What are "Targeted Moments of Environmental Disinfection" (TMED)?

We all want patient rooms to be as clean as possible and for patients to not be exposed to disease-causing pathogens. However, efforts to keep surfaces clean are not always successful. While environmental services cleaning protocols and hand hygiene reminders have made some progress, a new approach helps identify moments when targeted disinfection could be most helpful. Coined by James Gauthier, MLT, CIC and coauthors Carol Calbrese, BS, RN, CIC and Pter Teska, MBA, "Targeted Moment of Environmental Disinfection" (TMED), refers to cleaning and disinfecting specific high‑risk surfaces immediately before or after patient care activities that are likely to generate significant environmental contamination. It builds on the World Health Organization’s concept of “Five Moments for Hand Hygiene,” applying a similar logic to surface disinfection.

Rather than relying solely on once‑daily cleaning routines, TMED focuses on five key moments that are more likely to transmit disease-causing pathogens to a vulnerable patient:

1. Disinfect the overbed table before placing food, drink, or equipment on an over‑bed table

2. Disinfect bedrails and bed space before and after aseptic practices (changing a dressing, inserting a line, catheter care, etc.)

3. Disinfect bedrails and bed space after any activity that involved feces or respiratory secretions
4. Disinfect bed rails, overbed table, and bed space after bathing within bed area.
5. Disinfect any item that has been (or could have been) on the floor such as cell phones and chargers, headphones, purses, etc.

TMED’s aim is to use available time and resources more wisely by focusing efforts on surfaces touched most frequently by staff and patients, instead of cleaning all areas uniformly all the time.

Why does TMED matter?

• Daily cleaning can leave gaps: Routine once‑a‑day cleaning often misses contamination generated throughout the day. TMED can fill those gaps by applying disinfection immediately before or after risky activities.

• High‑touch surfaces rapidly accumulate pathogens: Nurses, techs, physicians and visitors may touch bedrails and other patient surfaces dozens of times daily without cleaning them. Contamination during routine care visits can pose direct risk to patients if not addressed promptly.

• Designed to help modify human behavior: Like the WHO’s hand hygiene model, TMED teaches staff when critical moments occur and embeds disinfection into workflow—improving compliance and outcomes. 

Because human processes are not enough...

In environments where cleaning may lag contamination events, a biocidal surface serves as a continuous approach to infection prevention. This acts as a safety net, because:

• Biocidal surfaces kill pathogens on frequently touched surfaces between scheduled cleaning.

• Biocidal surfaces keep the bioburden at benign levels, reducing transmission risk and HAI rates to a statistically significant level

• When routine cleaning compliance slips, biocidal activity continues to actively kill disease-causing organisms.

Together, TMED and biocidal surfaces offer layered protection: immediate response at critical moments, plus continuous microbial reduction over time. The synergy creates a safer care environment, minimizing transmission risk beyond what daily cleaning alone can achieve.