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Efficacy, Selection and Use of Disinfectants and Detergents in Environmental Cleaning/Disinfection
William A. Rutala, PhD, MPHDirector, Hospital Epidemiology, Occupational Health and Safety;
Professor of Medicine and Director, Statewide Program for Infection Control and Epidemiology
University of North Carolina at Chapel Hill and UNC Health Care, Chapel Hill, NC
DISCLOSURES
• Consultation and Honoraria ASP (Advanced Sterilization Products), Clorox
• Honoraria 3M
• Grants CDC, CMS
Efficacy, Selection and Use of Disinfectants and Detergents in Environmental Cleaning/Disinfection
• Role of the environment in disease transmission• Factors that affect disinfection• Advantages/disadvantages of disinfectants used on
environmental surfaces and non-critical patient equipment• Efficacy of disinfectants• Selection and use of disinfectants
Efficacy, Selection and Use of Disinfectants and Detergents in Environmental Cleaning/Disinfection
• Role of the environment in disease transmission• Factors that affect disinfection• Advantages/disadvantages of disinfectants used on
environmental surfaces and non-critical patient equipment• Efficacy of disinfectants• Selection and use of disinfectants
DISINFECTION AND STERILIZATIONRutala, Weber, HIPAC. www.cdc.gov, 2008
• EH Spaulding believed that how an object will be disinfected depended on the object’s intended use CRITICAL - objects which enter normally sterile tissue or the
vascular system or through which blood flows should be sterile SEMICRITICAL - objects that touch mucous membranes or skin
that is not intact require a disinfection process (high-level disinfection[HLD]) that kills all microorganisms except for high numbers of bacterial spores
NONCRITICAL - objects that touch only intact skin require low-level disinfection
DISINFECTION AND STERILIZATION
• EH Spaulding believed that how an object will be disinfected depended on the object’s intended use CRITICAL - objects which enter normally sterile tissue or the
vascular system or through which blood flows should be sterile SEMICRITICAL - objects that touch mucous membranes or skin
that is not intact require a disinfection process (high-level disinfection[HLD]) that kills all microorganisms except for high numbers of bacterial spores
NONCRITICAL - objects that touch only intact skin require low-level disinfection
KEY PATHOGENS WHERE ENVIRONMENTIAL SURFACES PLAY A ROLE IN TRANSMISSION
• MRSA• VRE• Acinetobacter spp.• Clostridium difficile
• Norovirus• Rotavirus• SARS
ENVIRONMENTAL CONTAMINATION LEADS TO HAIsWeber, Rutala, Miller et al. AJIC 2010;38:S25
• Frequent environmental contamination• Microbial persistence in the environment • HCW hand contamination with the environment• Prior room occupant with MRSA, VRE, CDI is a significant risk for
acquisition of these pathogens. • Improved surface disinfection removes pathogens and reduce
HAIs
ENVIRONMENTAL CONTAMINATION ENVIRONMENTAL CONTAMINATION ENDEMIC AND EPIDEMIC MRSAENDEMIC AND EPIDEMIC MRSA
Dancer SJ et al. Lancet ID 2008;8(2):101-13
ENVIRONMENTAL SURVIVAL OF KEY PATHOGENS ON HOSPITAL SURFACES
Pathogen Survival Time
S. aureus (including MRSA) 7 days to >12 months
Enterococcus spp. (including VRE) 5 days to >46 months
Acinetobacter spp. 3 days to 11 months
Clostridium difficile (spores) >5 months
Norovirus (and feline calicivirus) 8 hours to >2 weeks
Pseudomonas aeruginosa 6 hours to 16 months
Klebsiella spp. 2 hours to >30 months
Adapted from Hota B, et al. Clin Infect Dis 2004;39:1182-9 andKramer A, et al. BMC Infectious Diseases 2006;6:130
FREQUENCY OF ACQUISITION OF MRSA ON GLOVED HANDS AFTER CONTACT WITH SKIN AND ENVIRONMENTAL SITES
No significant difference on contamination rates of gloved hands after contact with skin or environmental surfaces (40% vs 45%; p=0.59)
Stiefel U, et al. ICHE 2011;32:185-187
RELATIVE RISK OF PATHOGEN ACQUISITIONIF PRIOR ROOM OCCUPANT INFECTED
0 0.5 1 1.5 2 2.5 3 3.5 4
MDR Acinetobacter (Nseir S, 2011)
C. diff (Shaughnessy M, 2011)
VRE (Drees M, 2008)
MDR Pseudomonas (Nseir S, 2011)
VRE (Huang S, 2006)
VRE* (Dress M, 2008)
MRSA (Huang S, 2006)
* Prior room occupant infected, 120% increased risk; ^Any room occupant in prior 2 weeks infected. Otter , Yezli, French. ICHE. 2012;32:687-699
EVALUATION OF HOSPITAL ROOM ASSIGNMENT AND ACQUISITION OF CDI
Study design: Retrospective cohort analysis, 2005-2006
Setting: Medical ICU at a tertiary care hospital
Methods: All patients evaluated for diagnosis of CDI 48 hours after ICU admission and within 30 days after ICU discharge
Results (acquisition of CDI) Admission to room previously occupied
by CDI = 11.0% Admission to room not previously
occupied by CDI = 4.6% (p=0.002)
Shaughnessy MK, et al. ICHE 2011;32:201-206
TRANSMISSION MECHANISMS INVOLVING THE SURFACE ENVIRONMENT
Rutala WA, Weber DJ. In:”SHEA Practical Healthcare Epidemiology” (Lautenbach E, Woeltje KF, Malani PN, eds), 3rd ed, 2010.
ACQUISITION OF MRSA ON HANDS AFTER CONTACT WITH ENVIRONMENTAL SITES
ACQUISITION OF MRSA ON HANDS/GLOVES AFTER CONTACT WITH CONTAMINATED EQUIPMENT
TRANSFER OF MRSA FROM PATIENT OR ENVIRONMENT TO IV DEVICE AND TRANSMISSON OF
PATHOGEN
TRANSMISSION MECHANISMS INVOLVING THE SURFACE ENVIRONMENT
Rutala WA, Weber DJ. In:”SHEA Practical Healthcare Epidemiology” (Lautenbach E, Woeltje KF, Malani PN, eds), 3rd ed, 2010.
ACQUISITION OF C. difficile ON PATIENT HANDS AFTER CONTACT WITH ENVIRONMENTAL SITES AND THEN INOCULATION OF MOUTH
Donskey CJ. Am J Infect Control 2013;41:S12
Disinfectant Product SubstitutionsDonskey CJ. AJIC. May 2013
Improve Effectiveness of Cleaning/DisinfectionDonskey AJIC. May 2013
Automated Disinfection Devices Donskey CJ. AJIC. May 2013
Does Improving Surface Cleaning and Disinfection Reduce Healthcare-Associated Infections?
Donskey CJ. AJIC. 2013;41:S12-S19
“As reviewed here, during the past decade a growing body of evidence has accumulated suggesting that improvements in environmental disinfection may prevent transmission of pathogens and reduce HAIs. Although, the quality of much of the evidence remains suboptimal, a number of high-quality investigations now support environmental disinfection as a control strategy”
Efficacy, Selection and Use of Disinfectants and Detergents in Environmental Cleaning/Disinfection
• Role of the environment in disease transmission• Factors that affect disinfection• Advantages/disadvantages of disinfectants used on
environmental surfaces and non-critical patient equipment• Efficacy of disinfectants• Selection and use of disinfectants
Efficacy of Disinfection Influencing Factors
Rutala, Weber, HIPAC. www.cdc.gov. 2008
• Organic load present-interfere by protect microbe from exposure or alters the disinfectant making it less antimicrobial
• Type of microbial contamination-intrinsic resistance varies
• Level of microbial contamination-larger the number of microorganisms, the more time needed to inactivate them
• Concentration of disinfectant-the more concentrated the disinfectant, the greater its efficacy and the shorter the time to achieve kill. Use manufacturer’s recommended use-dilution.
Efficacy of Disinfection Influencing Factors
• Temperature-activity increases as temperature increases
• pH-increase in pH improves the antimicrobial activity of some disinfectants (e.g., Quat) but decreases the activity of others (e.g., hypochlorites)
• Duration of exposure-must be exposed to disinfectant for kill time
• Water hardness-high concentrations can reduce the rate of kill because cations in water interact with disinfectant to form insoluble precipitates
Efficacy, Selection and Use of Disinfectants and Detergents in Environmental Cleaning/Disinfection
• Role of the environment in disease transmission• Factors that affect disinfection• Advantages/disadvantages of disinfectants used on
environmental surfaces and non-critical patient equipment• Efficacy of disinfectants• Selection and use of disinfectants
PROPERTIES OF AN IDEAL DISINFECTANT Rutala and Weber. Infect Control Hosp Epidemiol. In press
• Broad spectrum-wide antimicrobial spectrum
• Fast acting-should produce a rapid kill
• Remains Wet-meet listed kill/contact times with a single application
• Not affected by environmental factors-active in the presence of organic matter
• Nontoxic-not irritating to user
• Surface compatibility-should not corrode instruments and metallic surfaces
• Persistence-should have sustained antimicrobial activity
• Easy to use
• Acceptable odor
• Economical-cost should not be prohibitively high
• Soluble (in water) and stable (in concentrate and use dilution)
• Cleaner (good cleaning properties) and nonflammable
LOW-LEVEL DISINFECTION FOR NONCRITICAL EQUIPMENT AND SURFACES
Exposure time > 1 minGermicide Use Concentration
Ethyl or isopropyl alcohol 70-90%Chlorine 100ppm (1:500 dilution)Phenolic UDIodophor UDQuaternary ammonium UDImproved hydrogen peroxide 0.5%, 1.4%____________________________________________________UD=Manufacturer’s recommended use dilution
Quaternary ammonium compounds (e.g., didecyl dimethyl ammonium bromide, dioctyl dimethyl ammonium bromide)
Rutala, Weber. Am J Infect Control 2013;41:S36-S41
Advantages Bactericidal, fungicidal, virucidal
against enveloped viruses (e.g., HIV) Good cleaning agents EPA registered Surface compatible Persistent antimicrobial activity when
undisturbed Inexpensive (in dilutable form) Not flammable
Disadvantages Not sporicidal In general, not tuberculocidal and
virucidal against non-enveloped viruses High water hardness and cotton/gauze
can make less microbicidal A few reports documented asthma as
result of exposure to benzalkonium chloride
Affected by organic matter Multiple outbreaks ascribed to
contaminated benzalkonium chloride
Sodium HypochloriteRutala, Weber. Am J Infect Control 2013;41:S36-S41
Advantages Bactericidal, tuberculocidal, fungicidal,
virucidal Sporicidal Fast acting Inexpensive (in dilutable form) Not flammable Unaffected by water hardness Reduces biofilms on surfaces Relatively stable (e.g., 50% reduction in
chlorine concentration in 30 days) Used as the disinfectant in water treatment EPA registered
Disadvantages Reaction hazard with acids and ammonias Leaves salt residue Corrosive to metals (some ready-to-use products
may be formulated with corrosion inhibitors) Unstable active (some ready-to-use products may
be formulated with stabilizers to achieve longer shelf life)
Affected by organic matter Discolors/stains fabrics Potential hazard is production of trihalomethane Odor (some ready-to-use products may be
formulated with odor inhibitors). Irritating at high concentrations.
Improved Hydrogen PeroxideRutala, Weber. Am J Infect Control 2013;41:S36-S41
Advantages Bactericidal, tuberculocidal, fungicidal,
virucidal Fast efficacy Easy compliance with wet-contact times Safe for workers (lowest EPA toxicity
category, IV) Benign for the environment Surface compatible Non-staining EPA registered Not flammable
Disadvantages More expensive than most other
disinfecting actives Not sporicidal at low
concentrations
AlcoholRutala, Weber. Am J Infect Control 2013;41:S36-S41
Advantages
Bactericidal, tuberculocidal, fungicidal, virucidal
Fast acting Non-corrosive Non-staining Used to disinfect small surfaces such
as rubber stoppers on medication vials No toxic residue
Disadvantages Not sporicidal Affected by organic matter Slow acting against non-enveloped viruses (e.g.,
norovirus) No detergent or cleaning properties Not EPA registered Damage some instruments (e.g., harden rubber,
deteriorate glue) Flammable (large amounts require special storage) Evaporates rapidly making contact time compliance
difficult Not recommended for use on large surfaces Outbreaks ascribed to contaminated alcohol
PhenolicsRutala, Weber. Am J Infect Control 2013;41:S36-S41
Advantages Bactericidal, tuberculocidal,
fungicidal, virucidal Inexpensive (in dilutable form) Non-staining Not flammable EPA registered
Disadvantages Not sporicidal Absorbed by porous materials
and irritate tissue Depigmentation of skin caused
by certain phenolics Hyperbilirubinemia in infants
when phenolic not prepared as recommended
Efficacy, Selection and Use of Disinfectants and Detergents in Environmental Cleaning/Disinfection
• Role of the environment in disease transmission• Factors that affect disinfection• Advantages/disadvantages of disinfectants used on
environmental surfaces and non-critical patient equipment• Efficacy of disinfectants• Selection and use of disinfectants
Most Prevalent Pathogens Causing Healthcare-Associated Infections
Rutala, Weber. Infect Control Hosp Epidemiol. In press
Staphylococcus aureus (15.6%) E coli (11.5%) Coagulase-negative Staphylococcus (CoNS)
(11.4%) Klebsiella (8.0%) Pseudomonas aeruginosa (7.5%) Enterococcus faecalis (6.8%) Candida albicans (5.3%) Enterobacter spp. (4.7%) Other Candida spp. (4.2%) Enterococcus faecium (4.1%) Enterococcus spp. (3.0%) Proteus spp. (2.5%) Serratia spp. (2.1%) Acinetobacter baumanii (1.8%)
Modify Disinfectant Used C. difficile spores-over the past
decade, incidence of C. difficile increasing and now most common in some hospitals
Norovirus
DECREASING ORDER OF RESISTANCE OF MICROORGANISMS TO DISINFECTANTS/STERILANTS
PrionsSpores (C. difficile)
MycobacteriaNon-Enveloped Viruses (norovirus)
FungiBacteria (MRSA, VRE, Acinetobacter)
Enveloped VirusesMost Susceptible
Most Resistant
EFFECTIVENESS OF DISINFECTANTS AGAINST MRSA AND VRE
Rutala WA, et al. Infect Control Hosp Epidemiol 2000;21:33-38.
Tuberculocidal Activity of DisinfectantsRutala et al. Am J Med 1991;91:267S
A modified AOAC tuberculocidal activity test was used to assess 14 hospital disinfectants
Effective-2% glut, 0.8%HP plus 0.06% PA, 1000ppm chlorine
Not effective-QUATs, 100ppm chlorine, and 0.13% glut not effective
C. difficile spores
DISINFECTANTS AND ANTISEPSISC. difficile spores at 20 min, Rutala et al, 2006
• No measurable activity (1 C. difficile strain, J9) CHG Phenolic 70% isopropyl alcohol 95% ethanol 3% hydrogen peroxide Disinfecting spray (65% ethanol, 0.6% QUAT) Disinfecting spray (79% ethanol, 0.1% QUAT) 0.06% QUAT; QUAT may increase sporulation capacity- Lancet
2000;356:1324 10% povidone iodine 0.5% hydrogen peroxide
DISINFECTANTS AND ANTISEPSISC. difficile spores at 10 and 20 min, Rutala et al, 2006
• ~4 log10 reduction (3 C. difficile strains including BI-9) Bleach, 1:10, ~6,000 ppm chlorine (but not 1:50) Chlorine, ~19,100 ppm chlorine Chlorine, ~25,000 ppm chlorine 0.35% peracetic acid 2.4% glutaraldehyde OPA, 0.55% OPA 2.65% glutaraldehyde 3.4% glutaraldehyde and 26% alcohol
Product + Practice
ALL “TOUCHABLE” (HAND CONTACT) SURFACES SHOULD BE WIPED WITH DISINFECTANT
“High touch” objects only recently defined (no significant differences in microbial contamination of different surfaces) and
“high risk” objects not epidemiologically defined.
MICROBIAL BURDEN ON ROOM SURFACES AS A FUNCTION OF FREQUENCY OF TOUCHING
Surface Prior to CleaningMean CFU/RODAC (95% CI)
Post Cleaning (mean)Mean CFU/RODAC (95% CI)
High 71.9 (46.5-97.3) 9.6
Medium 44.2 (28.1-60.2) 9.3
Low 56.7 (34.2-79.2) 5.7
The level of microbial contamination of room surfaces is similar regardless of how often they are touched both before and after cleaning
Therefore, all surfaces that are touched must be cleaned and disinfected
Huslage K, Rutala WA, Weber DJ. ICHE. 2013;34:211-212
Surface Disinfection
• Wipe all “touchable” or “hand contact” surfaces with sufficient wetness to achieve the disinfectant contact time (> 1 minute). • Daily disinfection of surfaces (vs cleaned when soiled)
in rooms of patients with CDI and MRSA reduced acquisition of pathogens on hands after contact with surfaces and on hands caring for the patient
Efficacy, Selection and Use of Disinfectants and Detergents in Environmental Cleaning/Disinfection
• Role of the environment in disease transmission• Factors that affect disinfection• Advantages/disadvantages of disinfectants used on
environmental surfaces and non-critical patient equipment• Efficacy of disinfectants• Selection and use of disinfectants
Key Considerations for Selecting the Optimal Disinfectant for Your Facility
Rutala, Weber. Infect Control Hosp Epidemiol. In press
Consideration Question to Ask Score (1-10)
Kill Claims Does the product kill the most prevalent healthcare pathogens
Kill Times and Wet-Contact Times
How quickly does the product kill the prevalent healthcare pathogens
Safety Does the product have an acceptable toxicity rating, flammability rating
Ease-of-Use Odor acceptable, shelf-life, in convenient forms (wipes, spray), water soluble, works in organic matter, one-step (cleans/disinfects)
Other factors Supplier offer comprehensive training/education, 24-7 customer support, overall cost acceptable (product capabilities, cost per compliant use, help standardize disinfectants in facility
Disinfectants
• Disinfectants are recommended for noncritical patient care objects (CDC, 2008)• Disinfectants are recommended for Precaution/Isolation
patients (CDC, 2007)• Disinfectants are recommended for blood/OPIM (OSHA,
1991)• Disinfectants (or detergents) are recommended for other
noncritical environmental surfaces (CDC, 2002 and 2008)
DISINFECTION OF NONCRITICAL PATIENT-CARE DEVICESRutala, Weber, HICPAC. 2008 www.cdc.gov
• Disinfect noncritical medical devices (e.g., blood pressure cuff) with an EPA-registered hospital disinfectant using the label’s safety precautions and use directions. Most EPA-registered hospital disinfectants have a label contact time of 10 minutes but multiple scientific studies have demonstrated the efficacy of hospital disinfectants against pathogens with a contact time of at least 1 minute. By law, the user must follow all applicable label instructions on EPA-registered products. If the user selects exposure conditions that differ from those on the EPA-registered product label, the user assumes liability for any injuries resulting from the off-label use and is potentially subject to enforcement action under FIFRA. (II, IC)
CLEANING AND DISINFECTING ENVIRONMENTAL SURFACES
Cleaning (removes soil) and disinfecting is one-step with disinfectant-detergent. A one-step product
achieved EPA claim in presence of soil. No pre-cleaning necessary unless spill or gross
contamination.
Justification for Using a Disinfectant for Non-Critical Surfaces/Patient Equipment• Disinfectants have antimicrobial activity and detergents do not• Surfaces may contribute to transmission of epidemiologically-important
pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter
• Disinfectants prevent HAIs• Disinfectants are more effective than detergents in reducing
contamination on surfaces• Detergents become contaminated and result in seeding the patient’s
environment with bacteria• Disinfection of non-critical patient care items and equipment is
recommended for patients on isolation
Justification for Using a Disinfectant for Non-Critical Surfaces/Patient Equipment• Disinfectants may have antimicrobial activity and detergents do not• Surfaces may contribute to transmission of epidemiologically-important
pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter
• Disinfectants prevent HAIs• Disinfectants are more effective than detergents in reducing
contamination on surfaces• Detergents become contaminated and result in seeding the patient’s
environment with bacteria• Disinfection of non-critical patient care items and equipment is
recommended for patients on isolation
Donskey CJ. Am J Infect Control 2013;41:S12
Surface DisinfectionEffectiveness of Different Methods
Rutala, Gergen, Weber. 2013, Unpublished Results
Technique (with cotton) MRSA Log10 Reduction (QUAT)
Saturated cloth 4.41
Spray (10s) and wipe 4.41
Spray, wipe, spray (1m), wipe 4.41
Spray 4.41
Spray, wipe, spray (until dry) 4.41
Disposable wipe with QUAT 4.55
Control: detergent 2.88
Transfer of C. difficile Spores by Nonsporicidal Wipes
Cadnum et al. ICHE 2013;34:441-2
• Detergent/nonsporicidal wipes transfer or spread microbes/spores to adjacent surfaces; disinfectants inactivate microbes
Justification for Using a Disinfectant for Non-Critical Surfaces/Patient Equipment• Surfaces may contribute to transmission of epidemiologically-important
pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter, others• Disinfectants prevent HAIs• Disinfectants are more effective than detergents in reducing
contamination on surfaces• Detergents become contaminated and result in seeding the patient’s
environment with bacteria• Disinfection of non-critical patient care items and equipment is
recommended for patients on isolation• Disinfectants may have persistent antimicrobial activity
Bacterial Contamination of Water With and Without a Disinfectant
• Detergent become contaminated and result in seeding the patient’s environment with HA pathogens. Ayliffe et al. Brit Med J. 1966;2:442-5
Justification for Using a Disinfectant for Non-Critical Surfaces/Patient Equipment• Surfaces may contribute to transmission of epidemiologically-important
pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter, others• Disinfectants prevent HAIs• Disinfectants are more effective than detergents in reducing
contamination on surfaces• Detergents become contaminated and result in seeding the patient’s
environment with bacteria• Disinfection of non-critical patient care items and equipment is
recommended for patients on isolation-CDC 2007 and OSHA 1991• Disinfectants may have persistent antimicrobial activity
QUATS AS SURFACE DISINFECTANTSWITH PERSISTENT ACTIVITY
Study of computer keyboards: Challenge with VRE or P. aeruginosa
Keys wiped with alcohol or quats (CaviWipes, Clorox Disinfecting Wipes, or Sani-Cloth Plus)
Persistent activity when not removed
Rutala WA, White MS, Gergen MF,Weber DJ. ICHE 2006;27:372-77.
Justification for Using a Disinfectant for Non-Critical Surfaces/Patient Equipment• Surfaces may contribute to transmission of epidemiologically-important
pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter, others• Disinfectants prevent HAIs• Disinfectants are more effective than detergents in reducing
contamination on surfaces• Detergents become contaminated and result in seeding the patient’s
environment with bacteria• Disinfection of non-critical patient care items and equipment is
recommended for patients on isolation• Disinfectants may have persistent antimicrobial activity
Efficacy, Selection and Use of Disinfectants and Detergents in Environmental Cleaning/Disinfection
Detergents No measurable antimicrobial activity Contaminated surfaces provide an important source of HA pathogens Similar cost (~$0.20/use gallon) Disinfectants are cause of skin, respiratory irritation or allergy No evidence that using disinfectants selects for antibiotic-resistant
bacteria Disinfectants should be used where there are scientific studies
demonstrating benefit Employ disinfectant on noncritical surfaces for all hospitalized
patients as unsuspected colonization is a routine occurrence
How About “Green” Products?
• Today, the definition of green is unregulated• It can mean:
Sustainable resources/plant-based ingredients Free of petrochemicals Biodegradable No animal testing Minimal carbon footprint Traded fairly
• It can, but does not always mean “safer”
Efficacy of “Green” Products to Inactivate MDR Pathogens
Rutala, Gergen, Weber. Unpublished results. 2013
• No measurable activity against A. baumannii, A. xyloxidans, Burkholderia cenocepacia, K. pneumoniae, MRSA and P. aeruginosa, VRE, Stenotrophomonas maltophilia
It appears that not only is disinfectant use important but how often is important
Daily disinfection vs clean when soiled
Daily Disinfection of High-Touch SurfacesKundrapu et al. ICHE 2012;33:1039
Daily disinfection of high-touch surfaces (vs cleaned when soiled) with sporicidal disinfectant (PA) in rooms of patients with CDI and MRSA reduced acquisition of pathogens on hands after contact with surfaces and of hands caring for the patient
Kill Claims for Most Prevalent Pathogens
• Each disinfectant requires a specific time it must remain in contact with the microbe to achieve disinfection-kill time or contact time• Some disinfectants may have a kill time for bacteria of 1m, which
means bacteria in label disinfected in 1m• Other products, often concentrated formulas require dilution, are
registered by the EPA with contact time of 10m• Such a long contact time is not practical
CONTACT TIMES FOR SURFACE DISINFECTION
• Follow the EPA-registered contact times, ideally Some products have achievable contact times for
bacteria/viruses (30 seconds-2 minutes) Other products have non-achievable contact times
• If use a product with non-achievable contact time Use >1 minute based on CDC guideline and scientific literature Prepare a risk assessment
http://www.unc.edu/depts/spice/dis/SurfDisRiskAssess2011.pdf
IMPROVED HYDROGEN PEROXIDE (HP) SURFACE DISINFECTANT
• Advantages 30 sec -1 min bactericidal and virucidal claim (fastest non-bleach contact
time) 5 min mycobactericidal claim Safe for workers (lowest EPA toxicity category, IV) Benign for the environment; noncorrosive; surface compatible One step cleaner-disinfectant No harsh chemical odor EPA registered (0.5% RTU, 1.4% RTU, wet wipe)
• Disadvantages More expensive than QUAT
BACTERICIDAL ACTIVITY OF DISINFECTANTS (log10 reduction) WITH A CONTACT TIME OF 1m WITH/WITHOUT FCS.
Rutala et al. ICHE. 2012; 33:1159-61
Organism Oxivir-0.5% 0.5% HP Clorox HC HP Cleaner-Dis 1.4%
1.4% HP 3.0% HP QUAT
MRSA >6.6 <4.0 >6.5 <4.0 <4.0 5.5
VRE >6.3 <3.6 >6.1 <3.6 <3.6 4.6
MDR-Ab >6.8 <4.3 >6.7 <4.3 <4.3 >6.8
MRSA, FCS >6.7 NT >6.7 NT <4.2 <4.2
VRE, FCS >6.3 NT >6.3 NT <3.8 <3.8
MDR-Ab, FCS
>6.6 NT >6.6 NT <4.1 >6.6
Improved hydrogen peroxide is significantly superior to standard HP at same concentration and superior or similar to the QUAT tested
• MRSA, VRE, C. difficile, MDR-Acinetobacter comprise a growing reservoir of epidemiologically important pathogens that have an environmental mode of transmission
• Contaminated surface environment in hospital rooms is important in transmission of HA pathogens
• Appropriate use of disinfectants prevent transmission of pathogens and reduce HAIs
• All touchable surfaces should be wiped with disinfectant• Detergents alone do not kill pathogens and can cross-contaminate the
environment
Efficacy, Selection and Use of Disinfectants and Detergents in Environmental Cleaning/Disinfection
Summary
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