and requires systematic changes of cleaning cloths and solutions. Each step prevents recontamination of already-cleaned surfaces.
The Human Element: Why Knowledge Isn’t Enough
Despite precise protocols and clear science, healthcare-associated infections persist. The missing element often isn’t knowledge but implementation in real-world conditions.
“Most infection control failures happen under time pressure,” Teresa admits. “When three patients are waiting and providers are asking how much longer, even well-trained staff may rush through critical steps.”
This pressure extends beyond individual cleaning staff. Administrators face financial realities that push for higher patient volumes and faster room turnover. Providers feel rushed and may unknowingly create pressure for corners to be cut.
“The most important infection control tool isn’t a high-tech disinfectant,” Teresa says. “It’s creating systems where staff have adequate time to follow protocols correctly.”
The Accountability Gap
Another challenge is the invisible nature of success. “Nobody compliments you for infections that didn’t happen,” Teresa notes with a wry smile. “When we do our jobs perfectly, nothing happens. No one gets sick. There’s no visible outcome to celebrate.”
This reality creates accountability challenges. Without implementing testing systems like ATP monitoring (which measures biological residue on surfaces) or UV marking (which reveals missed areas), facilities have little way of knowing whether cleaning protocols are actually being followed.
A Fundamental Reframe
My father eventually recovered, but the experience left lasting impressions on our family. We now view clinic cleanliness through entirely different eyes. When I see environmental services staff working in medical facilities, I no longer see people performing custodial work—I see infection preventionists performing a critical clinical function.
“The most important thing patients can understand,” Teresa tells me as we finish our shadow day, “is that in healthcare environments, cleaning isn’t a housekeeping function—it’s a medical intervention that’s just as important as proper medication or surgical technique.”
For anyone entering a healthcare facility—as a patient, family member, or staff—this perspective shift matters. The person cleaning that exam room isn’t just tidying up between patients. They’re performing a critical medical procedure that could quite literally save the next patient’s life.